SLR - April 2017 - Brett P. Vessell

Incidence and Epidemiology of Foot and Ankle Injuries in Elite Collegiate Athletes

Reference: Hunt KJ, Hurwit D, Robell K, Gatewood C, Botser IB, Matheson G. Incidence and Epidemiology of Foot and Ankle Injuries in Elite Collegiate Athletes. Am J Sports Med. 2017 Feb; 45(2): 426–33.

Scientific Literature Review

Reviewed By: Brett P. Vessell, DPM
Residency Program: KentuckyOne Health/Jewish Hospital, Louisville, KY

Podiatric Relevance: Foot and ankle injuries are common in athletes. These injuries often result in surgical intervention, which for collegiate athletes can mean considerable missed time from sports or even loss of scholarship opportunities. Understanding the injury trends and epidemiology is crucial for the development of effective injury prevention strategies, as well as return-to-play protocols.

Methods: An epidemiological study was performed over a two-year period where injury records from 1,076 athletes participating in 37 different sports, all from the same NCAA DI school, were reviewed. Inclusion criteria were any foot/ankle injury that was sustained during an NCAA-sanctioned event and subsequently received medical treatment. Independent variables included athlete and injury demographics, missed days, physician visits, imaging results and whether the injury required surgery. Injury incidence, relative frequency distributions and sample proportions were dependent metrics for this investigation.

Results: One thousand thirty-five (27 percent) foot/ankle injuries were recorded out of a total of 3,861 musculoskeletal injuries. Twenty-one percent (218 of 1,035) caused the athlete to miss at least one day of participation, with the average length being 12.3 days. Twenty-seven percent of athletes with foot/ankle injuries were referred to an outside physician for evaluation with 84 percent requiring radiological imaging. The overall injury rate was 3.8 per 1,000 athlete exposures. The most frequent injuries of the foot/ankle involved ankle ligaments, tendinopathies and bony stress injuries.

Conclusion: Foot and ankle injuries are commonplace in athletes. It is vital that podiatrists understand the prevalence and epidemiology of these injuries. Within a large NCAA DI athletics program, 27 percent of all total musculoskeletal injuries over a two-year period involved the foot/ankle. Additionally, 21 percent of these injuries resulted in missed time. The sports with the highest incidence rate (>75th percentile) were women’s gymnastics, women’s cross-country, women’s soccer and men’s cross country. This shows a significantly higher foot/ankle injury incidence rate in female athletes and in women’s sports as a whole.

However, limitations to this study include only recording injuries for a two-year period. Additionally, Stanford University is located in a temperate climate with most of the sporting events held in warm and largely ideal weather.

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