The No. 1 Miami Hurricanes' College Football Playoff hopes took a massive hit this week. The Canes' star wide receiver Malachi Toney suffered a high ankle sprain in practice ahead of Miami's massive road game against No. 11 Notre Dame on Saturday night.
Per the school, Toney will undergo surgery to repair the sprain, which will put him out for at least the remainder of Miami's regular season. According to On3Sports, Toney will undergo what's called a Tightrope surgery to repair the sprain. The typical recovery timetable for the surgery is around four weeks.
As of Nov. 6, there are six weeks until the first round of the first round of the College Football Playoff. That's all to say things are gonna be tight.
The Sporting News spoke with Dr. Norman E. Waldrop III, a foot and ankle surgeon at the Andrews Sports Medicine & Orthopedic Center, a world-renowned orthopedic clinic in Birmingham, Ala.
Dr. Waldrop, who specializes in athlete injuries, is also on staff with the Alabama Crimson Tide football team and New Orleans Saints. Below, Dr. Waldrop explains Toney's diagnosis, what his surgery will entail and what the recovery process typically looks like.
MORE: How villainous Miami ruled the 1980s and steered its rivalry with Notre Dame
What to know about Miami WR Malachi Toney's diagnosis and recovery
What happened to Malachi Toney?
As first reported by ESPN's Pete Thamel, Toney suffered a high ankle sprain during practice on Wednesday ahead of the Notre Dame game. Miami issued a statement that Toney was "undergoing further testing." Shortly thereafter, Thamel confirmed the star RB was having surgery.
Toney's injury occurred during practice on Wednesday when he got "caught up in a play with a cornerback", according to On3's Pete Nakos.
What is Malachi Toney's injury?
According to reports, Toney suffered a high ankle sprain during practice on Wednesday ahead of the Notre Dame game.
"There are different grades [of sprains]," Dr. Waldrop told The Sporting News. "You have grade one, grade two, to grade three. Grade twos are the ones that are the gray area. Grade ones are stable, and you can play through them. It can be as quick as a week. It can sometimes be two or three weeks. Grade twos are the gray area where it's what we call 'subtle instability,' and that's where it gets difficult in terms of whether a player can play or not play."
What is a high ankle sprain?
According to the Cleveland Clinic, a high ankle sprain occurs when tears or damage occur to the high ankle ligaments that connect the tibia to the fibula in the leg. The ligaments are called "syndesmosis," which also refers to the joint itself.
How does a high ankle sprain differ from a standard ankle sprain?
Per UT Southwestern Medical Center, common ankle sprains happen when the lower portion of the ankle rolls inward. High ankle sprains are more significant "rotational injuries" that place stress on the syndesmotic ligaments above the ankle that hold the shin bones together.
Can you play football with a high ankle sprain?
Depending on the grade of the ankle sprain, sometimes players can play through the injury.
"It depends on putting everything together," Dr. Waldrop said. "The physical exam, what they look like, what the injury was like, how the player looks after the injury, how they respond to the injury in the first 24 hours. And then also what the MRI and then stress X-rays or stress exam look like. The grade threes are the obvious unstable, no-brainer, need surgery, etc."
What is a Tightrope surgery for a sprained ankle?
The Tightrope implant was developed by Arthtex. During the surgery, a non-absorbable fiber called "FiberWare" is placed in between two metal buttons to secure the joints.
"The tightrope is almost the perfect implant for this injury," Dr. Waldrop explained. "It's an implant made by Arthrex, which is an orthopedic company. It's a flexible implant that allows motion, but is two brackets with ropes in between. And so, what the tightrope is doing is stabilizing the implants while allowing you to still have appropriate motion to allow the ankle to heal normally."
Dr. Waldrop added that the surgery itself is a quick one, with one estimate putting the surgery time around 25 minutes. Prior to inputting the tightrope, the ankle is usually scoped so that the full extent of the injury is assessed before the Tightrope device is implanted.
Why is Tightrope surgery a preferred method of treatment?
"The tightrope has been a game-changer in my practice in terms of how to manage this injury," Dr. Waldrop said. "And has really changed how we look at this injury."
Previously, high ankle sprains were managed conservatively by "lengthy periods of immobilization" according to the National Institute of Health.
"Surgeons were really only doing it [surgery] in the most extensive cases," Dr. Waldrop explains. "And typically, it ended up being a three-month recovery, and sometimes longer. And sometimes they never got back right."
Dr. Waldrop added that when comparing athletes at Alabama who had the Tightrope versus ones who did not, those who had the surgery did better long-term than those who did not.
"The implant has made such a difference," Dr. Waldrop said. "Because what happens is the implant allows us to rehab them faster and more efficiently, which gives your ankle a better result."
What is the recovery process and timeline like for Tightrope surgery?
The average recovery time from the surgery is around four weeks, but it depends on a number of different factors.
"The most challenging position to get a guy back after a high ankle sprain and this surgery is defensive back. It's not close, because they have to backpedal. After defensive back, running backs and wide receivers are a challenge because they have to work in open spaces. They don't tolerate the big braces and the taping like linebackers and defensive linemen and offensive linemen do, and so oftentimes they take more time."
According to Dr. Waldrop, patients can sometimes start bearing weight on the ankle as soon as four days after surgery. Patients can usually then run at full speed about four weeks after that, but it is entirely patient-dependent.
That timeline changes if the player also suffers an injury to the deltoid ligament in the foot. The deltoid is a ligament located on the inside of the ankle and foot that connects the inner ankle bone to various other bones in the foot and ankle.
"Once you get the swelling under control, your ankle can move normally, it's not stiff," Dr. Waldrop said. "When it can move normally, you can walk normally. When you can walk normally, you can get on the anti-gravity treadmill.
"We can alter your weight-bearing on that to allow you to have a normal gait. When you have a normal gait, we can then run you with an altered weight. You can run normally. We then progress you to land."
Dr. Waldrop added that looking at video and analyzing athletes' progressions during those steps is a huge part of the rehab process in determining their progress.
Malachi Toney’s surgery compared to Tua Tagovailoa, others
Although the Tightrope surgery was developed in 2005, it reached the college football mainstream in 2018. One of the most prominent was Alabama starting quarterback Tua Tagovailoa, who had the procedure done twice in 2018 and 2019. In 2018, Tagovailoa left the Tide's SEC Championship Game against Georgia in the fourth quarter after one of his lineman stepped on his foot:
— CFB Kings (@CFBKings) December 2, 2018Back-up quarterback Jalen Hurts, who was benched for Tagovailoa in the national championship game the season prior, came off the bench for him and won the game.
Tagovailoa underwent the "Tightrope" surgery after the game. At the time, the procedure was a relatively new treatment for high ankle sprains.
The Alabama quarterback underwent the surgery after the Tide's Dec. 1 win over Georgia. He returned in time for the Tide's CFP semifinal game against Oklahoma on Dec. 29, exactly four weeks after sustaining the injury.
He played without limitations against the Sooners, throwing for 318 yards with four touchdowns during Alabama's 45-34 win. The Tide lost 44-16 to Clemson in the national title game, but Tagovailoa played the whole game.
"At the time, there was the assumption that the surgery was done because it was done to get him back on the field so he could play in the game," Dr. Waldrop said, who was on Alabama's staff at the time. "Which is not right. You do the surgery because the ankle needs the surgery, because it's the right thing to do for the ankle. Now, if you can come back fast from it, awesome. We'll let you do it."
In 2019, Tagovailoa suffered the injury again on his opposite ankle, which he had injured the season before, during No. 1 Alabama's 35-13 win over Tennessee on Oct. 19. Initially, then-Tide head coach Nick Saban had said he would be out for one to two weeks with an ankle sprain.
Nick Saban said Tua Tagovailoa could be out 1-2 weeks with a high ankle sprain. pic.twitter.com/Wfh98lfaob
— SportsCenter (@SportsCenter) October 20, 2019But a day later, the school announced that he had undergone Tightrope surgery to repair the injury. He returned exactly three weeks later in time for Alabama's Nov. 9 game against LSU. He ended up suffering a season-ending hip injury a week later against Mississippi State, not related to his ankle.
Elsewhere in the SEC, former Georgia tight end and Las Vegas Raiders star Brock Bowers underwent the surgery in 2023. During Georgia's 37-20 win over Vanderbilt on Oct. 14, Bowers left the game with an ankle injury.
He missed the Dawgs' next two games against Florida and Missouri, but returned four weeks after the injury for Georgia's 52-17 win over Ole Miss. Bowers finished with three catches for 34 yards including a touchdown. He played in Georgia's next game against Tennessee, but missed the Dawgs' regular-season finale against Georgia Tech after surgically-repaired ankle felt sore during warm-ups.
He played in Georgia's SEC title game against Alabama. He did not play in the Dawgs' Orange Bowl against Florida State to get the healthy ankle in time to prepare for the NFL Draft.
Former Tide offensive tackle Cam Robinson had the surgery and returned to the field in two weeks, per Dr. Waldrop. Former Notre Dame quarterback Riley Leonard also underwent the surgery in the spring of 2024. Kansas City Chiefs quarterback Patrick Mahomes also played through a high ankle sprain in 2023, but he didn't need surgery. also had the surgery Patrick
How soon can Toney return?
Miami's remaining three regular season games are against Duke on Nov. 14, Virginia Tech on Nov. 21 and Boston College on the 28th. As of this week, Toney would reach the four-week mark by Dec. 3, which would be just before a potential ACC title game for the Canes on Saturday, Dec. 5. The first round of the CFP is set to begin on Friday, Dec. 18, a full six weeks from now.
MORE: Revisiting Miami's last win at Notre Dame that sparked rivalry
Miami remaining schedule
| Date | Opponent | Weeks After Surgery |
| Nov. 7 | Vs. Notre Dame | < 1 Week |
| Nov. 14 | Vs. Duke | 1 Week |
| Nov. 21 | Vs. Virginia Tech | 2 Weeks |
| Nov. 28 | Vs. Boston College | 3 Weeks |
| Dec. 5 | Potential ACC Title Game | 4 Weeks |
"If you can check all the boxes in rehab, if you can play in four weeks, you can play in four weeks. If you can play in six weeks, you can play in six weeks. As long as you hit the rehab numbers and the rehab protocol, and you check all the boxes, we'll let you play,
So theoretically, Toney could return in time for Miami's ACC title game in four weeks, assuming the Hurricanes make it. That may also depend on if Miami truly needs to win that game to make it into the CFP.
"I personally don't put a number on how long it's going to take," Dr. Waldrop said. "But I tell them if you rehab appropriately and you rehab well and you show us that you can do all the things that are necessary to play, I'll let you play as quick as you can play."
But a return to the team in time for a CFP game in six weeks perhaps is the more conservative approach.
Without Toney, Miami will have to rely on the likes of receivers Cooper Barkate, Daylyn Upshaw and tight end Elija Lofton. None of those guys are as explosive or dynamic playmakers as Toney, but Miami will have to make do over the next few weeks.
