Review
Foot and Ankle Injuries in Professional Soccer PlayersFuß- und Sprunggelenk-Verletzungen im professionellen Fußball

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Abstract

Soccer is a physically demanding and highly competitive sport with a high rate of injuries. The foot and the ankle joint are especially at danger. Risk factors of foot and ankle injuries in soccer players are: lack of structured warm up training, neuromuscular deficits, inadequate training, chronic fatigue, previous injuries, foul play, artificial turf, and others. While the most common injury is the ankle sprain, complex injuries like fractures, ligament tears, and cartilage damage can occur. Such injuries have a high impact on the player's career. Professional soccer players are pressured to meet the expectations of the clubs, and the public. While most injuries to the foot and ankle joint can be treated conservatively, complex injuries require anatomic reconstruction to allow for quick rehabilitation and return to play earliest possible.

Zusammenfassung

Fußball stellt eine hohe Anforderung an den Bewegungsapparat, ist sehr kompetitiv und weist eine hohe Verletzungsrate auf. Der Fuß und das Sprunggelenk sind besonders verletzungsanfällig. Risikofaktoren für Fuss- und Sprunggelenk-Verletzungen im Fußball sind: Fehlen eines strukturierten Aufwärmtrainings, neuromuskuläre Defizite, inadäquates Training, chronische Ermüdung, vorangehende Verletzungen, Fouls, Kunstrasen u.a. Die häufigste Verletzung ist mit Abstand das Distorsionstrauma des oberen Sprunggelenkes. Komplexe Verletzungen mit Frakturen, ligamentären Verletzungen, und Knorpelschäden können auftreten. Solche Verletzungen haben einen großen Einfluss auf die Karriere des Fußballers, da er sowohl den Erwartungen der Medien als auch der Vereine gerecht werden muss. Ein Großteil der Verletzungen kann konservativ behandelt werden. Bei komplexen Verletzungen ist ein operativer Eingriff oft unumgänglich. Das Ziel ist eine zügige Rehabilitation mit der baldigen Rückkehr in den Wettkampfsport.

Introduction

Soccer is a high demand team sport involving constantly changing complex movement patterns. Walking, running, and sprinting, sudden changes in direction, jumping, and body contact require a high grade of coordination and body control. With roughly 200.000 professional soccer players and around 240 million amateur soccer players, soccer is a game with worldwide appeal. However, with rising popularity, the incidence of injuries is increasing. The game presents a wide variety of musculoskeletal problems to the sports physician and orthopaedic surgeon. Especially the lower extremity with the ankle and foot, knee, and thigh is prone to injuries [1]. The high injury rate among soccer players in general and female players in particular constitutes a considerable problem for the player, the team, the club, and given the popularity of for society at large. Health consequences are seen not just in the short term but also in the dramatic increase in the risk of career break and early problems, as osteoarthritis. Foot and ankle account for most of the injuries in soccer players [2].

Section snippets

Who is at risk?

Soccer is a widely popular sport, with participants being women and men of all age groups and skill levels. Overall, soccer injuries are more frequent with higher age of the participants, while incidence of injury in preadolescent players is low [3]. The incidence of injuries during practice is lower than during competition (1:2) [4]. Amateur soccer players have less injuries then professional soccer players [1].

What is at risk?

The most common site of injury in soccer player is the lower extremity. Breaking it

Ankle Sprains

Ankle sprains account for 40% of all sport injuries and 80% of all soccer injuries [12]. Around 85% of all ankle sprains are due to an inversion trauma with the foot in various degrees of plantar flexion. The ligaments most commonly involved are the anterior talofibular (ATFL) and calcaneal fibular ligament (CFL). Ankle joint stability has a mechanical and postural component. Ligament integrity is responsible for mechanical stability of the ankle joint. Functional stability is maintained by

Prevention

Prevention measures are needed not only to prevent acute injuries, but also long term effects of injuries, like osteoarthritis [34]. Important prerequisites for preventing injuries is a structured warm up training (FIFA 11+ program) [35] and professional coaching [36]. Shooting exercises can lead to muscle strains, if adequate warm up is not performed [7]. Athletes starting playing soccer in a club before the age of six years, are less prone to injuries. Players with long careers are usually

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