Epidemiology of Foot and Ankle Injuries in NCAA Jumping Athletes in the United States from 2009-2014

Objectives: The purpose of this study was to describe the epidemiology of foot and ankle injuries in men’s and women’s NCAA basketball, women’s volleyball, and women’s gymnastics during the 2009-2010 through 2013-2014 seasons.Methods: Injury surveillance data was obtained from the NCAA Injury Surveillance Program (ISP) for the 2009-2010 through 2013-2014 seasons. Injuries were examined by mechanism, activity during injury, participation restriction time, and recurrence. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs), and risk ratios (RR) with 95% confidence intervals were calculated. Reported sex differences were calculated for men’s and women’s basketball. All 95% confidence intervals not containing 1.0 were considered statistically significant.Results: During the study period, 1136 players sustained foot and ankle injuries (483 male, 653 female) over 612,680 AEs. In total, these injuries resulted in a combined rate of 1.85/1000 athlete-exposures (AEs; 95% CI 1.75 -1.97). Ankle sprains were the most common injury overall (63.7%), with lateral ligamentous complex (LLC) injuries comprising 77.1% of all ankle sprains. The most common foot injury varied based on sport and sex. Ankle injury rates were higher in male vs female basketball players (IRR=1.33, 95% CI 1.13 -1.57), but foot injury rates did not differ. Foot injuries occurred at half the rate of ankle injuries, but were significantly more likely to be severe (time loss over 30+ days) (IRR=3.37, 95% CI 1.91-5.949). Among basketball and volleyball athletes, player contact was the most common mechanism of injury and occurred most often while engaging in team jumping activities (rebounding, shooting, blocking, spiking). Surface contact was the most common mechanism in gymnasts. Female gymnasts had higher chronic injury rates than all other sports examined (0.485/1000 AEs, 0.304-0.735, p<0.002). Overall, female basketball players were 1.98 times more likely to suffer an overuse injury than male athletes (95% CI 1.14-3.45, p=0.005).Conclusion: Athletes participating in jumping sports have a higher rate of lateral ligamentous complex ankle sprains than other NCAA sports. Deterring player contact during jumping and landing by way of coaching and/or rule changes may reduce injury rates and improve player safety. The increased prevalence of chronic injuries in female collegiate athletes competing in jumping sports necessitates further investigation in order to identify opportunities to reduce injury rates through prevention and training programs.Injury counts, percentages and rates per 1000 athlete-exposures (AEs) by diagnosis and event type.Men’s Basketball Women’s BasketballDiagnosis n (%) Rate (95% CI) % NTL % Severe % Acute % Chronic n (%) Rate (95% CI) % NTL % Severe % Acute % ChronicAnkleOverallLocal 350 (100.0) † 1.62 (1.46, 1.80) 44.9 1.4 98.9 1.1 238 (100.0) 1.22 (1.07, 1.39) 47.5 2.9 99.6 0.4LLC Sprain 275 (78.6) † 1.27 (1.13, 1.43) 44.0 0.4 99.6 0.4 198 (83.2) 1.02 (0.88. 1.17) 49.5 1.5 100.0 0.0Deltoid Sprain 34 (9.7) 0.16 (0.11, 0.22) 55.9 † 0.0 100.0 0.0 18 (7.6) 0.09 (0.05, 0.15) 33.3 0.0 100.0 0.0Syndesmotic Sprain 18 (5.1) 0.08 (0.05, 0.13) 50.0 0.0 100.0 0.0 7 (2.9) 0.04 (0.01, 0.07) 71.4 0.0 100.0 0.0Ankle Contusion 6 (1.7) 0.03 (0.01, 0.06) 33.3 16.7 66.7 33.3 3 (1.3) 0.02 (0.00, 0.04) 33.3 0.0 100.0 0.0Fracture 3 (0.9) 0.01 (0.00, 0.04) 0.0 66.7 100.0 0.0 3 (1.3) 0.02 (0.00, 0.04) 0.0 100.0 100.0 0.0Other Ankle Injury 17 (4.9) 0.08 (0.05, 0.13) 42.9 7.1 92.9 7.1 12 (5.0)) 0.06 (0.03, 0.11) 33.3 11.1 88.9 11.1FootOverallTotal 133 (100.0) 0.62 (0.52, 0.73) 65.4 10.5 85.7 † 14.3 101 (100.0) 0.32 (0.42, 0.63) 68.3 8.9 69.3 30.7¶Foot/Toe Contusion 18 (13.5) 0.08 (0.05, 0.13) 61.1 0.0 88.9 11.1 11 (10.9) 0.06 (0.03, 0.10) 90.9 0.0 100.0 0.0Midfoot Sprain 19 (14.3) 0.09 (0.05, 0.14] 63.2 † 5.3 100.0 0.0 9 (8.9) 0.05 (0.02, 0.09) 55.6 0.0 88.9 11.4Plantar Fasciitis 8 (6.0) 0.04 (0.02, 0.07) 87.5 0.0 37.5 62.5 9 (8.9) 0.05 (0.02, 0.09) 88.9 0.0 33.3 66.7Turf Toe 14 (10.5) 0.06 (0.04, 0.11 ) 78.6 0.0 85.7 † 14.3 5 (5.0) 0.03 (0.01, 0.06) 100.0 0.0 60.0 40.0Plantar Fascia Strain 8 (6.0) 0.04 (0.02, 0.07) 75.0 0.0 75.0 25.0 5 (5.0) 0.03 (0.01, 0.06) 60.0 20.0 60.0 40.0Fracture 21 (15.8) 0.10 (0.06, 0.15) 60.6 19.7 90.5 9.5 11 (10.9) 0.06 (0.03, 0.10) 61.3 12.9 81.8 18.2Other Foot Injury 45 (33.8) 0.21 (0.15, 0 28) 75.6 2.2 86.7 13.3 51 (50.5) 0.26 (0.19, 0.34) 72.6 3.9 64.7 35.3¶Women’s Volleyball Women’s GymnasticsDiagnosis n (%) Rate (95% CI) % NTL % Severe % Acute % Chronic n (%) Rate (95% CI) % NTL % Severe % Acute % ChronicAnkleOverallLocal 127 (100.0) 0.81 (0.68, 0.96) 39.4 3.9 99.2 0.8 75 (100.0) 1.65 (1.30, 2.07) 54.7 5.3 88.0 12.0LLC Sprain 105 (82.7) 0.67 (0.55, 0.81) 41.0 2.9 99.0 1.0 31 (41.3) 0.68 (0.46, 0.97) 38.7 3.2 100.0 0.0Deltoid Sprain 4 (3.2) 0.03 (0.01, 0.07) 50.0 0.0 100.0 0.0 12 (16.0) 0.26 (0.14, 0.46) 33.3 8.3 100.0 0.0Syndesmotic Sprain 9 (7.1) 0.06 (0.03, 0.11) 11.1 11.1 100.0 0.0 4 (5.3) 0.09 (0.02, .023) 75.0 0.0 75.0 25.0Ankle Contusion 1 (0.8) 0.01 (0.00, 0.04) 100.0 0.0 100.0 0.0 4 (5.3) 0.09 (0.02, 0.23) 100.0 0.0 100.0 0.0Fracture 1 (0.8) 0.01 (0.00, 0.04) 0.0 100.0 100.0 0.0 3 (4.0) 0.07 (0.01, 0.19) 33.3 66.7 66.7 33.3Other Ankle Injury 7(5.5) 0.04 (0.02, 0.09) 42.9 0.0 100.0 0.0 21 (28.0) 0.46 (0.29, 0.71) 81.0 0.0 66.7 33.3FootOverallTotal 60 (100.0) 0.38 (0.29, 0.49) 68.3 3.3 68.3 31.7 52 (100.0) 1.15 (0.86, 1.50) 59.6 11.5 75.0 25.0Foot/Toe Contusion 2 (3.3) 0.01 (0.00, 0 05) 50.0 0.0 100.0 0.0 14 (26.9) 0.31 (0.17, 0.52) 78.6 7.1 100.0 0.0Midfoot Sprain 9 (15.0) 0.06 (0.03, 0.11) 66.7 0.0 88.9 11.1 4 (7.7) 0.09 (0.02, 0.23) 100.0 0.0 50.0 50.0Plantar Fasciitis 5 (8.3) 0.03 (0.01, 0.07) 80.0 0.0 0.0 100.0 3 (5.8) 0.07 (0.01, 0.19) 100.0 0.0 0.0 100.0Turf Toe 3 (5.0) 0.02 (0.00, 0.06) 100.0 0.0 100.0 0.0 3 (5.8) 0.07 (0.01, 0.19) 33.3 0.0 100.0 0.0Plantar Fascia Strain 3 (5.0) 0.02 (0.00, 0.06) 100.0 0.0 33.3 66.7 1 (1.9) 0.02 (0.00, 0.12) 100.0 0.0 100.0 0.0Fracture 9 (15.0) 0.06 (0.03, 0.11) 63.2 5.3 55.6 44.4 8 (15.4) 0.18 (0.08, 0.35) 40.7 18.5 62 5 37.3Other Foot Injury 29 (48.3) 0.19 (0.12, 0.27) 75.9 0.0 75.9 24.1 19 (36 5) 0.42 (0.25, 0.65) 57.9 10.5 73.7 26.3Data originate from the Datalys Center for Sports injury Research and Prevention Injury Surveillance Program, 2009/2010-2013/2014.†Men versus women Injury rate ratio >1.00 and does not include 1.00 in the 95% CI.¶Women versus men injury rate ratio >1.00 and does not include 1 00 in the 95% CI.