Journal of Athletic Training
Journal of Athletic Training
? by the National Athletic Trainers’ Association, Inc
Ankle Injuries Among United States High School
Sports Athletes, 2005–2006
Alex J. Nelson, BA*; Christy L. Collins, MA†; Ellen E. Yard, MPH†;
Sarah K. Fields, JD, PhD*; R. Dawn Comstock, PhD*†
*The Ohio State University, Columbus, OH; †Columbus Children’s Research Institute, Children’s Hospital,
Context: Ankle injuries are the most common sport-related
injuries. To date, no studies have been published that use na-
tional data to present a cross-sport, cross-sex analysis of ankle
injuries among US high school athletes.
Objective: To investigate the incidence rates of ankle injuries
by sex, type of exposure, and sport.
Design: Descriptive epidemiologic study.
Setting: One hundred US high schools.
Patients or Other Participants: United States high school
Main Outcome Measure(s): We reviewed ankle injury data
collected over the 2005–2006 school year from a nationally rep-
resentative sample obtained by High School RIO, an injury sur-
veillance system. Specific sports studied were boys’ football,
boys’ and girls’ soccer, girls’ volleyball, boys’ and girls’ basket-
ball, boys’ wrestling, boys’ baseball, and girls’ softball.
Results: An estimated 326396 ankle injuries occurred na-
tionally in 2005–2006, yielding an injury rate of 5.23 ankle in-
juries per 10000 athlete-exposures. Ankle injuries occurred at
a significantly higher rate during competition (9.35 per 10000
athlete-exposures) than during practice (3.63) (risk ratio ? 2.58;
95% confidence interval ? 2.26, 2.94; P ? .001). Boys’ bas-
ketball had the highest rate of ankle injury (7.74 per 10000
athlete-exposures), followed by girls’ basketball (6.93) and
boys’ football (6.52). In all sports except girls’ volleyball, rates
of ankle injury were higher in competition than in practice. Over-
all, most ankle injuries were diagnosed as ligament sprains with
incomplete tears (83.4%). Ankle injuries most commonly
caused athletes to miss less than 7 days of activity (51.7%),
followed by 7 to 21 days of activity loss (33.9%) and more than
22 days of activity loss (10.5%).
Conclusions: Sports that combine jumping in close proximity
to other players and swift changes of direction while running
are most often associated with ankle injuries. Future research
on ankle injuries is needed to drive the development and im-
plementation of more effective preventive interventions.
Key Words: injury surveillance, injury epidemiology, lower
• This is the first study to compare the epidemiology of ankle injuries across sports and between sexes among US high
school athletes using nationally representative data.
• Among US high school athletes participating in 9 sports during the 2005–2006 school year, ankle injuries accounted for
22.6% of all injuries, with a total ankle injury rate of 5.23 injuries per 10000 athlete-exposures.
• Of the high school sports studied, the 4 that involve jumping in close proximity to other players and swift changes of
direction while running (football, basketball, soccer, and volleyball) were those with the highest rates of ankle injury.
• Studies are needed to enhance our understanding of ankle injuries in high school athletes and to drive the development
and implementation of more effective targeted preventive interventions.
enrolled students and demonstrates the 17th straight year of
growth in high school athletic participation. Although athletics
play an important role in an adolescent’s adoption of a healthy
lifestyle, including physical fitness, participation in any sport
carries an inherent risk of injury. As high school athletic par-
ticipation continues to grow, the incidence of sport-related in-
jury is also expected to increase.
Patterns of sports-related injury vary by sport,2–4sex,2,3,5–7
age,2,3,8,9and type of athletic exposure (eg, competition or
practice).6,10Despite sport-specific patterns, one fact is con-
sistent: of the nearly 2000000 injuries that occur yearly in
n the 2005–2006 school year, more than 7.1 million stu-
dents in the United States (US) participated in high school
athletics.1This represents an all-time high of 53.5% of
organized high school athletics,11the ankle is the most com-
monly reported body site of injury.1,2,4–8,10–17The high rate
of ankle injuries among athletes has driven researchers to at-
tempt to identify risk factors2–6,8,10–12,17,18and preventive
methods.16,19–21Prior reports of ankle injuries among athletes
have included single sports in a limited population,5,6,15,17
evaluation of risk or preventive factors,16,19,20,21and general
sport-related injury studies in which the ankle was only one
of many injured sites.2–4,8–13,16,18,22None of these authors
have presented a comparative epidemiology of ankle injuries
across sports and between sexes among high school athletes
using nationally representative data. Well-designed surveil-
lance systems are needed to collect the accurate exposure and
Journal of Athletic Training
in close proximity to other players and swift changes of di-
rection while running (football, basketball, soccer, and volley-
ball) were those most often associated with injuries to the an-
kle. To enhance our understanding of ankle injuries in high
school athletes, future researchers could combine the reporting
power of High School RIO with the preseason studies and
tracking that have been used in prior studies, such as preseason
evaluation of postural sway,21ankle strength and flexibility,21
preseason compilation balance scores,16and presence of par-
ticular types of ankle braces and their resultant effective-
ness.19,20Future research will add to our growing knowledge
of the patterns of ankle injuries and, thus, will drive the de-
velopment and implementation of more effective preventive
The lead author was funded by the Samuel J. Roessler Scholarship
from the Landacre Honor Society at The Ohio State University Col-
lege of Medicine. This study was funded by the Centers for Disease
Control and Prevention (CDC), grant R49/CE000674. The content of
this report is solely the responsibility of the authors and does not
necessarily represent the official views of the CDC.
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Alex J. Nelson, BA, contributed to analysis and interpretation of the data and drafting, critical revision, and final approval of the article.
Christy L. Collins, MA, contributed to conception and design; acquisition and analysis and interpretation of the data; and drafting, critical
revision, and final approval of the article. Ellen E. Yard, MPH, contributed to conception and design, acquisition of the data, and critical
revision and final approval of the article. Sarah K. Fields, JD, PhD, contributed to conception and design and drafting, critical revision,
and final approval of the article. R. Dawn Comstock, PhD, contributed to conception and design; acquisition and analysis and interpretation
of the data; and drafting, critical revision, and final approval of the article.
Address correspondence to Christy L. Collins, MA, Center for Injury Research and Policy, Columbus Children’s Hospital, 700 Children’s
Drive, Columbus, OH 43205. Address e-mail to firstname.lastname@example.org.