Football, a high-intensity team sport with variable biomechanical load, is characterized by a significant incidence of injuries, particularly to the lower limbs. Among these, ankle injuries account for a considerable percentage, with a substantial impact both in terms of interruption of sporting activity and in the risk of recurrence and chronicity.
According to UEFA data (Elite Club Injury Study), approximately 15–20% of all injuries in professional football involve the tibiotarsal joint. Lateral ankle sprain is the most common type, followed by osteochondral lesions and fractures. The incidence is higher among defenders and midfielders, and increases on artificial turf pitches and during the final stages of the match, when fatigue compromises neuromuscular stability.
Classification of Injuries
1. Lateral (inversion) sprain
- Ligament injuries of the lateral compartment (anterior talofibular ligament, calcaneofibular ligament
- Grades I–III according to the degree of structural damage
- Often associated with joint effusion and localized pain
2. Medial ankle sprain (eversion)
- Less frequent but often more severe
- Involvement of the deltoid ligament and sometimes the tibiofibular syndesmosis
3. Injuries of the tibiofibular syndesmosis
- Known as ‘high ankle sprain’
- Typical of high-energy rotational injuries
- They require longer recovery times and careful clinical and instrumental evaluation.
4. Stress or impact fractures
- Distal tibial metaphysis, talus, or base of the 5th metatarsal
- They require immobilization and, in unstable cases, surgical treatment.
5. Osteochondral lesions of the talus
- Frequently secondary to inadequately treated or recurrent ankle sprains
- They may progress to chronic instability and early osteoarthritis.
Predisposing factors
- Previous sprain episodes (recurrence in up to 70 % of cases)
- Chronic ankle instability
- Deficits in proprioception and neuromuscular control
- Foot biomechanical abnormalities (overpronation, pes cavus)
- Inadequate physical conditioning and absence of a functional warm-up routine
Diagnosis
A comprehensive diagnostic approach should integrate:
- Clinical examination: assessment of swelling, joint stability, localized pain
- Functional assessment: anterior drawer test and talar tilt test
- Imaging: standard X-rays to rule out fractures; MRI in cases of suspected complex ligamentous or osteochondral injury; ultrasound for dynamic follow-up
Treatment
The length of each phase is determined by injury severity, patient-specific factors, and the intensity and frequency of treatment.
Acute phase
- POLICE protocol (Protection, Optimal Loading, Ice, Compression, Elevation)
- Targeted immobilization in injuries of grade II or higher
- Anti-inflammatory drugs only in the initial phase, with caution not to inhibit the healing process
Subacute stage of recovery
- Restoration of joint range of motion
- Initiation of isometric muscle strengthening
- Assisted joint mobilization and soft tissue therapy
Functional rehabilitation phase
- Progressive proprioceptive exercises
- Strengthening of the peroneal muscles and the core
- Gradual progression to weight-bearing, running, and cutting maneuvers
Surgical treatment
- Indicated in complex ligamentous injuries or in cases of chronic instability unresponsive to conservative treatment
- Surgical options include ligament reconstruction and arthroscopy for associated injuries
Prevention
Primary and secondary prevention is essential, especially in individuals with a history of recurrent sprains. The most effective protocols include:
- Neuromuscular training
- Proprioceptive training with wobble boards and uneven surfaces
- Targeted strengthening of stabilizer muscles
- Application of functional taping or ankle bracing in high-risk individuals
- Cardiovascular conditioning and weekly training load management
Ankle injuries, although often underestimated, can significantly compromise a footballer’s career, especially if poorly managed. Early diagnosis, progressive rehabilitation, and prevention through targeted exercises are key to reducing incidence, severity, and risk of recurrence.
References
- Ekstrand J et al. UEFA injury study. Br J Sports Med, 2023.
- Fong DTP et al. A systematic review on ankle injury. Sports Med, 2007.
- Gribble PA et al. Evidence-based prevention of ankle sprains. J Athl Train, 2020.
- van Rijn RM et al. Prognosis of acute lateral ankle sprain: A systematic review. Am J Sports Med, 2008.
