How may a maximal velocity shot in soccer lead to ankle impingement syndrome?

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How may a maximal velocity shot in soccer lead to ankle impingement syndrome?

Introduction

Soccer is a high energy, high contact sport played by millions worldwide with a prominent injury rate.  As soccer is a high intensity and due to the nature of the sport, most of the injuries occur within the lower extremity of the leg.

  Ankle impingement syndrome is a frequent injury which occurs in soccer, and Barile et al (1998) classified joint impingement syndrome as “a painful syndrome caused by friction of the joint tissues.” Yet there is no definite hypothesis for why this injury occurs.  It is known, however, that osteophytes, which are bony spurs, have been reported in as many as 60% of soccer players,  Massada (1991), this condition was first named “athlete’s ankle” or “footballers ankle” by Morris (1943) and later by McMurray (1950).  Although it is clear that these osteophytes are present, it is not fully understood how they occur and why they are present.

      In order for ankle impingement syndrome to be fully understood the ankle joint needs to be explained.  The ankle is a complex joint, and is actually made up of two joints: the true ankle joint and also the subtalar joint.  The true ankle joint consists of the tibia, fibula and the talus, and is responsible for the up and down movements of the ankle.  The subtalar joint lies beneath the true ankle joint and consists of the talus and the calcaneus, and is responsible for side to side movement of the foot.

  Ligaments are also present in the ankle and the major ligaments are: the anterior tibiofibula ligament, which connects the tibia to the fibula, the lateral collateral ligaments, which connect the fibula to the calcaneus, and also the deltoid ligaments, which connect the tibia to the talus and calcaneus.  

  It is also important to understand what the term velocity means, and Hall (1991) classified velocity as “the change in position, or displacement which occurs during a given period of time.”

  Two theories currently exists to try and explain the exact cause and formation of taliotibial osteophytes, and one such theory is that, “recurrent traction on the joint capsule during maximal plantar flexion movements of the foot, as is assumed to occur during kicking actions in soccer, is the essential cause, resulting in traction spurs.”  This theory was proposed and cited by Biedert (1991), Cutsuries et al (1994), Massada (1991), and McMurray (1950).

  More recent studies have concluded another theory for osteophyte formation is “direct damage to the rim of the anterior ankle cartilage in combination with recurrent micro trauma” this could be caused by the direct impact of the soccer ball on the anterior of the ankle.  This theory was proposed and cited by Lees et al (1991), Levendusky et al (1988), McCrudden et al (1991), van Dijk et al (1996), and van Dijk et al (1997).

  Although these theories are suggested in many other studies there is relatively little experimental support for any of the theories, and therefore results in the formation of osteophytes and ankle impingement syndrome remaining ambiguous.

  There have been two phases identified in a kicking action, and these phases were proposed by Beraud and Gahery, (1997).  They identified the first stage of the kick as the early postural adjustment (EPA), and stated that little movement was present during this stage, and that it occurred between the “first movement of the postural knee and the first muscle event” Beraud and Gahery, (1997).  The second phase of the kick was identified as the back lift and follow through of the kicking action.

  The most relevant previous study to examine when observing how a maximal velocity shot in soccer may lead to ankle impingement syndrome is that conducted by Tol et al (2002).  The study examined 150 kicking actions performed by 15 professional soccer players, and observed where the ball made contact with the foot, and the location of osteophytes in the participating players.

  In order for this to be achieved Tol et al used high speed video equipment and joint markers.  The results from this study supported the theory proposed and cited by Lees et al (1991), Levendusky et al (1988), McCrudden et al (1991), van Dijk et al (1996), and van Dijk et al (1997), as the study concluded that  ankle impingement syndrome is caused by “…recurrent ball impact” Tol et al (2002).

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  The experiment being conducted for this experiment will involve using 2D video analysis of a soccer kick.  In order for this to be achieved, the subject will have to strike a soccer ball with maximal velocity using the instep of their foot, as this type of kick generates the fastest ball speed. (Asai et al, 2002).  The 2D video analysis will then be used to examine whether the ankle moves into hyper-plantarfelxion, and enable a conclusion to be drawn on whether osteophytes are prone to occur due to the repeated nature of the maximal velocity soccer kick.

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