Professional football is a high-contact and high-risk sport with musculoskeletal injury, particularly the foot and ankle. The ankle injuries typically occur as sprains, whereas foot injuries are the most common in the form of metatarsal fractures. They usually happen in the field as a result of quick actions, the change of directions, and violent play. These injuries may damage the cartilage and eventually result in osteoarthritis (OA), causing chronic pain and disability.
Corticosteroids, local anesthetics, platelet-rich plasma, and hyaluronic acid are injection therapies that relieve pain and accelerate recovery, but their long-term safety remains uncertain. Injections can cause overuse and mask the pain, increasing the deterioration of cartilage. Male professional footballers who are retired are at a higher risk of developing foot and ankle OA than men in the general population. The objective of the study was to determine whether foot or ankle trauma and corticosteroid independently contribute to OA development in retired male professional footballers.
This case-control study was conducted between August 2020 and October 2021 as part of the Foot and Ankle Osteoarthritis and Cognitive Impairment in Retired UK Soccer Players (FOCUS) study. They were retired male players aged 40 years and above who had played in the top four divisions of the English Football League. Out of the earlier number of 1207 players, 878 agreed to participate. A significant injury was defined as one that caused pain on most days for at least three months and resulted in complete absence from all training and matches. The respondents indicated the use of corticosteroid injections in the foot or ankle. The primary finding was self-reported OA, which was the diagnosis or surgery of a general practitioner of age 40 or older. A subgroup of radiographic assessments was conducted in five NHS-based hospitals.
Covariates included age, body mass index, nodal OA, hallux valgus, gout, flat-footedness, length of career, dose of training, and number of matches played. The adjusted odds ratios (aOR) with 95% confidence intervals (CI) were obtained through logistic regression analysis and had a significance of P < 0.05
A recent study of former footballers found a strong link between foot and ankle osteoarthritis (OA), previous injuries, and joint injections. Of 878 players invited, 468 responded, and 424 were eligible for analysis, including 63 with OA and 361 without.
Players with OA had played more matches (532 vs 455; P = 0.028) and were more likely to have had foot or ankle injuries (73.3% vs 42.5%; P < 0.001) and injections (75.0% vs 48.4%; P < 0.001). Corticosteroid injections were also more common (57.1% vs 32.1%; P < 0.001). Other joint problems, including nodal OA, gout, and hallux valgus, were more frequent among affected players.
In statistical analysis, prior injury (adjusted odds ratio 4.23; 95% CI 1.88–9.48) and joint injection (adjusted odds ratio 2.62; 95% CI 1.19–5.78) remained independent predictors of OA (P < 0.05), showing both as key long-term risk factors.
The study established a close relationship between OA and former footballers with a history of foot or ankle injury. OA was also attributed to injections, probably as a result of treating injuries. The combination of injury and injection accounted for 74% of OA risk and indicated that they are key contributors to post-career OA. Joint degeneration could be facilitated by acute and recurrent joint injuries, coupled with active usage of corticosteroids. This is to be done through preventive measures, cautious administration of injections, and long-term monitoring, which are essential to protect joint retired professional footballers.
Reference: Thanoon AA, Espahbodi S, Shuaib MA, et al. Injury and local injection and the risk of foot/ankle osteoarthritis: a case–control study in retired UK male professional footballers. Rheumatology. 2025;keaf518. doi:10.1093/rheumatology/keaf518
