Plant and Twist Injuries in Football

As a high-impact sport that requires speed, agility, power and strength, football players are often engaged in quick movements and changes in direction, increasing the potential for lower extremity injuries.

Individual factors such as strength, imbalance, previous injuries, playing surface, shoe type, age, and intensity of the activity, play a crucial role in determining vulnerability to injuries in any sport.

Among the most injured joints on the field is the first metatarsal phalangeal joint (MTPJ), with a higher incidence of these injuries occurring on artificial surfaces as compared to grass.

When a player is being tackled or if there is intense force applied at pushoff as the player sprints off the line, the big toe could land hard on the artificial surface causing injury to the cartilage of the first MTPJ.

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This could also be the result of external forces (such as being hit by an opponent) or general rotational forces which occur when one is cutting sharply as the foot stays firm on the ground.

The rotational forces cause the hallux to remain glued to the surface, leading to a locking of the first MTP, which results in an osteochondral compression injury.

Among some of the less common injuries could be a stretch or rupture of the flexor capsule, tendons or fracture of the sesamoid bones.

Turf toe is a collective term used to describe a sprain of the medial or lateral collateral ligaments around the big toe joint, caused when the big toe is bent beyond its normal range of motion.

The playing surface and flexibility of footwear are considered to be the most common etiological factors for turf-toe type injuries. The athlete is most vulnerable while pivoting with lightweight flexible cleats on hard playing surfaces, especially with a weak foot posture.

Sharp acceleration, deceleration or cutting during the game, can cause ankle sprains. These occur when the upper body moves faster than the foot as it remains planted on the surface. This twists the ligaments especially of the lateral side (inversion), causing swelling, tenderness and instability in the ankle.

The anterior cruciate ligament (ACL) can also be injured in several ways on the field - stopping suddenly, changing direction rapidly or landing from a jump. The use of cleats increases the risk of stretches and tears in the ACL.

A progressive approach to both rehabilitation and prevention is required to reduce the likelihood of re-injury and to get the players back on the field quickly and safely.

Proper rest, conditioning and exercises (involving strengthening and flexibility) must be an inclusion in any rehabilitation program to reduce injury levels.

It is highly important to conduct a thorough evaluation of the athlete’s foot structure, as well as shoe and cleat wear, and to make adjustments accordingly.

Active rehabilitation programmes need to focus on treating biomechanical faults in the lower extremity because of the negative implications in movement and postural alignment. 

With foot postural disparities minimised, the athlete will have a reduced predisposition to lower extremity injuries during a game. This will help in enhancing performance and preventing plant and twist injuries in football.  

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