LITERATURE REVIEW

ligaments and up to 10% resulted in fractures around the foot and ankle. All sports have their own unique

rules, regulations and strategies that structure and guide the duration, intensity and movement patterns along with the varying levels and type of physical contact. These specific differences are what expose each individual participant to the risk of a foot or ankle injury. Ankle injuries as part of overall injury rates for each sport as reported within the scientific literature are shown in Figure 1. This clearly shows that each sport contains its own bias and level of risk of developing a foot or ankle injury, often occurring through different mechanisms causing stress to the joints and surrounding tissues. The most common foot and ankle injuries within each sport are explained under individual headings throughout the article, and Table 1 shows the most common general risk factors that lead to foot and ankle injury across all sports.

TRACK & FIELD The ankle sprain forms one of the least frequent types of injury in track and field but reportedly shows the highest re-occurrence rate. One hypothesis centres around the fact that often the ankle injury is considered a lower grade injury, where, though uncomfortable, the athlete is often still able to compete. This sport involves exceptionally high impact and stress around the foot and ankle and ignoring the injury and its natural healing times often results in a cycle of injury, compete, injury, compete. This leads to a progressively longer healing time and recovery with each cycle, ultimately taking the participant away from the sport. Interestingly, it appears that the presence of a coach at training has a positive effect on injury rates, reducing the total almost by half (3). The highest profile injury within

track and field is the stress reaction, most frequently involving the tibia but often the navicular bone or metatarsals. A stress reaction is the result of the bone’s unsuccessful ability to adapt to the mechanical load applied. Broadly speaking this injury involves a combination of a slowing of the normal bone healing process post-exercise,

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Track

and field Rugby

Cricket Soccer

Basketball Netball

0 5 10

11.2% 11.6%

17.9% 21.2% 15.9% 39.8% 15 20 25 30 35 40 45

Figure 1: The percentage of injuries that involve the ankle within different sports. Adapted from Fong et al. (2).

reducing the ability to remodel the stressed areas of bone and/or a change to the loading cycle (impact) of more or harder activity generating additional, unaccustomed stress on the bone (4). Recent advances show vertical loading reaction (VLR), which relates to the speed at which each impact occurs, is the key precipitating factor in the development of a sporting related stress fracture (5). This concept supports the link with one of the common physiological factors associated with this injury, calf girth. The increased calf girth correlates with a decrease in injury rate, with this measurement able to predict future injury with a reported 80% accuracy. It is thought the additional strength and dynamic components of the larger calf muscles will lead to a greater control of the speed at which the impact forces occur. Other possible predictors of future bone related injury in athletes are leg-length discrepancy, low bone mineral density and low fat diets but this is a very complex area often involving multiple causes and therefore should only be approached by those with the appropriate skills.

BASKETBALL The ankle injury in basketball is considered very commonplace, making up approximately a quarter of all reported injuries. Interestingly male and female ankle injury patterns are similar with

around 90% of these considered low to moderate grade ligament sprains and around 2% resulting in a fracture. The majority of the ankle sprains occur during offensive rather than defensive tasks and a significantly greater number occur during games rather than training (6). The biggest influence on ankle injuries within basketball relates to landing, with the highest number occurring while landing on an opponent’s foot or sudden impact while in the air causing a sharp twisting movement prior to landing. A common saying in sport is ‘injury is just part of the game’ (7) suggesting that they are unpreventable. On the face of it, these two mechanisms cannot be changed, but a recently improved level of understanding of these risk factors has lead to excellent interventions and an estimated reduction in injury and importantly re-injury rates by up to a third. The two key factors that have

been clinically shown to reduce the risk of sustaining an ankle injury in

RISK FACTORS HAS LEAD TO AN ESTIMATED REDUCTION IN INJURY AND RE-INJURY RATES BY UP TO A THIRD

AN IMPROVED LEVEL OF UNDERSTANDING OF THE

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