Foot and Ankle Injuries in Footballers: A Pilot Epidemiological Study

Background: As the popularity of sport increases so does the risk of injury, with 19 million sporting injuries/year in England and Wales alone. Football is the UK's most popular sport. It has been estimated that professional footballers have levels of injury approximately 1000 times greater than high-risk industrial occupations. Since approximately 86% of football injuries occur in the lower extremity, we focussed on the foot and ankle. We developed a pilot questionnaire and tested it among footballers seeking to estimate the prevalence of foot/ankle injuries and the risk factors for such injuries. Methods: The questionnaire was developed after a comprehensive literature search and was iteratively improved with input from footballers, podiatrists, physiotherapists and rheumatologists. The questionnaire was tested among footballers from 3 different teams: 1 amateur, 2 semi-professional. Questionnaire responses were validated against club records of medical or physiotherapy interventions. Results: In total 42 footballers were surveyed, yielding 34 (81%) responses amongst whom 44% reported at least one foot/ankle injury within the past 12 months. In total, 273 injuries at any body site were reported with 114 (42%) affecting the foot (n = 44, 16%) or ankle (n = 70, 26%). Amongst this pilot cohort, we found that recent foot/ankle injuries were significantly more likely to occur during a match vs. practice (P < 0.0001) and injuries were significantly more likely to occur in the dominant limb (P < 0.0001). Players who reported shorter warm-up times (< 30 min) reported significantly more foot/ankle injuries (P = 0.050) and in particular those who warmed-up for < 15 min (P = 0.017). Looking at the overall injuries sustained, footballers who had suffered ≥ 5 injuries in their career thus far were significantly older (P = 0.03), heavier (P = 0.01) and taller (P = 0.004) but their BMI was not significantly associated. Only 26% of players wore ankle supports; however, neither reported use of supports or insoles nor the type of football boot worn were significantly associated with reporting recent foot/ankle injury. Conclusions: Foot and ankle injuries are common yet simple methods of injury prevention (e.g. ankle supports) are rarely used. It is necessary to educate footballers, club staff and the general public about injury prevention as once the first injury occurs, the cycle of injuries may become chronic. The questionnaire has proved a valid tool in identifying the prevalence and risk factors for these injuries. Knowing the risk factors for certain injuries will increase the awareness for injury prevention. For example, if a footballer knows that being heavier can increase their injury chances, they may be encouraged to monitor and maintain an ideal weight, thus reducing their injury chances. Overall, the high level of injuries in football is unacceptable and the mindset needs to change from accepting injuries as inevitable, to making injury prevention part of the game.