LITERATURE REVIEW
change of direction or sudden contact within the air, where a defensive player, post-vertical jump and with a plantarflexed foot, is at greatest risk of landing on an opponent or during a sudden twist to adjust their body.
RUGBY Rugby is a sport involving high-intensity player-on-player contact, multiple changes of direction and all played on a surface that is constantly changing throughout a game and from day to day. The number of ankle injuries in rugby can account for up to a fifth of all injuries sustained throughout one season, equalling up to 13% of the total time lost to injury. Interestingly there is a roughly equal 50 : 50 split between the ankle injuries occurring during contact with another player and those in non-contact situations (16). This suggests almost half the ankle injuries sustained in some way could be prevented. Around half, and in some cases
up to three quarters, of the ankle injuries sustained in rugby involve the lateral ligaments and capsule. One significant factor relates to the playing surface, with approximately 60% of lateral ligament injuries, and almost all fractures, occurring on hard surfaces. Those matches played on slippery wet grass appear to more frequently involve the inferior tibiofibular syndesmosis, or sprain of the ankle joint capsule (16).
The timing of these injuries is
important as a significant proportion of the ankle sprains in rugby occur in the final 20 mintes of each half but interestingly the fractures to both tibia and fibula almost always occur in the 3rd and 4th quarters of the game (16).
CONCLUSION This article has described some of the common risk factors within sport and highlighted a few sport-specific injuries and their possible causes around the topic of the foot and ankle. The author hopes this snapshot has opened your mind to an understanding that not all foot and ankle injuries are the same and that some are preventable. Remember that each sport is
different, each person playing a sport is different, and each injury is different.
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Any assessment and subsequent rehabilitation should take into account the initial mechanism of injury, the structures injured, the sports being played and, most importantly, the individual. The evidence is clear, through understanding your sport and the risk factors associated with foot and ankle injuries it is possible to reduce their severity and frequency. In rehabilitation all attempts must be made to minimise the risk of further injury as athletes can
remain at risk of further injury for up to 1 to 2 years and possible discomfort for up to 2 to 6 years post-injury. The following articles hope to create a link between understanding
SOCCER IS RESPONSIBLE FOR BETWEEN ONE THIRD AND ONE HALF OF ALL SPORTING INJURIES WITHIN EUROPE
TABLE 1: THE RISK FACTORS ASSOCIATED WITH THE DEVELOPMENT OF FOOT AND ANKLE INJURY INFLUENCE OF RISK FACTOR
RISK FACTOR Age
Game or training
In some sports it is the older players, and in other sports it is the younger players, who have the greater risk of ankle injury.
The effort level of most sports between training and games often results in an increased intensity and thus overreaching, leading to greater disruption of the quality of movements that protect the body from injury. The majority of sports show an increase in ankle injury rates during games with some showing up to a 50% rise from training alone.
Level of play (recreational to competitive)
Position played Fitness
This has a clear association with the frequency and type of ankle injury sustained within most sports. The ability of the athlete to interpret and adapt to avoid unaccustomed movements or inappropriate contact allowing for the optimised movements that reduce exposure to the situations that apply stress to the joint or tissue around the ankle.
The risk factor within each sport, and the position played within that sport, impacts the risk of ankle injury greatly. This is often due to the movements performed relative to the position played.
Those showing reduced fitness have a significantly higher re-injury rate, sometimes up to 3 or 4 times higher. Those who are not back to normal fitness levels fatigue sooner and therefore it is more difficult to perform the correct movements that would limit any exposure to situations that would stress the foot or ankle.
Mental component
In some sports it has been shown that an unwillingness to learn ‘new’ tasks and remain ‘open minded’ to new ideas during training or rehabilitation restricts the bodies exposure to all the movement patterns within a sport. Meaning when they are exposed to this movement within the competitive situation their body could be too slow to react, potentially resulting in injury.
Footwear
In a number of sports inappropriate control of the foot has been shown to greatly increase the number of foot and ankle injuries, with the shoe being highlighted as a potential cause. However, in each sport this mechanism is different, e.g. in basketball physical support to the ankle joint to limit one-off movements, though in football the boots impact biomechanical control of the midfoot on a repetitive basis.
Previous injury
In all sports this appears to be one of the biggest indicators of re-injuring the foot or ankle. The literature shows that those who have sustained an ankle injury within the past 12–24 months are at a significantly greater risk of re- injuring their ankle.
Time in minutes within the game
Most sports show that at some point within the game there is a greater frequency of ankle injuries. For example, this occurs in the final 20 min of a rugby game (possibly relating to muscle fatigue), but is within the first quarter in netball (possibly relating to neurological fatigue).
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