TOPLINE:

Foot or ankle injuries during professional football careers were associated with an increased risk for foot or ankle osteoarthritis (OA) among retired male professionals.

METHODOLOGY:

• Researchers conducted a case-control study within the Foot/ankle Osteoarthritis and Cognitive impairment in retired UK Soccer players (FOCUS) cohort to determine whether foot or ankle injuries and injections independently increase the risk for foot or ankle OA in retired male professional footballers.
• They included 424 retired UK male professional footballers from the FOCUS study, comprising 63 cases with foot or ankle OA (mean age, 63.22 years) and 361 control individuals (mean age, 63.08 years).
• Foot or ankle injury was defined as injury with pain lasting most days over 3 months during their career, and injection was assessed as corticosteroids or other agents administered into foot or ankle joints during their career.
• The primary outcome was GP-diagnosed foot or ankle OA or a history of forefoot or ankle surgery performed at the age of 40 years or above.

TAKEAWAY:

• Among the 63 cases, 45 reported being diagnosed with foot or ankle OA by a GP, and 18 had forefoot or ankle surgery at the age of 40 years or above.
• A higher percentage of cases vs control individuals experienced foot or ankle injury (73.3% vs 42.5%) and reported a history of any type of foot or ankle injection (75.0% vs 48.4%), any ankle injection (61.2% vs 36.6%), and ankle corticosteroid injection (57.1% vs 32.1%; P < .001 for all).
• Foot or ankle injury (adjusted odds ratio [aOR], 4.23; P < .001) and a history of any type of foot or ankle injection (aOR, 2.62; P = .017) were significant risk factors for foot or ankle OA.
• The receiver operating characteristic curve analysis showed a good discriminative power of injury alone as a risk factor for foot or ankle OA (area under the curve [AUC], 0.69; 95% CI, 0.61-0.77), with the AUC rising to 0.73 (95% CI, 0.66-0.80) when injections were added to the model. No difference was noted between the AUC with the injury and injection model and a model with 16 available risk factors.

IN PRACTICE:

"Preventing foot/ankle injuries in professional footballers remains a key clinical priority, given their strong association with subsequent OA in retired UK male professional footballers. Programmes such as those focused on strengthening, proprioception, and neuromuscular training that have been shown to reduce lower limb injury risk, might be considered in this respect," the authors wrote.

SOURCE:

This study was led by Ahmed Ali Thanoon, Academic Rheumatology, Injury Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, England. It was published online on October 22, 2025, in Rheumatology.

LIMITATIONS:

The questionnaire survey assessed injury and injection retrospectively, which may have introduced recall bias. Footballers with significant foot or ankle injuries might have been more likely to participate, potentially introducing selection bias. The self-reported nature of the diagnosis of OA on the basis of GP assessment or surgery could have led to misclassification bias.

DISCLOSURES:

This study was funded by the Football Association, the Professional Footballers' Association, and the Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis. Some authors reported receiving grants and/or honoraria from various organisations. One author reported being the director of UK Research and Innovation and Versus Arthritis Advanced Pain Discovery Platform, and another author reported being the deputy director of the Applied Research Collaboration Wessex.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.