Ankle injuries in soccer players I. Ankle sprain

Over the past three decades, musculoskeletal injuries in soccer have increased due to the increase in participants playing the sport, and with them, ankle injuries. These injuries occur due to several factors, including constant acceleration and deceleration, changes in direction, and repeated contusions from tackles by opposing players.

Several sports trauma studies have correlated these ankle injuries with an increased risk of developing osteoarthritic changes in the ankles of former soccer players (up to 6%). Therefore, it is crucial to determine the causes and mechanisms that cause these injuries.

Certain studies classify risk factors for ankle injuries as follows:

1.- Intrinsic or athlete-specific:

• Previous injuries (most important)
• Anatomical characteristics of the soccer player (type of pes cavus, joint laxity, or anatomical misalignment)
• Isokinetic functional deficits, for example, weakness or loss of strength in the hip abductors, ankle instability, or reduced strength in the lower extremities
• Reduced ankle dorsiflexion
• Impaired proprioception, understood as the awareness of the joint's spatial position
• Athlete's age
• Increased body mass index

2.- Extrinsic or related to the environment:

• Direct contact with an opponent (the most important, 20-30% of all injuries)
• Environmental conditions
• Inadequate equipment
• Artificial turf
• Insufficient training
• Inadequate warm-up
• Type of sporting activity

The most common mechanisms that cause ankle injuries These are:

• Injuries from contact with another player.
• Injuries without direct contact.
• Injuries from sliding tackles.
• Injuries from contact with equipment (post or ball).
• The first two account for the majority of cases (89%).

The incidence of foot and ankle injuries in elite soccer ranges between 3 and 9 injuries per 1,000 hours of play. They are more common in the dominant lower extremity, and competition is the most common time of injury compared to training.

There are no studies in the literature that find significant differences between the incidence rates of ankle injuries between male and female soccer players.

The most common injuries in soccer are muscle injuries, especially of the hamstrings, quadriceps, hip, and calf. The latter typically occur at the end of the first half of a match. According to some epidemiological studies on sports trauma, the most common injury to the ankle joint is the ankle sprain.

These ankle sprains occur in the lateral ligament complexes (the most common injury is to the anterior talofibular ligament, 67% of cases), the medial ligament complex (due to involvement of the medial lateral ligament or deltoid ligament, 9% of cases), the tibiofibular syndesmosis (also known as a high sprain, 12% of cases), and myotendinous injuries, approximately 11%. Fractures are rare and account for 1% of all ankle injuries in soccer.

Regarding myotendinous injuries, Achilles tendon injuries account for 2.5% of all injuries and 3.8% of time off work in men's professional soccer. Older players are more prone to this injury, and there is often injury progression from tendinopathy to acute partial or complete rupture. Preseason is the time of highest incidence of Achilles tendon injuries.

Players with a previous ankle sprain are five times more likely to suffer a new ankle sprain than players without previous ankle sprains.

The main goal in treating an ankle sprain is to prevent ankle instability. Various sports trauma studies have indicated that only 20% of ankle sprains result in chronic joint instability. Therefore, 80% will recover without sequelae with conservative treatment.

Initial treatment for an acute sprain will require rest, elevation, compression, and ice. Pain control is recommended, but not with NSAID-type anti-inflammatory medications, as these can interfere with the initial physiological phases of recovery. Immobilization with splints or casts, if used, should not last longer than the first few days; functional treatment and exercises are recommended later.

It is not possible to predict recovery times due to the wide variety of injuries that exist; therefore, the time required to return to activity or play depends on the severity of the sprain and the presence of any associated injuries.