SLR - March 2017 - John Dresser

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):426–433.

Scientific Literature Review

Reviewed By: John Dresser, DPM
Residency Program: St. Francis Hospital and Medical Center, Hartford, Connecticut

Podiatric Relevance: Success in intercollegiate athletics requires rigorous training, regimented practices and highly competitive contests. In certain sports, injuries to the lower extremities occur more regularly and can result in significant disability and time lost from participation. Studies have shown that lower-extremity injuries account for a significant portion of collegiate injuries across all divisions, as high as one half of all injuries reported. Despite reports from selected sports, overall incidence and epidemiology of lower-extremity injuries in collegiate athletes is unknown. This study is designed to give a definitive overall incidence and epidemiology of foot and ankle injuries in collegiate athletics.  

Methods: Authors reviewed Stanford University’s injury database, a Division 1 collegiate program, to determine the incidence and epidemiology of foot, ankle and lower-leg injuries occurring in this population. Detailed injury data were prospectively collected and in a secured electronic data base over a two-year period. The database was reviewed for all foot and ankle injuries between July 2010 and June 2012 that required evaluation and medical treatment. The inclusion criteria consisted of foot and ankle injuries that were sustained during an NCAA sanctioned event, practice or competition and received medical treatment from an athletic trainer and/or team physician.

Results: During the study period, a total of 1,076 individual student athlete’s (580 males, 496 females) suffered 3,861 total musculoskeletal injuries; 61 percent in males and 39 percent in females. Of the 3,861 total musculoskeletal injuries, 468 athletes sustained a total of 1,035 injuries (27 percent of all injuries) involving the foot, ankle and lower leg. Female athletes sustained foot/ankle injuries at a significant higher rate (53 percent) compared with male athletes (47 percent).

Conclusions: The data suggests a higher incidence rate for injury to the foot and ankle than previously reported. In this Division 1 cohort, 27 percent of all musculoskeletal injuries involved either the foot or ankle. Foot and ankle injury rates and missed-time injuries in female athletes and women’s sports seem to be higher than previously reported compared with male athletes, particularly for bone stress injuries. The data shows that overuse type injuries are very common, particularly in running, field and court sports. However, acute injuries have predisposing risk factors that may provide an opportunity for prevention. For example, variations of postural sway with one leg have been associated with increased prevalence of ankle injury in basketball players. Injury database systems, in conjunction with evaluation of biomechanics, conditioning techniques and nutrition, provide a platform to find answers to injury risk questions.

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