Objective There is a paucity of data on the incidence and severity of tram tracks related cycling injuries. The aim of this study is to get insight into the incidence, severity and characteristics of tram tracks related cycling injuries, potentially defining significant ‘hotspots’ in the Ghent city area. Methods A one-year, multicenter, prospective, observational study was conducted. Patients presenting to the emergency departments of all 4 Ghent hospitals with tram tracks related cycling injury, were included. Data on patient demographics, circumstances of the accident and type of injury were collected. Results 149 patients were included, with a median age of 31 years. 42 patients had fractures, 39 patients required wound sutures, 79 and 49 patients suffered from bruising and abrasions respectively. Only 5 patients required admission. No patients died or suffered life-threatening injuries. Women (65.1%) presented more frequently than men (34.9%). Forty-tree percent of all accidents happened in autumn (p < 0.001). Accidents happened more frequently in rainy conditions (p < 0.001). Mean number of days off work was 2.7 days, significantly increasing to 6.56 days when sustaining a fracture or dislocation (p = 0.02). Conclusion Tram tracks are potentially dangerous and may lead to clinically important injuries and significant number of days off work.