Background:​ Gymnastics is a competitive and popular sport that is started at an early age, and elite female gymnasts reach their prime in mid-teenage years. The level of intensity of practice and competition, the number of events, and the degree of difficulty of the maneuvers make gymnastics one of the most injury-producing sports.

Methods:​ Over a 3-year period, 14 elite, female gymnasts were seen in one foot and ankle center. The mean age was 17 (range 14 to 21) years. All gymnasts sustained acute or sub-acute injuries to the foot or ankle requiring surgery. The mechanism of injury, the type of injury, operative repair, and followup were recorded.

Results:​ There were five Lisfranc fracture-dislocations, and five talocalcaneal, two multiple metatarsal, one medial malleolar, one phalangeal, and one sesamoid fracture. All injuries had operative repair. One gymnast with a Lisfranc injury was able to return to full competition;​ all others with a Lisfranc injury retired from gymnastics, were lost to followup, or graduated from college. One gymnast with a talar osteochondral injury was not able to return to competition but all other injured gymnasts were able to return to gymnastics at the same level or higher.

Conclusion:​ Elite female gymnasts can sustain significant injury to the foot and ankle region. In our study, Lisfranc injuries were most likely career-ending.