Available online 15 November 2023, 151023

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Female participation in sports has steadily increased over the past several decades, and so has the prevalence of injuries in the female athletic population. However, there has not been a concomitant increase in the literature discussing the specific injury patterns more common in this population. In particular, the incidence in ankle injuries is higher in female athletes compared to their male counterparts, specifically acute ligament, syndesmotic sprains, and chronic instability. This chapter aims to describe these ankle injuries with focus on the female athlete. We offer sex-specific treatment and rehabilitation strategies with the goal of providing improved care for the female athlete who sustains ankle injury.

Section snippetsINTRODUCTION

Female participation in sports at all levels has increased over the past several decades, as changes in laws, such as Title IX, and greater emphasis on the benefits of exercise have occurred.1 Previously “male-dominated” sports have seen a rise in female participation. Injury rates among female athletes have also increased, as societal pressures and higher demands on these athletes have been amplified in recent years.2 Epidemiologic studies have demonstrated that the incidence of ankle injuries

ACUTE LATERAL ANKLE SPRAIN

Acute lateral ankle sprains are a leading cause of missed participation in sports among females and can lead to considerable disability. Ankle sprains have been cited as the most frequent musculoskeletal injury, accounting for about 20% of all injuries and nearly 5% of patients presenting to emergency rooms and urgent care settings.6 The lateral ligament complex of the ankle is the most frequently injured single structure in the body.7 It consists of the calcaneofibular ligament (CFL), anterior

HIGH ANKLE SPRAIN: SYNDESMOTIC INJURY

In contrast to the commonly diagnosed lateral ligamentous ankle sprain, medial sprains and syndesmotic injuries occur far less frequently with a prevalence of only about 10% of all ankle sprain diagnoses.4 High ankle sprains with syndesmotic injuries, however, are important for the clinician to accurately recognize, diagnose, and treat given the significantly greater missed time from sports and long-term disabilities.4,7,13 The anatomy of the syndesmosis is important to understand, consisting

CHRONIC ANKLE INSTABILITY

Chronic ankle instability is characterized by a history of one acute lateral ankle sprain, subsequent sprains, patient-reported episodes of the ankle “giving way,” and often subjective deficits in ankle function for greater than one year following the initial lateral sprain.19 Chronic ankle instability leads to decreased range of motion, strength, postural control, and altered movement patterns during sports when compared to individuals without instability.19 Female athletes have been found to

REHABILITATION STRATEGIES

Rehabilitation strategies must be tailored to the sex of the athlete suffering from an ankle injury, given the anatomic, biomechanical, hormonal, and psychological differences between males and females.2 Gianakos et al. described the female-focused guidelines for rehabilitation to facilitate a safe return to sports.2 The three phases of rehabilitation include restoring preinjury joint range of motion, then restoring preinjury strength, and finally performing sport-specific training until the

CONCLUSIONS

Female athletes sustain a greater incidence of lateral ankle sprains, which can lead to the debilitating condition of chronic ankle instability. Though males have been shown to have increased rates of syndesmotic injuries, certain sports predispose females to this pattern of injury; however, further research is necessary to determine the underlying causes and to be able to treat these patients properly. With more females being involved in sports at higher levels of competition, understanding

Disclosure

Dr. Mary K Mulcahey, MD, FAAOS

AAOS: Board or committee member

American Journal of Sports Medicine Electronic Media: Editorial or governing board

American Orthopaedic Association: Board or committee member

American Orthopaedic Society for Sports Medicine: Board or committee member

Arthrex, Inc: Paid consultant; Paid presenter or speaker

Arthroscopy: Editorial or governing board

Arthroscopy Association of North America: Board or committee member

Association of Bone and Joint Surgeons: Board or committee

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