National injury prevention measures in team sports should focus on knee, head, and severe upper limb injuries

Differences in Injury Profiles Between Female and Male Athletes Across the Participant Classification Framework: A Systematic Review and Meta-Analysis

BACKGROUND

Female sex is a significant determinant of anterior cruciate ligament (ACL) injury. It is not understood if sex is a key determinant of other sports-related injuries.

OBJECTIVE

The aim of this systematic review was to identify where differences in injury profiles are most apparent between the sexes in all sports across the six-tiered participant classification framework.

METHODS

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the 'implementing PRISMA in Exercise, Rehabilitation, Sport medicine and SporTs science'(PERSiST) guidance. The databases PubMed, CINAHL, Web of Science, SPORTDiscus, Medline, Scopus, Cochrane Library and EBSCO were searched from database inception to 24 April 2023. Longitudinal, prospective and retrospective cohort studies and cross-sectional and descriptive epidemiology studies that used standard injury data collection were included. Studies were excluded if injuries were not medically diagnosed and if injuries were not reported and/or analysed by sex. Two reviewers independently extracted data and assessed study quality using the Downs and Black checklist.

RESULTS

Overall, 180 studies were included (8 tier-5, 40 tier-4, 98 tier-3, 30 tier-2, 5 tier-1 studies; one study included data in two tiers). Of those, 174 studies were of moderate quality and six studies were of limited quality. In sex-comparable sports, there was moderate evidence that female athletes had greater risk of knee injury (relative risk (RR) 2.7; 95% CI 1.4-5.5), foot/ankle injuries (RR 1.25; 95% CI 1.17-1.34), bone stress injury (RR 3.4; 95% CI 2.1-5.4) and concussion (RR 8.46; 95% CI 1.04-68.77) than male athletes. Male athletes were at increased risk of hip/groin injuries (RR 2.26; 95% CI 1.31-3.88) and hamstring injuries (RR 2.4; 95% CI 1.8-3.2) compared with females, particularly in dynamic sports. Male athletes were 1.8 (1.37-2.7) to 2.8 (2.45-3.24) times more likely to sustain acute fractures than female athletes, with the highest risk in competition.

DISCUSSION

Most studies in all cohorts were of moderate quality (mean/range of scores tier-5: 17 ± 2.2 [14-20], tier-4: 16.9 ± 1.9 [11-21], tier-3: 16.9 ± 1.5 [11-20], tier-2: 16.3 ± 2.2 [11-20], tier-1 studies: 15.6 ± 1.3 [14-17] out of 28 on the Downs and Black checklist), with only six studies of limited quality. Female athletes' propensity for bone stress injuries highlights opportunities to reinforce development of optimal bone health during adolescence and to outline the effects of energy availability. Earlier strength development and exposure to neuromuscular training programmes and modification of skill development in female athletes may be effective strategies for reducing lower limb injury risk. Key components of neuromuscular training programmes could be beneficial for reducing hip/groin and hamstring injury risk in male athletes. There may be a need for sex-specific prevention and return-to-sport protocols for sports-related concussion in female athletes.

CONCLUSIONS

Female sex was a key determinant of sports-related injuries beyond ACL injury including foot/ankle injury, bone stress injury and sports-related concussion. Male sex was a key determinant of hip/groin, hamstring injury and upper limb injury.

TRIAL REGISTRY

PROSPERO registration number: CRD42017058806 (last updated on 7th June 2023).

Analysis of Injuries in the Swiss U20 Elite Ice Hockey Season 2019/2020-A Retrospective Survey

(1) Background: In Switzerland, there is little data on injury characteristics in elite ice hockey players aged under 20 years (U20 Elite juniors). This study aimed to determine the injury rate and type of injury in Swiss U20 ice hockey players. (2) Methods: The present study was carried out in a retrospective, non-experimental design using an online questionnaire provided to the 314 elite players of the 12 Swiss U20 Elite ice hockey teams. The injury rate, rate ratios, injury location, type and severity of injury, and injury mechanism were reported. (3) Results: Seventy-three athletes from 11 teams volunteered (response rate = 24%). A total of 30 out of 45 recorded injuries led to time loss in practice and competition. Injury occurred once or twice during the 2019/2020 season. For each player, the injury rate was 0.66 per 1000 practice hours and 2.98 per 1000 competition hours (injury rate ratio = 4.5). The head/neck region was the most common injury location (45.5%). (4) Conclusions: Knowledge of injury characteristics in ice hockey is necessary for meaningful injury management and injury prevention. The results of the present study provide information on the injury rate, location, types, severity, and mechanism in elite Swiss U20 ice hockey players. Most injuries result from contact with another player. More strict sanctioning for irregular behavior and fair play can serve as preventive measures. Further studies should examine different preventive measures such as wearing full-face coverage.

'Benched' the effect of the COVID-19 lockdown on injury incidence in sub-elite football in Australia: a retrospective population study using injury insurance records

OBJECTIVES

The primary aim of this study was to compare injury rates pre- and post-COVID-19 lockdown in sub-elite football (soccer) players by analysing the full season and the first month of each season between 2018 and 2020. Secondary aims were to describe the incidence, location and type of injuries and to compare injuries by age group and sex.

DESIGN

Descriptive epidemiological study.

METHODS

A de-identified insurance database was retrospectively coded using the Orchard Sports Injury Classification System. Injury incidence per 1000 hours as well as incidence rate ratios (IRR) with confidence intervals were calculated.

RESULTS

No significant difference was found in the overall incidence rate in 2020 compared with the 2018 and 2019 seasons (IRR, 1.04 [95% CI, 0.96-1.13]; p = 0.294). However, overall injuries increased by 26% (IRR: 1.26 [95% CI 1.07-1.47]; p < 0.005) and joint sprains increased by 45% (IRR: 1.45 [95% CI 1.14-1.84]; p < 0.005) in the first month of 2020 compared with 2018-2019. Between 2018 and 2020, there were 4149 injury insurance claims, with anterior cruciate ligament (ACL) ruptures accounting for 19% of all injuries. When comparing sex, female players had significantly more ankle sprains whilst male players suffered more dental injuries.

CONCLUSIONS

This study adds to a growing body of evidence investigating injury rates post-COVID-19 lockdowns in sport. Sub-elite players appear to be at higher risk of joint injuries within the first month of training following a period of lockdown. Overall, stakeholders involved in sub-elite football should prioritise knee and ankle joint injury prevention.

Supplementary orthopaedic screening for children and adolescents to prevent permanent skeletal deformities - protocol for the "OrthoKids" study

BACKGROUND

Skeletal deformities (SD) in children and adolescents can lead to arthritic conditions, impairment of quality of life, and high treatment costs in the long term. However, comprehensive data on the prevalence of SDs in children and adolescents are limited and it remains therefore unclear whether there is a healthcare gap. "OrthoKids" is a project that addresses this evidence gap by implementing an orthopaedic screening for children and adolescents that supplements existing detection examinations within statutory standard care in Germany.

OBJECTIVE

To detect SDs so that they can be treated as needed at an early stage.

METHODS

The implementation of the supplementary orthopaedic screening will be evaluated through an exploratory cohort study that is set up in the German state Baden-Wuerttemberg. 20,000 children and adolescents aged 10 to 14 years will be recruited as a prospective cohort. A retrospective control cohort will be formed based on claims data provided by two cooperating statutory health insurances (SHIs). Participating children and adolescents receive a one-time orthopaedic screening. If at least one SD is diagnosed, treatment will be provided as part of the statutory standard care. Within the scope of the project, a follow-up examination will be performed after one year. An IT-platform will complement the study. The primary outcome measure is the point prevalence of scoliosis, genu varum/valgum, hip dysplasia, and flat feet. Secondary outcome measures are (i) the point prevalence of further less common SDs, (ii) health-related quality of life (HRQoL), (iii) sports ability based on activity (physical/athletic), physical constraints, and (sports) injuries, as well as (iv) monetary consequences of the orthopaedic screenings' implementation. Implementation determinants will be evaluated, too.

DISCUSSION

If the supplementary orthopaedic screening proves to be viable, it could be considered as a supplementary examination for children and adolescents within the frame of SHI in Germany. This could relieve the burden of disease among children and adolescents with SDs. In addition, it could disburden SHIs in the medium to long term.

TRIAL REGISTRATION

The OrthoKids study was registered in the German Clinical Trials Registry (Deutsches Register Klinischer Studien (DRKS)) on 26th July 2022 under the number 00029057.

RESPONSES OF TAI CHI IN UPPER LIMB SPORTS INJURIES REHABILITATION ON YOUNG PEOPLE

ABSTRACT Introduction Practicing sports can strengthen the body both physically and mentally. Although Tai Chi can help injured athletes to recover quickly and shorten the return to sports training and competition, there are still no detailed studies about its effectiveness in lower limb injuries in young people. Objective Analyze the effects of Tai Chi in upper limb sports injuries rehabilitation on young people. Methods 91 patients with sports injuries are selected and randomly divided into a control group (n=44) and an experimental group (n=47). The control group received regular exercises for rehabilitation, while the experimental group used Tai Chi exercises. Mathematical statistics are used to analyze the effects before and after the activities. Results There are considerable statistical differences in the effects of exercise on the two groups of patients. Conclusion Tai Chi exercise can help young people recover from upper limb sports injuries. Evidence level II; Therapeutic Studies - Investigating the results.

The Most Common Handball Injuries: A Systematic Review

Handball is a team sport involving a great physical demand from its practitioners in which a high number of injuries occur, affecting individual and collective performance. Knowledge of the injuries is of great importance for their prevention. The objective of the present study was to identify, locate and compare the most frequent injuries and injury mechanisms in handball practice. It was carried out following the Preferred Informed Item for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The source of data collection was direct consultation of the PubMed and Medline databases. Several keywords were used for the documentary retrieval, and the quality of the studies that were selected was evaluated. Of the 707 studies retrieved, only 27 were considered appropriate for the review, and quality scores were obtained that ranged from 10 to 26 points, out of a maximum of 28. The most frequent injuries in handball players are located in the lower limbs (thigh, knee and ankle), and in the shoulder in the upper limbs. Regarding the playing position, the players who play over the 6-m line are the most affected by injuries, while the women players have a higher probability of injury. Most injuries occur during competition.

A Scoping Review of Injuries in Amateur and Professional Men’s Ice Hockey

Background:

Orthopaedic injuries are common in ice hockey at all levels and can result in physical and psychological adverse effects on these athletes.

Purpose:

Primarily, to summarize published data on orthopaedic hockey injuries at the junior through professional level. Secondarily, to characterize the literature based on anatomic site injured, return-to-play rates, cause/mechanism of injury, time lost, and treatments used.

Study Design:

Scoping review; Level of evidence, 4.

Methods:

PubMed, EMBASE, Cochrane library, and SCOPUS were searched using the terms “hockey” and “injuries” using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and 4163 studies involving orthopaedic injuries were identified. Our inclusion criteria consisted of accessible full-text articles that evaluated orthopaedic injuries in men’s ice hockey athletes of all levels. We excluded case reports and articles evaluating women’s ice hockey injuries, as well as those evaluating nonorthopaedic injuries, such as concussions; traumatic brain injuries; and facial, dental, and vascular injuries, among others. Studies were divided based on level of play and anatomic site of injury. Level of evidence, year published, country of corresponding author, method of data collection, incidence of injury per athlete-exposure, and time lost were extracted from each article.

Results:

A total of 92 articles met the inclusion criteria and were performed between 1975 and 2020, with the majority published between 2015 and 2020. These were divided into 8 anatomic sites: nonanatomic-specific (37%), intra-articular hip (20.7%), shoulder (9.8%), knee (8.7%), trunk/pelvis (7.6%), spine (7.6%), foot/ankle (6.5%), and hand/wrist (2.2%). Of these studies, 71% were level 4 evidence. Data were obtained mostly via surveillance programs and searches of publicly available information (eg, injury reports, player profiles, and press releases).

Conclusion:

This scoping review provides men’s hockey players and physicians taking care of elite ice hockey athletes of all levels with a single source of the most current literature regarding orthopaedic injuries. Most research focused on nonanatomic-specific injuries, intra-articular hip injuries, knee injuries, and shoulder injuries, with the majority having level 4 evidence.

Risk Factors Based on Analysis of Injury Mechanism and Protective Equipment for Ice Hockey Amateur Players

Considering the increasing popularity of ice hockey in South Korea, types of injuries and protective equipment for amateur club members need to be further studied. The purpose of the study is to investigate various injuries and protective equipment used by amateur players and to analyze different risk factors by collecting information on areas of injury and their mechanisms. The online survey for 102 participants was designed to address the general information of participants, types of injuries, information about ice hockey equipment, and open-ended questions about injuries and equipment. We conducted in-depth face-to-face interviews with five players about their experiences with injury and opinions about the protective equipment. In total, 60% of the survey participants had experienced injuries, including to the knee (22.6%), shoulder (21.6%), ankle (20.6%), and wrist (14.7%), in order of frequency. Types of injury included sprain (33.3%), contusion (31.4%), fracture (17.7%), abrasion (10.8%), and concussion (0.9%). Injury mechanisms included instances in which those with less proficiency in skating would be injured initially from player-to-player contact, and from landing on the ice or crashing into the fence afterward. We acknowledged how important wearing correctly sized equipment is for protection, and we highlighted the need to develop protective gear that accommodates Asian body measurements.

With the exception of the Hill-Sachs interval, CT and MRI show no significant differences in the diagnostic value of the HSL measurement regardless of the measurement technique

PURPOSE

The aim of the current study was to compare the diagnostic precision and reliability of different methods in measuring Hill-Sachs lesions (HSLs) using MRI and CT.

METHODS

A total of 80 consecutive patients with a history of anterior shoulder instability were retrospectively included. The preoperative CT and MRI scans of the affected shoulders were analysed. To investigate the ability of the Franceschi grading, Calandra classification, Richards, Hall, and Rowe grading scale, Flatow percentage and "glenoid track" assessment according to Di Giacomo et al. to quantify the extent of humeral bone loss, the results of each measurement method obtained with MRI were compared with those achieved with CT. In addition, the intra- and inter-rater reliabilities of each measurement method using CT and MRI were calculated and compared.

RESULTS

A significant difference was found between CT and MRI in the determination of the Hill-Sachs interval (HSI) (p = 0.016), but not between the results of any of the other measurement techniques. With the exceptions of the Franceschi grade and Calandra classification, all measurement methods showed good or excellent intra- and inter-rater reliabilities for both MRI and CT.

CONCLUSIONS

While the determination of the HSI with MRI was more accurate, all other analysed techniques for measuring the amount of humeral bone loss showed similar diagnostic precision. With regard to the intra- and inter-rater reliabilities, all measurement techniques analysed, with the exception of the Franceschi and Calandra classifications, provided good to very good reliabilities with both CT and MRI.

LEVEL OF EVIDENCE

III.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Ice Hockey: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association (NCAA) has sponsored women's ice hockey championships since 2001, and sponsorship has grown over time.

BACKGROUND

Routine examinations of injuries sustained by athletes are important for identifying and understanding patterns that can be used to inform sport safety practices.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program from 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 5.89 per 1000 athlete-exposures; preseason injury incidence rose sharply during 2016-2017 through 2018-2019. Head/face injuries (15.2%), knee injuries (13.2%), and shoulder injuries (12.9%) were the most commonly injured body parts, and injuries were most often classified as contusions (18.9%), strains (18.7%), and sprains (15.5%). Concussion (11.9%) was the most commonly reported specific injury, and concussion rates notably increased during 2017-2018 through 2018-2019.

SUMMARY

Study findings were generally consistent with the existing epidemiological evidence. Injury incidence in preseason and the etiology of strains warrant further attention in this population.

The Use of Wearable Sensor Technology to Detect Shock Impacts in Sports and Occupational Settings: A Scoping Review

Shock impacts during activity may cause damage to the joints, muscles, bones, or inner organs. To define thresholds for tolerable impacts, there is a need for methods that can accurately monitor shock impacts in real-life settings. Therefore, the main aim of this scoping review was to present an overview of existing methods for assessments of shock impacts using wearable sensor technology within two domains: sports and occupational settings. Online databases were used to identify papers published in 2010-2020, from which we selected 34 papers that used wearable sensor technology to measure shock impacts. No studies were found on occupational settings. For the sports domain, accelerometry was the dominant type of wearable sensor technology utilized, interpreting peak acceleration as a proxy for impact. Of the included studies, 28 assessed foot strike in running, head impacts in invasion and team sports, or different forms of jump landings or plyometric movements. The included studies revealed a lack of consensus regarding sensor placement and interpretation of the results. Furthermore, the identified high proportion of validation studies support previous concerns that wearable sensors at present are inadequate as a stand-alone method for valid and accurate data on shock impacts in the field.

Epidemiology of injuries in female and male senior Slovenian handball leagues

BACKGROUND

Handball is associated with a high frequency of injuries due to unexpected situations, external disturbances of movement and extreme positions of body segments. The purpose of this study was to identify and analyze injuries among female and male players from all five senior Slovenian handball leagues in the season 2010/2011.

METHODS

We conducted a retrospective epidemiological study using a questionnaire. Data were collected between February and May 2012. Descriptive analysis is provided.

RESULTS

Forty-five percent of all the players were injured, reporting 92 injuries. 0.58 injuries/player occurred, 57 (62%) in females and 35 (38%) in males. Injury incidence in females (27.7 injuries/1000 hours match, 0.97 injuries/1000 hours training) was higher than in men (10.6 injuries/1000 hours match, 0.5 injuries/1000 hours training), respectively. The left- and right-back players were injured most often (41%). Sprain was the most common injury type (55%). Most injuries were severe (29%). The lower limb was injured most frequently (62%). Ankle was injured the most commonly (35%), but ankle injuries were in most cases moderate (38%). More than 70% of knee injuries and 50% of shoulder injuries were severe. In 33%, cause of injury was contact with an opponent/teammate. Thirty-six percent of players reported shoulder and 36% ankle overuse syndromes.

CONCLUSIONS

Present findings showed a higher incidence of injuries in female than in male senior Slovenian handball players in the 2010/2011 season. Preventive programs should focus not only on the acute ankle and knee injuries, but also on overuse syndromes of the shoulder and ankle.

Nationwide sports injury prevention strategies: A scoping review

National strategies to prevent sports injuries can potentially improve health outcomes at a population level and reduce medical costs. To date, a compilation of the strategies that countries have attempted, and their effectiveness, does not exist. This scoping review sets out to: identify nationwide attempts at implementing sports injury prevention strategies; examine the impact of these strategies; and map them onto the Translating Research into Injury Prevention Practice (TRIPP) framework. Using Levac's scoping review method, we: (a) identified the research questions, (b) identified relevant studies, (c) identified the study selection criteria, (d) charted the data, and (e) reported the results. A search of MEDLINE, Scopus, SPORTDiscus, CINAHL, and Web of Science databases for articles published pre-June 2019 was conducted. We identified 1794 studies and included 33 studies (of 24 strategies). The USA (n = 7), New Zealand (n = 4), Canada (n = 3), the Netherlands (n = 3), Switzerland (n = 2), Belgium (n = 1), France (n = 1), Ireland (n = 1), South Africa (n = 1), and Sweden (n = 1) have implemented nationwide sports injury prevention strategies with 29 (88%) of the included studies demonstrating positive results. Mapping the strategies onto the TRIPP framework highlighted that only four (17%) of the 24 included strategies reported on the implementation context (TRIPP Stage 5), suggesting an important reporting gap. Nationwide sports injury prevention efforts are complex, requiring a multidimensional approach. Future research should report intervention implementation data; examine the implementation context early in the research process to increase the likelihood of real-world implementation success; and could benefit from incorporating qualitative or mixed research methods.

Injury Risk in New Zealand Rugby Union: A Nationwide Study of Injury Insurance Claims from 2005 to 2017

Objectives

The Accident Compensation Corporation is a compulsory, 24-h, no-fault personal injury insurance scheme in New Zealand. The purpose of this large-scale retrospective cohort study was to use Accident Compensation Corporation records to provide information about rugby injury epidemiology in New Zealand, with a focus on describing differences in risk by age and gender.

Methods

A total of 635,657 rugby injury claims were made to the Accident Compensation Corporation for players aged 5–40 years over the period 2005–2017. Information about player numbers and estimates of player exposure was obtained from New Zealand Rugby, the administrative organisation for rugby in New Zealand.

Results

Over three quarters of claims (76%) were for soft-tissue injuries, with 11% resulting from fractures or dislocations, 6.7% from lacerations, 3.1% from concussions and 2.0% from dental injuries. Body regions injured included shoulder (14%), knee (14%), wrist/hand (13%), neck/spine (13%), head/face (12%), leg (11%) and ankle (10%). The probability of a player making at least one injury claim in a season (expressed as a percentage) was calculated under the assumption that the incidence of claims follows a Poisson distribution. Players aged 5–6 years had a probability of making at least one claim per season of 1.0%, compared to 8.3% for players aged 7–12 years, 35% for age 13–17 years, 53% for age 18–20 years, 57% for age 21–30 years and 47% for age 31–40 years. The overall probability of making at least one claim per season across all age groups was 29%. The relative claim rate for adults (players aged 18 years and over) was 3.92 (90% confidence interval 3.90–3.94) times that of children. Ten percent of players were female, and they sustained 6% of the injuries. Overall, the relative claim rate for female players was 0.57 times that of male players (90% confidence interval 0.56–0.58). The relative claim rate of female to male players tended to increase with age. There were very few female players aged over 30 years; however, those who did play had higher claim rates than male players of the same age group (1.49; 90% confidence interval 1.45–1.53).

Conclusions

Injuries resulting from rugby are distributed across the body, and most of the claims are for soft-tissue injuries. Rates of injury increase rapidly through the teenage years until the early 20 s; for male players they then decrease until the mid-30 s. For female players, the injury rate does not decrease as players move into their 30 s. Combining Accident Compensation Corporation injury claim data with national player registration data provides useful information about the risks faced by New Zealand’s community rugby players, and the insights derived are used in the development of rugby injury prevention programme content.

Electronic supplementary material

The online version of this article (10.1007/s40279-019-01176-9) contains supplementary material, which is available to authorized users.

The 9+ screening test score does not predict injuries in elite floorball players

We aimed to examine whether the 9+ screening test score could predict injuries in elite floorball players. Eighty-four elite floorball players participated in the study. At baseline, two physiotherapists assessed the participants using the 9+ screening test. The test score reflects strength, stability, mobility, and functional movement pattern with an emphasis on the lower body and core. Injuries that occurred the following season (2013/2014) were recorded by medical staff, coaches, and/or self-reported by the players. Overall, there was no relationship between the 9+ screening test score and injury risk (OR = 0.96 per SD lower test score, P = .84). We, therefore, conclude that the 9+ screening test is not suited for overall injury risk prediction in elite floorball players. Whether the test may be used to predict risk of certain injury types more strongly related to inadequate mobility and strength (eg, muscle ruptures or strains) warrants further investigation.

Epidemiology of Foot Injuries Using National Collegiate Athletic Association Data From the 2009-2010 Through 2014-2015 Seasons

CONTEXT

Researchers analyzing data from the National Collegiate Athletic Association Injury Surveillance Program have not considered the differences in foot injuries across specific sports and between males and females.

OBJECTIVE

To describe the epidemiologic differences in rates of overall foot injuries and common injuries among sports and between sexes.

DESIGN

Descriptive epidemiology study.

SETTING

Online injury-surveillance data from 15 unique sports involving males and females that demonstrated 1967 injuries over 4 821 985 athlete-exposures.

PATIENTS OR OTHER PARTICIPANTS

Male and female athletes competing in National Collegiate Athletic Association sports from the 2009-2010 through 2014-2015 seasons.

MAIN OUTCOME MEASURE(S)

Foot injury rates (per 10 000 athlete-exposures) and the proportion of foot injuries were calculated for each sport. The effect of sex was calculated using Poisson-derived confidence intervals for 8 paired sports. A risk analysis was performed using a 3 × 3 quantitative injury risk-assessment matrix based on both injury rate and mean days of time loss.

RESULTS

Foot injury rates differed between sports, with the highest rates in female gymnastics, male and female cross-country, and male and female soccer athletes. Cross-country and track and field had the highest proportions of foot injuries for both female and male sports. The 5 most common injuries were foot/toe contusions, midfoot injuries, plantar fascia injuries, turf toe, and metatarsal fractures. Only track and field athletes demonstrated a significant sex difference in injury rates, with female athletes having the higher rate. The quantitative injury risk-assessment matrix identified the 4 highest-risk injuries, considering both rate and severity, as metatarsal fractures, plantar fascia and midfoot injuries, and foot/toe contusions.

CONCLUSIONS

Important differences were present among sports in terms of injury rates, the most common foot injuries, and the risk (combination of frequency and severity) of injury. These differences warrant further study to determine the mechanisms of injury and target intervention efforts.