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

As we previously discussed, muscle injuries and ankle sprains these are the most common injuries in soccer. We've already seen how ankle sprains can represent up to 80% of lower extremity injuries in soccer players, although they are not the only ones that can affect the ankle.

Bruises and contusions are common but minor injuries. They occur from contact with an opponent or the ground, and cause pain, inflammation, and reduced muscle function, but rarely become complicated or result in the player being sidelined.

Another injury that can occur in soccer players is osteochondral lesions 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 that are often confused with chronic ankle sprains due to their nonspecific symptoms. If suspected, it is important to perform radiological and magnetic resonance imaging. Treatment, depending on the size and location, may require surgery. There are sports trauma studies that support the use of platelet-rich plasma or hyaluronic acid to improve this injury.

Different 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 tibial fractures (22%). The vast majority of these injuries occur during competition.

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, tendinopathy of the midfoot or insertion, can be caused by overuse, training errors, personal physical predisposition, or even medications. Risk factors for overuse injuries to the Achilles tendon include hard playing surfaces, inappropriate footwear, increased training intensity, or decreased ankle dorsiflexion.

However, non-traumatic injuries are also common in soccer players. Repeated ball impact over the years causes these microtraumas on the anterior and inner side of the ankle, predisposing to the development of osteophytes (parrot-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 common condition in soccer players. It can be caused by acute trauma or by chronic stress the ankle is subjected to while playing soccer. It presents as pain in the back of the ankle and upon plantar flexion (when accelerating when driving) when kicking the ball or running. Various pathologies present in soccer players can cause this condition: Achilles tendon tendinopathy, symptomatic os trigonum (an accessory bone at the back of the talus that can cause pain), bursitis, fractures, etc. Most soccer players affected by posterior ankle impingement improve with conservative treatment.