Recovery from injury for athletes is a multifaceted process that requires physiologic healing of the injury and psychological readiness. Although the individual injury will dictate the terms of healing and different injuries require different recoveries, healing or near-healing of the orthopaedic injury is the first step along the path of return to play. Return to play encompasses a range of milestones that often begin with a limited return to the practice field and end with return to full competition in an unlimited manner. Optimizing the psychology of recovery can allow for a more linear recovery and help to remove some potential impediments. The orthopaedic surgeon ultimately works with a team of clinicians, including physical therapists and athletic trainers, to work toward returning an athlete to a maximal level of performance.

Following a lateral ankle sprain, chronic ankle instability (CAI) subjects show recurrent episodes of giving way, while copers do not exhibit giving way and overcome the challenging condition of postural control. During gait initiation (GI), individuals with CAI reveal shorter center of pressure (COP) displacement and earlier muscle activity compared with healthy controls. Copers have not been previously compared with healthy controls and individuals with CAI during GI. The study design was cross-sectional. Sixty participants (20 CAI, 20 copers, and 20 healthy controls) with a right (dominant) limb injury participated in the study based on inclusion and exclusion criteria. The short form of the Tampa Scale of Kinesiophobia was filled out. Participants performed GI with the nonaffected leg on the force plate that was synchronized with Electromyography Megawin for 2 strides. GI was divided into 3 phases based on COP excursion (S1, S2, and S3). Onset time and electromyography activity of both soleus and tibialis anterior muscles were analyzed along with maximum and mean excursion and velocity of COP excursion in the anterior-posterior and medial-lateral directions and the total phases of GI. The results indicated that the copers had a significantly higher peak of COP excursion in the medial-lateral direction during S2 (P = .029), S3 (P = .018), and total phases (P = .018) of GI compared with the individuals with CAI. Additionally, individuals with CAI showed earlier activation of the right soleus compared with healthy controls (P = .022). There was a significant difference in short form of the Tampa Scale of Kinesiophobia scores between individuals with CAI and other groups (P < .001). The findings demonstrated that individuals with CAI had earlier soleus activation and supraspinal alteration compared with controls. Copers who had lower Tampa Scale of Kinesiophobia scores exhibited an increased peak of COP excursion in the medial-lateral direction during GI compared with individuals with CAI.

Hip muscle function has been reported to be altered in individuals with chronic ankle instability (CAI). The purpose of this study was to determine whether the single-leg squat test (SLST) could be used to detect differences in proximal muscle activation between individuals with and without CAI and to determine if there were differences in strength of the hip lateral rotators, extensors, and abductors between individuals with and without CAI. A case-control study design was used to compare hip muscle activation and strength during the SLST between individuals with CAI, lateral ankle sprain copers, and healthy controls. Forty-eight participants (14 males, 34 females; median age = 22.00y) participated in this study. Participants were separated into CAI (n = 18), coper (n = 15), and control (n = 15) groups based on published criteria. Surface electromyography was used to measure muscle activation of the gluteus maximus and gluteus medius during the SLST. Strength of the hip lateral rotators, extensors, and abductors was measured using handheld dynamometry and quantified using maximum isometric body weight normalized torque. The CAI group utilized significantly more gluteus maximus muscle activation during the SLST than both the coper (P < .001) and control (P < .001) groups. The CAI group had weaker hip lateral rotators when compared with the coper (P = .001) and control (P < .001) groups, and weaker hip extensors strength when compared with the control group (P < .001). The results support existing literature demonstrating that there are proximal neuromuscular changes in individuals with CAI and suggest that the SLST has potential for use as a clinical measure of gluteus maximus activation in individuals with CAI. Further study is needed to determine whether the differences in activation are clinically detectable.

To investigate how physiotherapists approach lateral ankle sprain (LAS) rehabilitation and their rationale for exercise progression. We also sought to determine typical exercise dosage prescribed and the extent to which they rely on objective outcomes for guiding rehabilitation progression and return-to-sports decisions. We distributed an online survey using Qualtrics. The survey comprised a combination of 23 open and 8 closed questions to capture data on: participant demographics and clinical experience, typical caseload, LAS rehabilitation dosage, with clinical vignettes used to determine the time taken to reach key rehabilitation milestones, use of objective markers to inform rehabilitation progress, and progression to each milestone. Data were analyzed descriptively; open questions were inventoried and categorized. Proportions were then calculated per category. Ninety-six physiotherapists from Belgium, the Netherlands, and the United Kingdom responded to the survey, of which 23 completed all sections. On average, less than half (46%) of the responding therapists use objective measurements to guide rehabilitation progress. The estimated time to reach key clinical milestones is equivocal among participating physiotherapists. Most physiotherapists use pain and ankle impairments (eg,range of motion and muscle strength) to guide rehabilitation progress. This study indicates that progress in LAS rehabilitation is determined subjectively and that not the entire spectrum of impairments is assessed. Physiotherapists should implement more objective measures throughout LAS rehabilitation.

Clinical assessments are valid to grade ligament injury severity compared to ultrasound imaging in patients with acute lateral ankle sprains: a cross-sectional study.

Surgical intervention yields superior results over conservative management in calcaneal-side calcaneofibular ligament rupture.

Aim: The aim of this study was to determine the frequency, types, and injury regions of sports injuries among licensed male and female football referees working in the 8th Region of the Turkish Football Federation. Methods: This research was conducted using a cross-sectional survey model. The study group consisted of 130 volunteer football referees aged between 18 and 41 years. Data were collected through two different questionnaires administered via face-to-face interviews, and the analyses were performed using the SPSS 26.0 software. Results: According to the findings, the most common type of injury was muscle injuries. These were followed by knee and ankle sprains. It was determined that most injuries were concentrated in the lower extremities. In addition, statistically significant differences were found between refereeing experience and age, as well as injury frequency. The injury rate among male referees was higher than that among female referees, and this difference was statistically significant. Conclusion: It was concluded that most sports injuries among football referees occur due to physical strain and sudden movements during matches. Therefore, proper physical preparation and preventive exercise programs play an important role in reducing the risk of injuries.

Foot and ankle biomechanics play a central role in soccer performance, influencing stability, movement efficiency, and injury susceptibility. Although numerous structural and functional assessment tools exist, the literature lacks an integrated synthesis that evaluates these tests collectively in relation to injury mechanisms and sport-specific demands. This narrative review aims to critically examine commonly used biomechanical assessments—including FPI-6, Navicular Drop Test, Hallux Valgus Angle, plantar pressure analysis, CAIT, FAAM, weighted dorsiflexion ROM, and tibial torsion measurements—and to highlight their relevance for identifying risk factors in soccer players. Evidence indicates that structural abnormalities such as pes planus, subtalar overpronation, and hallux valgus alter plantar pressure distribution and increase the likelihood of overuse injuries, ankle sprains, and chronic instability. Functional measures including CAIT and FAAM provide complementary insight into ankle instability and sport-related performance limitations. By synthesizing current findings, this review underscores the need for comprehensive, multi-dimensional assessment strategies that support individualized training and injury-prevention programs in soccer.Keywords: Choronic Ankle Instability, CAIT, FAAM, FPI-6, Plantar Pressure, Soccer Biomechanics.

Chronic ankle instability (CAI) can develop in up to 40% of patients after a first-time ankle sprain. Advanced imaging and statistical shape modeling (SSM) provide the opportunity to evaluate if subtle differences in foot and ankle morphology, such as hindfoot alignment or cavus features, may contribute to structural predispositions for recurrent instability. In this study, a 14-bone SSM was created from weight-bearing CT data (n = 80) from patients with CAI (n = 23), cavus foot type (n = 29), and rectus (n = 28) foot type. Scans for the CAI group were from pre-operative imaging of patients undergoing surgical stabilization. Meary's angle (MA), hindfoot ankle alignment (HAA), and calcaneal inclination were measured for each scan using in-house code. Principal component analysis revealed that arch height (Mode 1, 36.9% of the variance) statistically distinguished the CAI and cavus groups from the rectus group. Minimal differences were observed between the CAI and cavus groups, with only Mode 5 (4.47% variance, = 0.09) separating the groups and Hotelling's T2 confirming minimal variation (~2% of particles). Radiographic measurements supported these findings with higher MA in CAI (12°) and cavus (17°) versus rectus (0.2°), and varus HAA in CAI (6.0°) and cavus (5.9°) compared to rectus (9.8°). Individuals with CAI demonstrated cavus-like morphology, indicating that bony alignment may be a structural contributor to recurrent instability. Clinically, these findings enhance our understanding that foot alignment plays a role in CAI. Surgical correction, when clinically appropriate, may need to address both osseous deformities and soft tissue laxity to improve stability. Level III Orthopedic Research Society.

Effects of TECAR Therapy Combined with Therapeutic Exercises on Acute Ankle Sprain: A Randomized Controlled Trial

Background: Ankle sprains are one of the most frequent ligament injuries in elite sports. Despite their high incidence, current rehabilitation approaches are often based on time-based criteria and neglect the physiological status of the injured tissues. Infrared thermography (IRT) is a non-invasive tool useful for detecting temperature asymmetries related to inflammation and tissue dysfunction. This study aimed to analyze the temporal evolution of ankle temperature asymmetry during return-to-play (RTP). Methods: A retrospective observational study of 26 ankle injuries analyzed with thermography that met the inclusion criteria. Thermograms were processed with a software to calculate temperature asymmetry in the ankle region of interest (ankleROI). Statistical analyses included paired and one-sample t-tests, as well as linear regression models, to assess temporal changes throughout the RTP process. Results: A significant hyperthermic response was observed immediately after injury (Δ = +0.594 °C; p < 0.001, Cohen’s d = 0.918). The first significant asymmetry reduction occurred between 21.5 and 28.5 days post-injury (Δ = −0.488 °C; p = 0.004), with a consistent weekly decrease of −0.109 °C (95% CI [−0.143, −0.078]). These findings indicate a progressive decrease in decrement on thermal asymmetry over approximately four weeks of RTP. Conclusions: IRT demonstrates potential as a physiological monitoring tool during the RTP process after ankle sprains. The observed pattern of temperature recovery provides objective reference thresholds that could complement existing functional and clinical criteria.

Radiation exposure, transition delays and costs associated with unnecessary imaging in children have stimulated research into clinical decision rules and other interventions to reduce imaging in the emergency department (ED). The objective of this systematic review is to examine the effectiveness of implementing interventions to reduce imaging in children with upper/lower extremity injuries in the ED. Seven databases and the grey literature were searched up to May 2024. Comparative studies assessing interventions to reduce imaging in children with upper/lower extremity injuries implemented in the ED were eligible. Two independent reviewers screened for study eligibility, quality assessment and data extraction, with disagreements settled via third-party adjudication. Changes in imaging are reported as ORs with 95% CIs, using a random effects model. From 9387 citations, eight unique studies enrolling 7793 children were included with the majority using a before-after design. Potential concerns for bias were documented due to a lack of reporting of key quality domains. Decision rules for ankle injuries successfully reduced radiography (OR=0.11; 95% CI 0.07 to 0.16, I2=38%). A decision rule for wrist injuries reduced imaging (OR=0.06; 95% CI 0.03 to 0.11); however, eight injuries were missed. Two studies implementing clinical guidelines reported decreases in radiographs per patient (p<0.001). One trial reported increased imaging in children assessed by triage nurses using an established clinical decision rule (OR=5.44; 95% CI 2.96 to 10.02), with 16 missed injuries identified. Guidelines incorporating clinical decision rules, particularly decision rules for ankle injuries, can reduce radiography for children with extremity injuries in the ED. Further investigations are warranted to identify other extremity injuries, the components of the intervention and the most efficient clinicians to target. CRD42016042875.

In the osteochondral autograft transfer system (OATS) procedure, a wide accessible area is required to introduce the femoral plug at varying angles. This may not always be achievable with a simple arthrotomy using anteromedial, posteromedial, or anterolateral approaches. The aim of this case presentation was to describe the use of an anterior chevron-type tibial osteotomy as a technical approach for treating a centrolateral osteochondral lesion of the talus (OLT) with the OATS technique. We present a case of a 48-year-old female patient with a history of chronic right ankle pain following an ankle sprain 32 years ago. The anterior osteotomy was performed with dimensions of ∼3 cm in width, 2 cm in depth, and 4 cm in height. After removing the anterior tibial bone block, we identified and debrided the OLT. The lesion site was prepared using a trephine, and a bone plug obtained from the lateral femoral trochlea was inserted, congruent with the surrounding articular cartilage. Finally, the temporarily removed anterior tibial bone block was reattached and secured with 3 cannulated screws. At the 44-month follow-up, the patient was asymptomatic and fully active. Level of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence.

Badminton is widely practiced among university students in China and provides substantial benefits for physical fitness, coordination, and social interaction, yet its high-intensity movements—including rapid direction changes and repetitive overhead strokes—also increase the risk of sport-related injuries. This study investigated the prevalence, causes, mechanisms, and preventive practices related to badminton injuries among students at XX College, Hohhot, Inner Mongolia, China. Using a cross-sectional survey design, 200 regular badminton participants completed a structured questionnaire covering demographic information, training habits, warm-up and prevention behaviors, injury history, perceived risk factors, and injury-prevention knowledge. Descriptive statistical analysis revealed a high prevalence of lower-limb injuries, particularly ankle sprains, muscle strains, and overuse conditions. Key contributing factors included inadequate warm-up, poor technique, fatigue, and inappropriate footwear, while students identified warm-up routines, strengthening exercises, and improved technique as important but insufficiently implemented prevention strategies. Many participants expressed the need for more formal education on injury prevention. Overall, the findings indicate that badminton-related injuries among college students are common yet highly preventable, highlighting the importance of strengthening warm-up practices, improving technical guidance, addressing fatigue, and promoting proper footwear use within university physical education programs.

&amp;lt;i&amp;gt;Background:&amp;lt;/i&amp;gt; Sports related injuries are a significant concern in football, affecting players’ performance, career longevity, and wellbeing. At Gore Football Club, the prevalence causes, and consequences of injuries, as well as rehabilitation practices and psychosocial support mechanisms, remain underexplored. &amp;lt;i&amp;gt;Objective:&amp;lt;/i&amp;gt; This study aimed to (1) Identify the most common types of sports-related injuries among players at Gore Football Club and their primary causes; (2) examine how injuries impact physical, technical, tactical, and psychological aspects of performance; (3) evaluate the rehabilitation and injury management practices in place and their effectiveness; and (4) explore the role of psychological and social support systems in the recovery and return-to-performance process. &amp;lt;i&amp;gt;Methods:&amp;lt;/i&amp;gt; A mixed-methods approach was used. Quantitative data were collected from 25 players via structured questionnaires and performance metrics (pre and post injury). Descriptive statistics summarized injury types, causes, and perceived impacts. Inferential statistics (Fisher’s Exact Test, paired?t tests) examined associations and differences. Qualitative data from interviews with injured players, coaches, and support staff were analyzed using thematic analysis to identify key themes in rehabilitation experiences and psychosocial support. &amp;lt;i&amp;gt;Results:&amp;lt;/i&amp;gt; The most frequently reported injuries were ankle sprains (40%) and hamstring strains (28%), with overtraining, inadequate warm up, and poor pitch conditions emerging as primary causes. Fisher’s Exact Test showed a significant association between ankle sprain and reporting overtraining (p ≈ 0.02). Paired comparisons of sprint performance indicated a statistically significant decline post-injury (mean increase in sprint time = 0.30 s; t (24) = 5.20, p &amp;lt; 0.001, Cohen’s d = 1.04). Among rehabilitation methods, physiotherapy was most used (80%) and significantly associated with higher perceived effectiveness (p ≈ 0.03). Although psychological support was available for 60% of players, only 48% utilized it; utilization did not show a statistically significant link to perceived rehabilitation success, but qualitative insights highlighted its value in motivation, confidence, and mental recovery. Strong social support from teammates and coaches was commonly reported. &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; At Gore Football Club, lower-limb injuries especially ankle sprains and hamstring strains prevail, often associated with overtraining and preparation deficits. These injuries produce measurable performance losses, which can be mitigated through structured rehabilitation, particularly physiotherapy. Psychosocial and social support plays a supplementary but meaningful role in recovery, though utilization is suboptimal. The findings underscore the need for integrated injury prevention strategies, structured return-to-play protocols, and strengthened psychological support frameworks in the club. Future research using larger, longitudinal samples and objective performance measures is recommended.

Abstract Exposure to cold environments significantly elevates the risk of sports-related foot and ankle injuries. Low temperatures induce stiffness in muscles, tendons, and ligaments, reduce tissue elasticity, and diminish overall joint flexibility. At the same time, frozen or hardened ground surfaces heighten impact forces while impairing the body's shock-absorption and adaptive response mechanisms. As a result, injuries such as ankle sprains (ligament tears), tendonitis, and stress fractures become more prevalent. Prevention is therefore essential and should focus on comprehensive warm-up routines, use of thermal and supportive equipment—including ankle braces—selection of footwear with adequate traction, and timely replacement of damp socks after exercise to maintain foot warmth and dryness.

Case Injury is an unfortunate consequence of playing American football, with injury rates in football being the highest across all sports at the high school and collegiate levels. Ankle injuries are among the most common, ranging from sprains to fractures. This paper examines three separate distal fibula fractures with syndesmotic injuries associated with collegiate American football players who experienced non-contact injuries on synthetic turf fields while wearing similar footwear designed for turf surfaces. These injuries were managed with open reduction internal fixation and syndesmotic fixation with suture button(s). Conclusion This recurrent injury pattern prompts a discussion on the health and financial impacts of sport surfaces like synthetic turf as well as footwear-surface interface on lower extremity injury risks and implications for athletes.

BACKGROUNDThe anterior talofibular ligament (ATFL) is the most commonly injured ligament in ankle sprains. While most individuals recover with conservative management, some patients develop persistent pain and instability from chronic ATFL tears. Surgical repair is often required, and minimally invasive techniques are gaining popularity.AIMTo evaluate the clinical outcomes of a novel, totally percutaneous (TP) modified Broström repair (MBR) for chronic ATFL insufficiency in a cohort of patients who failed conservative treatment.METHODSThis retrospective study analyzed 20 patients (14 males, 6 females; mean age, 28.7 years) who underwent TP-MBR between 2023 and 2024 at a tertiary trauma center. All patients had persistent pain and instability for at least 3 months despite conservative treatment. Diagnosis was confirmed by magnetic resonance imaging, arthroscopy, and stress testing. TP-MBR was performed using suture anchors and percutaneous ligament advancement. Functional outcomes were assessed using American Orthopaedic Foot and Ankle Society score and Karlsson score at a mean follow-up of 1.5 years.RESULTSAll procedures were completed successfully with no intraoperative complications. At a mean follow-up of 1.5 years, patients showed significant improvements in American Orthopaedic Foot and Ankle Society score (from 39.85 to 84.4; P < 0.001) and Karlsson scores (from 43.8 to 87.4; P < 0.001). All patients returned to pre-injury activity levels with resolution of instability. The technique resulted in minimal tissue trauma, reduced operative time, accelerated recovery, and excellent cosmetic outcomes. No recurrences or major complications occurred.CONCLUSIONTP-MBR is a safe and effective alternative to open Broström repair for chronic ATFL tears. It offers the benefits of a minimally invasive approach, including less trauma and faster rehabilitation, making it a valuable option for appropriately selected patients.

To determine the diagnostic value of high-frequency ultrasonography in the assessment of anterior talofibular ligament (ATFL) injury and concomitant lesions. We retrospectively analyzed the data of 1005 patients with acute, unilateral ATFL injuries diagnosed using high-frequency ultrasonography in our hospital between January 2021 and December 2024. We analyzed ATFL and calcaneofibular ligament (CFL) thickness in patients with right vs. left ankle injuries and those with complete vs. incomplete ATFL rupture. We also analyzed the damage to other supporting structures of the ankle to provide an imaging basis for clinical diagnosis and treatment. In patients with incomplete ATFL injury with concomitant CFL injury, the thickness of the left and right CFL was 1.75 ± 0.47mm and 1.90 ± 0.58mm, respectively (P < 0.01). The CFL thickness was 1.83 ± 0.54mm and 2.13 ± 0.54mm in patients with incomplete and complete ATFL injury, respectively (P < 0.001). The incidence of concomitant CFL and superior extensor retinaculum (SER) injuries significantly differed between patients with incomplete and complete ATFL rupture (P < 0.05). High-frequency ultrasonography is valuable for diagnosing acute ankle ligament injuries. CFL thickness was greater in patients with complete ATFL injury than in patients with incomplete ATFL injury. A trend toward increase CFL thickness on the right was noted, possibly due to right-sided dominance, though this requires further validation. ATFL injuries are frequently associated with concomitant CFL and SER injuries, and these structures should be carefully assessed during ultrasound examinations of acute ankle injuries.

Osteochondral lesions of the talus (OLTs) are common ankle injuries, even small OLTs (≤100 mm2) cause pain, swelling, and reduced mobility if untreated, yet an optimal treatment standard remains elusive. This study aimed to compare the midterm outcomes of arthroscopic debridement (AD) and bone marrow stimulation (BMS) techniques for small-sized OLTs and to determine possible association between lesion size and clinical efficacy. Patients with small-sized OLTs who received AD or BMS were retrospectively analyzed, with a minimum follow-up of 36 months. A 1:1 propensity score matching was performed, and 32 pairs of patients were matched. Clinical outcomes were assessed using the visual analog scale (VAS), the Karlsson Score, Foot Ankle Outcome Score (FAOS), and the ankle activity score (AAS) scores. In addition, a general linear model analysis was performed between patient demographics and Karlsson scores in 2 groups separately to detect potential risk factors. Finally, 28 patients in the AD group and 30 patients in the BMS group completed the follow-up and were enrolled with a mean follow-up period of 67.63 ± 17.01 months. No preoperative demographic differences were found between the 2 groups (all P > .050). Both AD and BMS groups showed significant improvements in all clinical scores postoperatively. No significant intergroup differences were found in all postoperative scores except FAOS ADL (P = .030). Correlation analysis showed a strong correlation between lesion area and the postoperative Karlsson score in the AD group (r = -0.673, P < .001), with lesions greater than 61.13 mm2 associated with worse outcomes. Arthroscopic debridement and bone marrow stimulation showed similar improvements in clinical scores for small osteochondral lesions of the talus (<60 mm2). For larger lesions (>60 mm2), AD outcomes were worse; given the single-center, retrospective design and modest sample size, this data-derived cutoff is exploratory and requires external validation.