Ankle injuries in soccer players II. Acute and overuse injuries beyond sprains

What are the most common acute and overuse injuries in soccer players' ankles?

Ankle sprains can account for up to 80% of lower extremity injuries in soccer players, although they are not the only ones that can affect the ankle. (See article on ankle sprains in soccer players)
Bruises and contusions are common but minor injuries. They occur from contact with an opponent or the ground, and cause pain, swelling, and reduced muscle function, but rarely become complicated or result in the player being sidelined.

What is an osteochondral injury of the talus?

Another injury that can occur in soccer players is an osteochondral injury of the talus. These are injuries to the cartilage of the talus (the ankle bone that articulates with the tibia and fibula). They cause poorly defined pain and recurrent inflammation, which are often confused with chronic ankle sprains due to their nonspecific symptoms. If a fracture is suspected, it is important to undergo radiological and magnetic resonance imaging (MRI). Treatment, depending on the size and location, may require surgery. Some sports trauma studies support the use of PRP (platelet-rich plasma) or hyaluronic acid to improve this injury.

Are ankle fractures common in soccer players?

Various sports trauma studies indicate the low frequency of ankle fractures in soccer players. Their incidence ranges between 1 and 9% of all injuries. Ankle fractures are the most common lower leg fractures (36%), followed by foot fractures (33%) and tibia fractures (22%). The vast majority of these injuries occur during competition.

What is the most common tendon injury in a soccer player's ankle?

According to published sports trauma studies on ankle injuries in soccer players, the most frequently affected ankle tendon is the Achilles tendon. Acute total rupture of the Achilles tendon is common in soccer. It is estimated that 9 cases per 100,000 Achilles ruptures are attributed to this sport. Non-traumatic injuries are also common in soccer players. Tendinitis and tendinopathy of the midfoot or insertion can be caused by overuse, training errors, personal physical predisposition, or even medications. Risk factors for Achilles tendon injuries due to overuse include hard playing surfaces, inappropriate footwear, increased training intensity, or decreased ankle dorsiflexion.

What overuse injuries occur in soccer players' ankles?

However, there are also non-traumatic injuries that are common in soccer players. The repeated impact of the ball over the years causes these microtraumas on the anterior and internal surfaces of the ankle to predispose to the development of osteophytes (parrot-beak-shaped bone formation that reflects joint degeneration) in the most anterior part of the ankle joint. This is known as anterior ankle impingement. Various sports trauma studies estimate that up to 60% of soccer players suffer from this injury, which can cause pain and restricted ankle dorsiflexion. To resolve this injury, the soccer player will most likely require surgery.
Posterior ankle impingement is another condition commonly seen in soccer players. It may be due to acute trauma or the chronic stress the ankle is subjected to while playing soccer. It presents as pain in the back of the ankle and upon plantar flexion (the act of accelerating when driving) when kicking the ball or running. Various pathologies present in football players can cause this condition: Achilles tendon tendinopathy, symptomatic os trigonum (accessory bone in the posterior part of the talus that can cause pain), bursitis, fractures, etc. Most football players affected by posterior ankle impingement improve with conservative treatment.

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