Severe Ankle Injuries Research Articles

Severe Knee, Ankle, and Shoulder Injuries among Korean Men and Women Freestyle Wrestlers: A Survey-based Cross-Sectional Study

Severe Knee, Ankle, and Shoulder Injuries among Korean Men and Women Freestyle Wrestlers: A Survey-based Cross-Sectional Study

Maisonneuve fracture treated with short leg cast: A case report with 41-month follow-up.

Maisonneuve fracture is a specific type of severe ankle injury. To our current knowledge, once a Maisonneuve fracture is diagnosed, the surgery is always recommended for fear of sequelae from inaccurate joint reconstruction. However, in this case, we treated a Maisonneuve fracture with a short leg cast, and the 41-month follow-up showed a favorable outcome with no post-traumatic osteoarthritis, chronic pain, and instability. Therefore, this case provides evidence for the feasibility of conservative treatment of Maisonneuve fracture. A female patient in her early twenties sprained her left ankle while running, suffering regional pain, swelling, and limited mobility. We diagnosed a Maisonneuve fracture with superior fibular fracture and Volkmann tuberosity fracture, a slight separation of inferior tibiofibular syndesmosis (ITS). The patient rejected our surgical recommendations in favor of nonsurgical treatment, in addition to refusing immobilization of the knee. Consequently, we had to treat her with a short leg cast for 8 weeks and asked her to return for regular follow-up visits. At the final follow-up, the radiography showed complete healing of proximal fibula fracture. The patient reported no discernible subjective differences between her bilateral ankles. The range of motion of the left ankle was measured at 22° of dorsiflexion and 40° of plantarflexion. Functional assessments using Olerud-Molander ankle scale and American Orthopedic Foot and Ankle Society Ankle-Hindfoot scale both scored 100 points. Additionally, the radiographic assessment classified arthritis as stage 0 according to Morrey-Wiedeman classification. To avoid missing and misdiagnosing, the physical examination should always extend to 2 neighboring joints. Secondly, if a Maisonneuve fracture is suspected, further computed tomography scans, radiography, and magnetic resonance imaging can help to determine the stability of the ITS and the integrity of the lateral collateral ligaments before making therapeutic decisions. Finally, considering the lateral collateral ligaments may remain intact, we recommend stabilizing ITS by repairing the medial ligaments, which can be conducted arthroscopically and be more minimally invasive, providing an elastic fixation that aligns better with the biomechanics of the ITS which is characterized as a micro-mobile rather than fully fixed joint.

The effect of the interaction between the exercise method and the level of ankle sprain injury in athletes on ankle stability

Background and purpose The aim of this research is to determine the effect of the interaction between the exercise method and the level of ankle sprain injury in athletes on ankle stability. Material and methods The location of this research was carried out in two places, namely the Bintang Physio Sport Bandung Clinic which is located at Jl. Pudak No. 11, Merdeka, Sumur Bandung District, Bandung City, West Java 40133 and PhysioZone Clinic which is located at Jl. Batununggal Indah IX No.2 (Batununggal Indah Club) Bandung City. This type of research is quantitative research with experimental research methods. The population in this study were athletes with Sprain Ankle conditions with screening that the population was an athlete who was medically diagnosed as suffering from Sprain Ankle by a doctor as proven by medical records and then a specific Physiotherapy examination was carried out using a) Anterior drawer test, b) Talar inversion tilt test, and c) Talar eversion tilt test. After being selected to examine the condition of Sprain Ankle, the athlete becomes part of the population. Purposive random sampling used in this research is sampling that has been adjusted in such a way, however, it is still continued with incidental sampling, namely taking respondents who happen to be present or available with a sample target of 8 people for each group. Results There is an effect of the interaction between the exercise method and the level of Ankle Sprain injury in athletes on ankle stability. Comparative analysis showed differences in ankle stability to Ankle Sprain injury rates with p values = 0.010 (p < 0.05). The results of the Tukey test with values Fcalculate = 5.158) > Ftabel for degrees of freedom 2 and 48 with values 3.819, or Fcalculate > Ftabel show that there is an ankle stability interaction between interventions. Conclusions The results of the hypothesis test proved that there was an interaction of ankle stability between the intervention of Proprioceptive exercise and Theraband exercise with the degree of Ankle Sprain injury in athletes, so it can be concluded that there was an interaction of ankle stability between the intervention of Proprioceptive exercise and Theraband exercise with the degree of severe, moderate, and mild ankle injury. This is evidenced by each intervention where the Proprioceptive exercise intervention at the degree of mild and moderate injury has the same stability value, while the Theraband exercise at the degree of moderate and severe injury has the same stability value. To further clarify the interaction of ankle stability between proprioceptive exercise intervention and theraband exercise with severe, moderate, and mild degrees of injury in athletes with Ankle Sprain.

Return to performance following severe ankle, knee, and hip injuries in National Basketball Association players.

The purpose of this study was to compare basketball performance markers 1 y prior to initial severe lower extremity injury, including ankle, knee, and hip injuries, to 1 and 2 y following injury during the regular National Basketball Association (NBA) season. Publicly available data were extracted through a reproducible extraction computed programmed process. Eligible participants were NBA players with at least three seasons played between 2008 and 2019, with a time-loss injury reported during the study period. Basketball performance was evaluated for season minutes, points, and rebounds. Prevalence of return to performance and linear regressions were calculated. A total of 285 athletes sustained a severe lower extremity injury. A total of 196 (69%) played for 1 y and 130 (45%) played for 2 y following the injury. A total of 58 (30%) players participated in a similar number of games and 57 (29%) scored similar points 1 y following injury. A total of 48 (37%) participated in a similar number of games and 55 (42%) scored a similar number of points 2 y following injury. Fewer than half of basketball players who suffered a severe lower extremity injury were participating at the NBA level 2 y following injury, with similar findings for groin/hip/thigh, knee, and ankle injuries. Fewer than half of players were performing at previous preinjury levels 2 y following injury. Suffering a severe lower extremity injury may be a prognostic factor that can assist sports medicine professionals to educate and set performance expectations for NBA players.

Preseason weight-bearing ankle dorsiflexion in male professional football players with and without a history of severe ankle injury: A novel analysis in an English Premier League club

ObjectivesAnkle injuries are common in professional football and have profound player/team/club consequences. The weight-bearing lunge-test (WBLT) assesses ankle dorsiflexion range-of-motion in football primary/secondary injury prevention and performance contexts. Data for uninjured and previously ankle-injured players in the English Premier League (EPL) is not available. This study analysed WBLT measurements (cm) within and between uninjured and previously severe ankle-injured players (injured-stiff group, injured-lax group) in one EPL club. DesignCross-sectional. SettingPreseason. ParticipantsForty-nine players (age 22.9 ± 4.6 yr; height 181.6 ± 5.2 cm; mass 77.7 ± 7.6 kg). Main outcome measuresPrevalence (%) of previous unilateral severe ankle injury (USAI). Side-to-side (right/left, dominant/nondominant, injured/uninjured) WBLT comparisons at group-level (t-test [within-group]; Welch's ANOVA [between-group]; effect sizes [within-/between-group]) and individual-level (limb symmetry index [%]; absolute-asymmetry [%]). ResultsPrevalence of USAI was 38.7%. There were no statistically-significant side-to-side differences for within-/between-group comparisons. Effect sizes: just-below-large (injured-stiff) and extremely-large (injured-lax) for within-group injured-side/uninjured-side comparisons; just-below-medium (injured-lax) to just-above-medium (injured-stiff) for injured-side comparisons to uninjured players. Absolute-asymmetries: uninjured players, 15.4±13.2%; injured-stiff, 21.8±33.6%; injured-lax 20.4±13.6%. ConclusionsOver one-third of players had previous USAI. Effect sizes indicate substantial within-group side-to-side differences and less substantial between-group differences. Across groups, some players had absolute-asymmetries that may elicit concern in ankle primary/secondary injury prevention and performance contexts.

Timing return-to-competition: a prospective registration of 45 different types of severe injuries in Germany\u2019s highest football league

IntroductionMany professional football players sustain at least one severe injury over the course of their career. Because detailed epidemiological data on different severe injuries in professional football have been missing so far, this study describes the frequency and return-to-competition (RTC) periods of different types of severe football injuries.Material and methodsThis epidemiological investigation is a prospective standardised injury analysis based on national media longitudinal registration. Injuries were classified according to the consensus statement by Fuller et al. (2006). The analysis includes injuries sustained by players of the first German football league during the seasons 2014–2015 to 2017–2018. Level of evidence: II.ResultsOverall, 660 severe injuries were registered during the four seasons (mean 165 per season; 9.2 per season per team; incidence in 1000 h: 0.77). The body region most frequently affected by severe injury was the knee (30.0%; 49.5 injuries per season/SD 13.2) followed by the thigh (26.4%; 43.5 injuries/SD 4.2) and the ankle (16.7%; 27.5 injuries/SD 5.0). The distribution of injuries over the course of a season showed a trend for ACL ruptures to mainly occur at the beginning of a season (45.8%), overuse syndromes such as achillodynia (40.9%) and irritation of the knee (44.4%) during the winter months and severe muscle and ankle injuries at the end of a season. ACL ruptures showed the longest RTC durations (median 222 days).ConclusionThis study presents detailed epidemiological data on severe injuries in professional football. The body region most frequently affected by severe injuries was the knee. Several types of severe injuries showed a seasonal injury pattern. The appropriate timing of RTC after an injury is one of the most important and complex decisions to be made. This study provides information on the typical time loss due to specific severe football injuries, which may serve as a guideline.

Mini-open Arthroplasty for Anterior Ankle Impingement

Osseous or soft tissue impingement of the anterior ankle can result in reduced dorsiflexion, pain and difficulty in walking that can significantly reduce the quality of life. Sometimes, conservative treatments fail and surgical intervention may be indicated. A 34- year-old male, who sustained a severe ankle injury five years back whilst waterskiing, complained of ongoing pain and disability. His initial injury had resulted in multiple fracture fragments within the anterior and posterior aspects of his right ankle. Upon performing clinical examination, reduced dorsiflexion with crepitus was noted and plain film radiographs exhibited multiple fragments within the anterior and posterior aspects of his ankle joint. Pain and limitation to motion were primarily affecting the anterior joint. The posterior aspect was only mildly symptomatic and not considered a primary consideration. Treatment involved a mini-open arthroplasty with removal of the osteophytes and margination of the chondral defects. Adequate dorsiflexion without crepitus was noted on the operating table and postoperative radiographs showed adequate removal of the osteophytes. He was kept non- weight bearing in a fibreglass back slab for 10 days before resuming partial weight bearing in a postoperative shoe and crutches. Mini-open arthroplasty may offer a viable alternative to large incision joint procedures or arthroscopy and may be a procrastinatory procedure for patients wishing to delay ankle joint arthrodesis or replacement.

New Machine Learning Approach for Detection of Injury Risk Factors in Young Team Sport Athletes.

The purpose of this article is to present how predictive machine learning methods can be utilized for detecting sport injury risk factors in a data-driven manner. The approach can be used for finding new hypotheses for risk factors and confirming the predictive power of previously recognized ones. We used three-dimensional motion analysis and physical data from 314 young basketball and floorball players (48.4% males, 15.72±1.79 yr, 173.34±9.14 cm, 64.65±10.4 kg). Both linear (L1-regularized logistic regression) and non-linear methods (random forest) were used to predict moderate and severe knee and ankle injuries (N=57) during three-year follow-up. Results were confirmed with permutation tests and predictive risk factors detected with Wilcoxon signed-rank-test (p<0.01). Random forest suggested twelve consistent injury predictors and logistic regression twenty. Ten of these were suggested in both models; sex, body mass index, hamstring flexibility, knee joint laxity, medial knee displacement, height, ankle plantar flexion at initial contact, leg press one-repetition max, and knee valgus at initial contact. Cross-validated areas under receiver operating characteristic curve were 0.65 (logistic regression) and 0.63 (random forest). The results highlight the difficulty of predicting future injuries, but also show that even with models having relatively low predictive power, certain predictive injury risk factors can be consistently detected.

Ankle osteoarthritis and its association with severe ankle injuries, ankle surgeries and health-related quality of life in recently retired professional male football and rugby players: a cross-sectional observational study

ObjectivesTo determine (1) the prevalence of ankle osteoarthritis (OA) among former professional football and rugby players, (2) assess the association between ankle injuries or ankle surgeries with ankle OA, and...

Characterization of Ankle Kinematics and Constraint Following Ligament Rupture in a Cadaveric Model.

Ankle sprains are a common injury that may need reconstruction and extensive physical therapy. The purpose of this study was to provide a description of the biomechanics of the ankle joint complex (AJC) after anterior talofibular (ATFL) and calcaneofibular (CFL) ligament rupture to better understand severe ankle injuries. The envelope of motion of ten cadaveric ankles was examined by manual manipulations that served as training data for a radial basis function used to interpolate ankle mobility at flexion angles under load and torque combinations. Moreover, ankle kinematics were examined, while tendons were loaded to identify how their performance is altered by ligament rupture. The increased force required to plantarflex the ankle following ligament rupture was measured by calculating the load through the Achilles. Following ATFL injury, the largest changes were internal rotation (5 deg) in deep plantarflexion and anterior translation (1.5 mm) in early plantarflexion. The combined ATFL and CFL rupture changed the internal/external rotation (3 deg), anterior/posterior translation (1 mm), and inversion (5 deg) throughout flexion relative to the isolated ATFL rupture. Moreover, the Achilles' load increased by 24% after the rupture of ligaments indicating a reduction in its efficiency. This study suggests that if patients demonstrate primarily an increased laxity in internal rotation, the damage has solely occurred to the ATFL; however, if the constraint is reduced across multiple motions, there is likely damage to both ligaments. Higher loads in the Achilles suggest that it is overloaded after the injury; hence, targeting the calf muscles in rehabilitation exercises may reduce patients' pain.

The Impact of a Previous Ankle Injury on Current Health-Related Quality of Life in College Athletes.

There has been an increased interest in understanding how ankle injuries impact patient outcomes; however, it is unknown how the severity of a previous ankle injury influences health-related quality of life (HRQOL). To determine the impact of a previous ankle injury on current HRQOL in college athletes. Cross-sectional study. Athletic training clinics. A total of 270 participants were grouped by the severity of a previous ankle injury (severe = 62, mild = 65, and no injury = 143). Participants completed the Foot and Ankle Ability Measure (FAAM) and the Short Form 12 (SF-12). A 2-way analysis of variance with 2 factors (injury group and sex) was used to identify interaction and main effects for the FAAM and SF-12. No interactions were identified between injury group and sex. Significant main effects were observed for injury group, where the severe injury group scored lower than athletes with mild and no injuries on the FAAM activities of daily living, FAAM Global, and SF-12 mental health subscale scores. In addition, a main effect was present for sex in the SF-12 general health, social functioning, and mental health subscales in which females reported significantly lower scores than males. Our findings suggest that a severe ankle injury impacts HRQOL, even after returning back to full participation. In addition, females tended to report lower scores than males for aspects of the SF-12, suggesting that sex should be considered when evaluating HRQOL postinjury. As a result, clinicians should consider asking athletes about their previous injury history, including how much time was lost due to the injury, and should mindful of returning athletes to play before they are physiologically and psychologically ready, as there could be long-term negative effects on the patients' region-specific function as well as aspects of their HRQOL.

High-Level Performance After the Return to Run Clinical Pathway in Patients Using the Intrepid Dynamic Exoskeletal Orthosis.

Severe ankle and foot injuries in the US military can result in high-level functional limitation, lost duty days, and medical discharge. To assess the effectiveness of the Return to Run Clinical Pathway (RTR) in returning patients with lower extremity fractures who utilized the Intrepid Dynamic Exoskeletal Orthosis (IDEO) to high-level mobility. Thirty servicemembers with lower extremity fractures who utilized the IDEO unilaterally and completed the RTR at Naval Medical Center San Diego were included in this retrospective operational review. The Comprehensive High-level Activity Mobility Predictor (CHAMP) and all subtests were completed prior to and after completion of the RTR as part of routine clinical care. An analysis of covariance (ANCOVA) was used to compare CHAMP scores before and after the RTR. Significant improvements were found in the T test (mean change, faster by 5.3 seconds; 95% confidence interval: 3.6, 7.1 seconds; P = .03) and total CHAMP score (mean change, 4.2 points; 95% confidence interval: 3.0, 5.3 points; P<.05). No significant changes were noted in the single-legged stance subtest, the Edgren sidestep test, or the Illinois agility test. The RTR led to improvements in high-level, multidirectional mobility in IDEO users with a history of fractures. Applicability of the intervention used in this study requires further validation before widespread use. Therapy, level 4. J Orthop Sports Phys Ther 2019;49(7):529-535. Epub 13 Feb 2019. doi:10.2519/jospt.2019.8763.

The peroneal artery perforator flap for the reconstruction of serious heel spoke injuries in children

Objective To explore the clinical effect of peroneal artery perforator flap for the treatment of serious heel spoke injuries in children. Methods From July, 2014 to September, 2017, 13 children with severe heel and ankle injuries were treated by peroneal artery perforator flap. There were 9 males and 4 females, with an average age of 6.5 years (ranged from 3 to 11 years). The size of flaps ranged from 10.0 cm×3.0 cm to 14.5 cm×5.0 cm. The donor sites were sutured directly or covered with skin grafting. Regular follow-up was performed to observe the survival status of the flap and the functional recovery of the ankle joint. Results Twelve flaps survived completely. One flap had partial marginal necrosis in the distal portion, which was healed after dressing. Partial inadequate venous return happened in 1 case, which also recovered by the removal of part of the suture. All cases were followed-up for 3 months to 20 months. The appearance, texture, and color of the flaps were similar to the surrounding skin. No ulcer occurred. All case acquired normal gait. Conclusion The peroneal artery perforator flap is a good option for reconstruction of serious heel spoke injuries in children. The flap has consistent blood supply while leaving minimal morbidity at donor site. Key words: Peroneal artery; Perforator flap; Spoke injury; Children; Heel

Avascular Necrosis of the Talus in Juveniles

Avascular necrosis of the talus after severe ankle injury is well known. Avascular necrosis of talus is extremely rare in juveniles. However, it has been controversial whether the incidence of AVN after fracture of talus is higher in adult than in juveniles. It is possible that the immature talus can be more susceptible to circulatory. As treatment of avascular necrosis of the talus, non-operative treatment could be considered in juveniles. Prolonged non weight bearing might not be necessary for avascular necrosis of the talus.

RISUS study: Rugby Injury Surveillance in Ulster Schools

ObjectiveTo examine injury patterns in adolescent rugby players and determine factors associated with injury risk.DesignProspective injury surveillance study.SettingN=28 Grammar Schools in Ulster, Ireland (2014–2015 playing season).Participants825 adolescent rugby players, across...

The influence of foot and ankle injury patterns and treatment delays on outcomes in a tertiary hospital; a one-year prospective observation

BackgroundAnkle and foot fractures are amongst the most common injuries, and patterns may vary from primary care set up to tertiary hospitals. Severe foot injuries are projected to have significantly worse outcomes and surgical delays are thought to alter prognosis. MethodsAll patients with foot and ankle trauma were prospectively evaluated at a Tertiary trauma centre over one year. The incidence, fracture patterns, risk factors, and outcomes were evaluated, and cases were divided into simple foot injuries (FASS≤3) and severe foot injuries (FASS>3). Injury mechanisms, associated injuries, and delays in treatment were evaluated, and outcomes were analyzed using Visual–Analogue Scale Foot and Ankle (VASFA), Maryland Foot Score (MFS) and Foot and ankle disability index (FADI). Results294 Foot and Ankle injuries (51 females, 243 males) were encountered in 2919 trauma cases (incidence of 10%). 80 patients (27.2%) had simple foot injuries and 214 (72.8%) had severe foot injuries. 29 patients (9.9%) were below 18years; most (65.3%) patients were between 18 and 45 years age. Road traffic accident was most commonest mode of injury, with ankle fractures (30.6%) the most common. Metatarsal fractures (27.9%) and calcaneal fractures (21.4%) were 2nd and 3rd most common injuries in the foot. Surgical delay averaged 1 day in both severe and simple injuries. Injury led to 32 (10.9%) below knee amputations. Outcome evaluation in 127 (91 severe, 36 simple injuries) patients showed mean Maryland foot score of 89.30 in simple injury group and 84.87 in severe injury group. Mean VASFA score was 82.87 (simple) and 81.87 in severe injury, and mean FADI score was 93.13 (simple) and 91.05 (severe injury). More detailed analysis revealed that more good scores (64.4%) were documented in severe injuries group, and more excellent scores (52.8%) in simple injuries group. ConclusionFoot injuries constitute 10% of all orthopaedic trauma at tertiary hospitals; Majority of them are severe foot injuries, with 68.7% being open injuries. Surgical delay was similar in simple and severe foot and ankle injuries. Outcomes of severe injuries were similar to simple foot and ankle injuries, reflecting on the quality of care that could be administered to them when they present to tertiary hospitals.

Incidence and Severity of Foot and Ankle Injuries in Men's Collegiate American Football.

Background:American football is an extremely physical game with a much higher risk of injury than other sports. While many studies have reported the rate of injury for particular body regions or for individual injuries, very little information exists that compares the incidence or severity of particular injuries within a body region. Such information is critical for prioritizing preventative interventions.Purpose:To retrospectively analyze epidemiological data to identify the most common and most severe foot and ankle injuries in collegiate men’s football.Study Design:Descriptive epidemiology study.Methods:Injury data were obtained from the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) for all foot and ankle injuries during the 2004-2005 to 2008-2009 seasons. Injuries were analyzed in terms of incidence and using multiple measures of severity (time loss, surgeries, medical disqualifications). This frequency and severity information is summarized in tabular form as well as in a 4 × 4 quantitative injury risk assessment matrix (QIRAM).Results:The rate of foot and ankle injuries was 15 per 10,000 athletic exposures (AEs). Five injuries were found to be responsible for more than 80% of all foot and ankle injuries: lateral ankle ligament sprains, syndesmotic (high ankle) sprains, medial ankle ligament sprains, midfoot injuries, and first metatarsophalangeal joint injuries. Ankle dislocations were found to be the most severe in terms of median time loss (100 days), percentage of surgeries (83%), and percentage of medical disqualifications (94%), followed by metatarsal fractures (38 days, 36%, and 49%, respectively) and malleolus fractures (33 days, 41%, and 59%, respectively). Statistical analysis suggests that the 3 measures of severity are highly correlated (r > 0.94), thereby justifying the use of time loss as a suitable proxy for injury severity in the construction of the QIRAM.Conclusion:Based on the QIRAM analysis, the 5 highest risk injuries were identified based on both incidence and severity (ankle dislocations, syndesmotic sprains, lateral ankle ligament sprains, metatarsal fractures, and malleolus fractures). A better understanding of the relative incidence and severity of these injuries will allow coaches, trainers, and researchers to more effectively focus their preventative interventions.

The effect of external ankle support on knee and ankle joint movement and loading in netball players

External ankle support has been successfully used to prevent ankle sprains. However, some recent studies have indicated that reducing ankle range of motion can place larger loads on the knee. The aim of this study was to investigate the effect of external ankle support (braces and high-top shoes) on the ankle and knee joint loading during a netball specific landing task. A repeated measure design. High performance netball players with no previously diagnosed severe ankle or knee injury (n=11) were recruited from NSW Institute of Sport netball programme. The kinematic and kinetic data were collected simultaneously using a 3-D Motion Analysis System and one Kistler force plate to measure ground reaction forces. Players performed a single leg landing whilst receiving a pass while wearing a standard netball shoe, the same shoe with a lace-up brace and a high-top shoe. Only the brace condition significantly reduced the ankle range of motion in the frontal plane (in/eversion) by 3.95 ± 3.74 degrees compared to the standard condition. No changes were found for the knee joint loading in the brace condition. The high-top shoes acted to increase the peak knee internal rotation moment by 15%. Both the brace and high-top conditions brought about increases in the peak ankle plantar flexion moment during the landing phase. Lace-up braces can be used by netball players to restrict ankle range of motion during a single leg landing while receiving a pass without increasing the load on the knee joint.

Time Lost from Play in Foot and Ankle Injuries of Professional Soccer Players

Objective: Ankle and foot injuries are common in professional soccer players, but the relation between injury severity and time lost from play is not well known. The aim of this study is to investigate the relationship between diagnosis, injury severity and time lost to play of professional soccer players with severe ankle and foot injuries with reviewing the recent literature. Design: Prospective evaluation of retrospectively collected data and review of the literature. Setting: Primary private practice. Patients: The medical records of two hundred lower extremity injuries of professional soccer players who admitted to our private clinic during the 2003-2004 professional national soccer league season were reviewed. Collected data of sixty-six players with severe ankle and foot injuries were included in the study. Type of injury, diagnosis, treatment, injury severity and finally, time lost from play were evaluated from the medical records. Injury severity (‘severe’ if >28 days, ‘moderate’ if between 8-28 days) and time lost from play were calculated from medical records and by telephone interviews with the players. Results: Most injuries (n=20, 32%) occurred during player-to-player contact. The most common diagnosis was ankle sprain (30.3%) with anterior talofibular ligament injury. Most (55%) hindfoot injuries were Achilles tendinopathy with or without rupture. Treatment was surgical in 23 patients (35%). The mean time lost from play for players with severe foot and ankle injuries was 61days (range 21-240 days); after Achilles tendon ruptures, the mean time lost was 180 days. Injury severity was severe (>28 days lost from play) in 64% patients and moderate (8-28 days lost from play) in 36% patients. Conclusion: Time lost to play can dramatically increase by the presence of severe ankle and foot injuries. Serious ankle and foot injuries in this study resulted in players being out of professional competition for about two months

The Mangled Foot and Ankle

To determine the outcome of the mangled foot and ankle undergoing limb salvage surgery that required free tissue flaps for wound closure compared with a similar patient foot and ankle injury group that underwent early below knee amputation (BKA). : Prospective longitudinal study. : Eight level 1 trauma centers. LEAP (Lower Extremity Assessment Project) study. One hundred seventy-four open severely injured hindfoot or ankle injuries (116 had salvage; 58 had a BKA). Patients either required immediate amputation or salvage was attempted. The Sickness Impact Profile (SIP) was the principal measure of outcome (higher SIP scores equal greater disability). Secondary outcomes included walking speed, number of rehospitalizations for injury-related complications, time to full weight-bearing, the visual analog pain scale, and return to work at 2 years. When compared to patients treated with standard BKA, salvage patients who required free flaps and/or ankle arthrodesis had significantly worse 2-year outcomes. They had overall SIP scores that were 2.5 points higher and psychosocial SIP scores that were 8.4 points higher at 24 months (P = 0.014 and P = 0.013, respectively). Physical SIP scores were 3.7 points higher in the free flap and/or arthrodesis group but only approached statistical significance (P = 0.10). After adjusting for the need for free flap and/or arthrodesis, the salvage pathway had clinically, but not statistically, significantly better overall and psychosocial SIP scores than the standard BKA patients (P = 0.34 and P = 0.20, respectively). : Patients with severe foot and ankle injuries who require free tissue transfer or ankle fusion have SIP outcomes that are significantly worse than BKA with typical skin flap design closure. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.