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The rate of knee osteoarthritis among former professional football players was found to be high. Analogously, the question arises whether former players might be at risk on the long-term for ankle osteoarthritis.

By dr. Vincent Gouttebarge, PhD

 

In a previous blog on FIFPro.org, knee osteoarthritis among former professional football players was discussed. Known worldwide as the leading cause of pain of the musculoskeletal system (muscles, bones, ligaments), osteoarthritis is a joint disease caused by the overuse of joint cartilage. Osteoarthritis results in irreversible cartilage change and damage in the affected joint that can lead to pain, stiffness, reduced function, instability, deformity, and activity impairments. The rate of knee osteoarthritis among former professional football players was found to be high, because of the sustain exposure to activities involving the knee joints and the occurrence of knee injuries during their career. Analogously, the question arises whether former players might be at risk on the long-term for ankle osteoarthritis. 

The rate of ankle osteoarthritis among former professional football players
Kuijt and colleagues explored in 2012 the recent scientific evidence about the rate of ankle osteoarthritis among former professional football players. Only two scientific studies were available about how many former professional football players suffer from ankle osteoarthritis, endorsing the lack of research about negative long-term health effects as a consequence of a football career. Based on both studies conducted in the United Kingdom, it was shown that 9% to 17% of former players having played professional football for nearly 14 years suffered from ankle osteoarthritis at an age around 40 years old. A recent study by Armenis and colleagues explored the rate of ankle/foot osteoarthritis in a group of 105 former Greek professional football players (older than 40 years) who had played professional football for 8 to 10 years. Osteoarthritis signs were found in 4 to 9% of these former professional football players. 

Whether the rate of ankle osteoarthritis in former professional football players is also alarming, can be put into perspective when compared to the general population or to athletes from other sport disciplines. As illustrated here below, it is clear that the rate ankle osteoarthritis in former players is high.

 

Comparison groups (age-matched) Rate of ankle osteoarthritis (%)
General population 1
Athletics 0.2
Boxing 0.4
High jumping 2.5
Ice hockey 0
Long distance running 0
Weight lifting 0.9
Former professional football players 9-17

 

The consequences of ankle osteoarthritis for quality of life
The adverse impacts of ankle osteoarthritis on the quality of life and functioning (work and daily living) of former professional football players can not be neglected, even if the number of scientific studies about it is limited. More than 12 years ago, two surveys were conducted in the United Kingdom among up to 285 former professional football players who had played professional football on average for nearly 14 years. From them, 138 suffered from osteoarthritis in a lower limb joint (hip, knee, ankle and/or foot), from which 33 from osteoarthritis in the right ankle and 20 from osteoarthritis in the left ankle. From the former professional football players suffering from osteoarthritis (not solely of the ankle), nearly 90% reported to have moderate or severe joint pain and discomfort, while around 65% indicated to experience moderate or severe problems with mobility and performing usual activities (work, study, house…). In addition, 37% of them reported moderate or severe problems with anxiety/depression because of their medical condition. From these former professional football players suffering from osteoarthritis, 12 were interviewed by telephone in order to retrieved further information about the consequences of their medical condition. With regard to pain, some former professional football players reported that their conditions were chronically very painful, and that the pain was significantly affecting their lives. With regard to restricted mobility and movement, some former professional football players reported that the lack of mobility was a major issue in their lives, moving being hardly possible, especially bending, kneeling and long-standing. With regard to employment, some former professional football players reported that no employer wanted to employ them with their conditions and that they abandoned their jobs for this reason.


The causes of ankle osteoarthritis
In general, age, gender, obesity, life style, joint injury and abnormal joint load have been recognized as risk factors for developing osteoarthritis. When it comes to ankle osteoarthritis in former professional football players, it remains unknown whether the sustain load on the ankle joints resulting from the intense and prolonged physical activities (running, sprinting, jumping and landing, dribbling and passing, duel forms with opponents) during both training and competition, contributes solely on the long-term to the high rate of ankle osteoarthritis.

 

Despite the lack of scientific studies involving large groups of participants, ankle osteoarthritis in former professional football players seems principally attributed to the occurrence and recurrence of ankle injury during a football career. Ligament and cartilage injuries of the ankle joint are common during training and competition, accounting approximately for 20 to 30% of all injuries. While mild ankle sprains do not impair recovery and return to play on short notice, recurrent or severe ankle injuries might have more drastic consequences during a football career in terms of related surgery, rehabilitation and long-term disability. In addition, these recurrent or severe ankle injuries, in combination with their potential surgical treatment, are seen as causes for ankle osteoarthritis on the longer term. 

 

Larsen and colleagues examined in 1999 the occurrence of ankle osteoarthritis in injured and uninjured elite football players, and found that ankle osteoarthritis was present in 33% of the injured joints and only 18% in the uninjured joints. More recently, Valderrabano and colleagues (2009) examined 406 ankles with osteoarthritis among regular patients and found that nearly 80% was due to a previous traumatic ankle injury.


 widthThe management of ankle osteoarthritis?

As acknowledged in my blog about knee osteoarthritis, a management program specifically meant for former professional football players suffering from ankle (and knee) osteoarthritis is lacking and should be developed, of course based on scientific evidence. The development of such a management program is currently having my attention, in consultation with the FIFPro.

 

 

 

 


Key points

  • Despite the lack of scientific studies, it has been suggested that a professional football career might cause negative long-term health effects, especially osteoarthritis of the ankle.
  • 9% to 17% of former players having played professional football for 8 to 14 years suffer from ankle osteoarthritis at an age around 40 years old.
  • This rate of ankle osteoarthritis among former players can be acknowledged as high when compared to other groups (general population around 1%; athletics 0.2%; boxing 0.4%; high jumping 2.5%).
  • 65% to nearly 90% of the former professional football players suffering from osteoarthritis reported to have moderate or severe problems related to joint pain, discomfort and impaired mobility.
  • 37% of the former professional football players suffering from osteoarthritis reported moderate or severe problems related to anxiety/depression because of their medical condition.
  • A management program for former professional football players suffering from ankle osteoarthritis is lacking and needs to be developed.

 

 

Former professional football player Dr. Vincent Gouttebarge is senior researcher at the Coronel Institute of Occupational Health from the Academic Medical Centre in Amsterdam (the Netherlands), and is co-owner of Vintta, a research and consultancy unit for sports health.