Foot or ankle injuries in professional football players may increase risk of osteoarthritis

A new paper in Rheumatology, published by Oxford University Press, finds that retired UK male professional football players who reported foot or ankle injuries during their careers were more likely to develop osteoarthritis in retirement. Retired players treated routinely with cortisone injections for their injuries were even more likely to report osteoarthritis.

Professional football is a high-speed contact sport with high risk of injury. Foot and ankle injuries are particularly common, with ankle sprains being the most regular ankle injury and metatarsal fractures the most frequent foot injury. These injuries occur more often during football matches than in practice due to the high speed, jumping, frequent changes in direction, and competitive nature of the game. Joint injury can lead to pain, swelling and damage to the articular cartilage and other joint tissues and result in subsequent foot/ankle osteoarthritis, which can result in disability or chronic pain.

Although injury is widespread in male professional footballers-almost 25% of players suffer foot or ankle injuries during their careers-the widespread use of injection therapies such as corticosteroids, local anesthetic, platelet-rich plasma, and hyaluronic acid remains controversial due to concerns about their long-term side-effects (and limited evidence supporting the effectiveness of such treatment).

Injections can alleviate pain and allow players to return to games more quickly. However, the treatment may hide underlying joint damage and could accelerate joint structural deterioration over time. The frequent use of injections may also worsen cartilage damage, particularly when combined with the high physical demands required in professional football.

Researchers here examined retired UK male football players between August 2020 and October 2021 about cases in which a general practitioner diagnosed foot/ankle osteoarthritis or preformed forefoot/ankle surgery after the players' retirement. Of the 424 retired professional football players studied, the investigators reported that 73 percent of retired players with osteoarthritis reported foot or ankle injuries, and 75 percent of players with osteoarthritis reported treatment with corticosteroid injections over the course of their careers.

The researchers caution that while corticosteroid injections are associated with higher rates of osteoarthritis, this does not necessarily mean injections are making osteoarthritis more likely, as injections are often given after injuries, that may have linked injections to osteoarthritis. The investigators do point out that retired football players with osteoarthritis did report a higher number of injections into a single ankle during a season, and many received more than four injections a season, which is more than what's recommended by physicians. 

Our findings clearly show that a significant foot or ankle injury during a player's career is a major, modifiable risk factor of osteoarthritis late in life."

Weiya Zhang, study's chief investigator