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12 Lessons

The ankle is the most commonly injured joint in sport. In international football, ankle injuries constitute 11% to 23% of all injuries recorded during FIFA competitions.1 The rate of ankle injuries in lower-level amateur players, children and adolescents is higher still, representing 35% of all injuries. 1

Most ankle injuries are relatively uncomplicated sprains of the lateral ligament complex. There are, however, a number of conditions which present in a similar manner to these sprains resulting in longer-term disability. As a result, it is important to be able to appropriately examine, evaluate and treat ankle injuries.

The purpose of this module is to provide an overview of ankle problems in football.

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Learning outcomes

By the end of this module you should be able to:

  • identify the major causes of ankle pain in football players;
  • confidently examine an athlete presenting with ankle symptoms;
  • appropriately order and interpret plain XR and ultrasound protocols;
  • have an awareness of the indications for CT imaging and MRI;
  • prescribe and maintain an appropriate rehabilitation programme;
  • know when to refer to a specialist;
  • initiate injury prevention strategies relating to ankle injuries;
  • appreciate the available injury prevention strategies for ankle injuries.


  • Review the provided text and media content
  • Read the suggested articles
  • Complete the case-based assessment task

Suggested reading

  • Brukner and Khan’s Clinical Sports Medicine – 4th Edition. Chapter 38 (pages 510-544) and Chapter 39 (pages 828-843).
  • D’Hooghe P, Kerkhoffs G, The Ankle in Football. 1st Edition: Springer Verlag 2014 (Chapters 11, 13, 15 and 19).


  1. Junge A, Dvorak J. Football injuries during the 2014 FIFA World Cup. Br J Sports Med. 2015;49(9):599-602.
  2. Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and mid-foot: Systematic review. BMJ. 2003;326(7386):417.
  3. Martin DE, Kaplan PA, Kahler DM, Dussault R, Randolph BJ. Retrospective evaluation of graded stress examination of the ankle. Clin Orthop Relat Res. 1996;(328)(328):165-170.
  4. Kerkhoffs GM, Handoll HH, de Bie R, Rowe BH, Struijs PA. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev. 2007;(2)(2):CD000380.
  5. Attenborough AS, Hiller CE, Smith RM, Stuelcken M, Greene A, Sinclair PJ. Chronic ankle instability in sporting populations. Sports Med. 2014;44(11):1545-1556.
  6. Quinn K, Parker P, de Bie R, Rowe B, Handoll H. Interventions for preventing ankle ligament injuries. Cochrane Database Syst Rev. 2000;(2)(2):CD000018.
  7. McCrory P, Bladin C. Fractures of the lateral process of the talus: a clinical review. “snowboarder’s ankle”. Clin J Sport Med. 1996;6(2):124-128.
  8. Judd DB, Kim DH. Foot fractures frequently misdiagnosed as ankle sprains. Am Fam Physician. 2002;66(5):785-794.
  9. Kaeding CC, Yu JR, Wright R, Amendola A, Spindler KP. Management and return to play of stress fractures. Clin J Sport Med. 2005;15(6):442-447.
  10. Robinson M, Fulcher M. Delayed healing of a navicular stress fracture, following limited weight-bearing activity. BMJ Case Rep. 2014;2014:10.1136/bcr-2013-203216.
  11. d’Hooghe P, Karlsson J. Postoperative outcome evaluation following surgical treatment of osteochondral lesions. Oper Tech Orthop. 2014;24(3):230-237.
  12. Alfredson H. Chronic midportion achilles tendinopathy: an update on research and treatment. Clin Sports Med. 2003;22(4):727-741.
  13. Kujala UM, Sarna S, Kaprio J. Cumulative incidence of Achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med. 2005;15(3):133-135.
  14. Taljanovic MS, Alcala JN, Gimber LH, Rieke JD, Chilvers MM, Latt LD. High-resolution US and MR imaging of peroneal tendon injuries. Radiographics. 2015;35(1):179-199.
  15. Raikin SM, Garras DN, Krapchev PV. Achilles tendon injuries in a United States population. Foot Ankle Int. 2013;34(4):475-480.
  16. Krolo I, Viskovic K, Ikic D, Klaric-Custovic R, Marotti M, Cicvara T. The risk of sports activities – the injuries of the Achilles tendon in sportsmen. Coll Antropol. 2007;31(1):275-278.
  17. Metzl JA, Ahmad CS, Levine WN. The ruptured Achilles tendon: operative and non-operative treatment options. Curr Rev Musculoskelet Med. 2008;1(2):161-164.
  18. Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ. Operative versus nonoperative management of acute Achilles tendon rupture: Expected-value decision analysis. Am J Sports Med. 2002;30(6):783-790.