Mechanisms of Foot and Ankle Injuries in Soccer

Eric Giza, Colin Fuller, Astrid Junge, and Jiri Dvorak

The American Journal of Sports Medicine

2003, Vol 31, pages 550-554

Research backed by FIFA (Fédération Internationale de Football Association), soccer's world governing body, has investigated the mechanism of foot and ankle injuries during competitive play. The researchers analysed all foot and ankle injuries that occurred during the 1998 World Cup, 1999 Under-17 World Championship, 2000 Olympics and 2001 Under-20 World Championship, to ascertain the circumstances surrounding the injury.

Previous research has shown that professional soccer players are more pre-disposed to ankle osteoarthritis than is the general population. As osteoarthritis is a common consequence of previous trauma, it is important to understand how these injuries occur so that preventative measures can be introduced.

The authors intended to identify foul play in the role of foot and ankle injuries, as well as the position of the foot and ankle at the time of injury, by utilising a video analysis method. Repeated video analysis has been shown to be a valid method of analysing contact injuries. Giza et al observed each injury to identify the following: the action of the tackling player (staying on feet, sliding in on ground, horizontal jump, or vertical jump); the tackle approach direction, defined as the spatial relationship of the tackling player to the tackled player at the start of the tackle (front, side, or behind); and the referee's decision (foul or not foul) at the time of the incident. In addition, the injured player's weight-bearing status, position of the foot and ankle, direction of the force exerted on the foot and ankle, and the resulting rotation at the time of the incident were identified. Those injuries where these factors could not be clearly identified on video were excluded from the study.

During the 180 matches of the four tournaments, there were 85 ankle and 29 foot injuries, of which the video coverage was adequate to provide an assessment of the tackle parameters for 76 of the incidents (52 ankle, 24 foot). Of these 76 injuries, 52 (69%) were contusions, 20 (26%) were sprains, and 4 (5%) were fractures. Giza et al found that 67% of the injuries occurred from direct contact with the foot or ankle, with significantly more injuries involving a force from the side compared with the anterior or posterior direction. Even for tackles from behind, the actual force direction on the foot or ankle was significantly more likely to be from the side than from the posterior direction, as the opponent attempts to hook a leg around the tackled player.

63% of recorded injuries were deemed to be foul play and the referee awarded a free kick. However, a high proportion of injuries (37%) were not deemed to be the result of foul play and the referee did not award a free kick. FIFA introduced instructions to referees that all tackles from behind were to be punished by a free kick. Giza et al observed that referees in the matches analysed did not always apply this rule. The authors proposed that this was due to the main thrust of the tackle coming from the side.

Another interesting observation which backs clinical findings was the fact that Giza et al found a higher proportion of injuries occurred when the tackled player was weigh-bearing compared to non weight-bearing. The authors also hypothesised that due to the mechanism of injury, the medial structures of the ankle were just as likely to be injured as the lateral structures - contrary to the previous published research, which always indicated lateral injuries were more frequent in soccer.

Because the research is undertaken by FIFA, there may be implications for rule changes. The high proportion of injury caused by challenges from the side may mean that these challenges may be deemed illegal. This would make attacking play slightly easier and defending more difficult. The number of injuries to attacking players may be reduced and the number of yellow and red cards to defenders may be increased. These moves would most likely be criticised by traditionalists who prefer soccer to be a physical contact sport.

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