Incidence and epidemiology of foot and ankle injuries in elite collegiate athletes

Hunt, Kenneth J.; Hurwit, Daniel; Robell, Kevin; Gatewood, Corey; Botser, Itamar B.; Matheson, Gordon

Affiliations

¹Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA

²Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA

³Department of Athletics and Physical Education, Stanford University, Stanford, California, USA

Abstract and keywords

Background: Foot and ankle injuries are increasing in competitive professional and collegiate athletics. Many of these injuries result in considerable missed time from sports and often require surgical intervention. To develop and implement effective practice participation strategies, return-to-play protocols, and injury prevention programs, an understanding of injury trends and epidemiology is vital.

Purpose: This study aimed to evaluate the incidence of foot and ankle injuries in elite athletes participating in 37 sports at a single National Collegiate Athletics Association (NCAA) Division 1 institution.

Study Design: Descriptive epidemiological study.

Methods: We evaluated the injury records of all varsity sports at a single NCAA Division 1 athletics program, including 1076 athletes participating in 37 sports. Detailed injury data were prospectively collected in a secure electronic database over a 2-year period. We reviewed the database for all foot/ankle injuries. 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: During the study period, a total of 3861 total musculoskeletal injuries were recorded. There were 1035 foot/ankle injuries (27%). Of all foot/ankle injuries, 21% (218 of 1035) caused the athlete to miss at least 1 day of participation, with an average of 12.3 days of time loss from sport. Furthermore, 27% of athletes with foot/ankle injuries were referred for office evaluation by a physician, and 84% of these required radiologic imaging. The overall injury incidence rate was 3.80 per 1000 athlete-exposures (AEs). The 4 sports with the highest incidence rate (>75th percentile) were women’s gymnastics, women’s cross-country, women’s soccer, and men’s cross country. The most frequently occurring foot/ankle injuries were ankle ligament injuries, tendinopathies or fasciopathies, and bone stress injuries.

Conclusion: The prevalence of foot/ankle injury in a large NCAA Division 1 athletics program was 27% of total musculoskeletal injuries over a 2-year period, with 21% of these injuries resulting in missed time. There were significantly higher foot and ankle injury incidence rates and more missed time in female athletes and women’s sports.

Keywords: foot and ankle, incidence rate, missed time, surgical treatment

Links

DOI: 10.1177/0363546516666815

PubMed: 27802962

WoS: 000394776900021

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2021	Stone JA, Miranda AD, Gerhardt MB, Mandelbaum BR, Giza E. Outcomes of surgically treated fifth metatarsal fractures in Major League Soccer athletes. Am J Sports Med. September 2021;49(11):3014-3020.
2023	Khuc E, Oloff LM. First metatarsophalangeal joint pathology in the athlete. Clin Podiatr Med Surg. January 2023;40(1):157-168.
2020	Lievers WB, Goggins KA, Adamic P. Epidemiology of foot injuries using National Collegiate Athletic Association data from the 2009–2010 through 2014–2015 seasons. J Athl Train. February 2020;55(2):181-187.
2021	Chan JJ, Geller JS, Chen KK, Huang H-H, Huntley SR, Vulcano E, Aiyer A. Epidemiology of severe foot injuries in US collegiate athletes. Orthop J Sports Med. April 2021;9(4):23259671211001131.