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Collegiate female gymnasts are at high risk of Achilles tendon injuries. Achilles tendon ruptures can negatively impact an athlete's ability to return to competitive sport. Understanding the natural history of Achilles tendon tears in collegiate female gymnasts is important in the development of preventive treatment. To expand our knowledge of the natural history of Achilles tendon ruptures among collegiate female gymnasts, a REDCap retrospective survey was emailed to athletic trainers on all 80 National Collegiate Athletic Association (NCAA) women's gymnastics teams. The survey gathered information regarding number of Achilles tendon injuries, pain prior to injuries, events and skills on which injuries occurred, and functional outcome after injuries among athletes competing in the 2013 to 2018 NCAA seasons. Forty-two of 80 (52.5%) programs responded to the survey. Seventy-one Achilles tendon ruptures were reported between 2013 and 2018. Among these, 46% had antecedent pain. Gymnasts sustained 95% of Achilles tendon ruptures while performing on floor exercise, with 98% of ruptures occurring during the take-off portion of a tumbling skill. Of the 61% of gymnasts who were able to return to competition, 59% were able to achieve the same level of function after injury. Achilles tendon ruptures in collegiate female gymnasts primarily occur during the take-off motion while tumbling on the floor exercise. Future studies should evaluate degenerative Achilles tendon changes in collegiate female gymnasts. A collaborative effort among gymnasts, coaches, judges, and medical experts is required to identify at-risk athletes and develop and implement injury prevention programs. [ Orthopedics . 2023;46(4):205-210.].

Abstract: Gymnastics is a popular sport with a high injury rate, particularly at the collegiate level. Achilles tendon rupture is a catastrophic injury with career-changing impact. Over the last decade, there has been a growing incidence of Achilles tendon ruptures, especially in female gymnasts. Currently, neither the effects of contributing risk factors on Achilles tendon rupture nor the research frameworks to guide future intervention strategies have been well described. This article reviews the functional anatomy and mechanical properties of the Achilles tendon, provides precollegiate and collegiate intrinsic and extrinsic risk factors for Achilles tendon rupture, and proposes a research framework to address this injury from a systemic perspective. Potential clinical interventions to mitigate Achilles tendon injury are proposed based on currently available peer-reviewed evidence., (Copyright © 2023 by the American College of Sports Medicine.)

Background: Achilles injury risk in women's collegiate gymnastics is 10-fold higher than in all other collegiate sports. This study aims to identify risk factors for Achilles tendon ruptures in collegiate female gymnasts., Hypothesis: Gymnasts with Achilles tendon ruptures will be more likely to report early gymnastics specialization, elite-level training before college, and performance of high-difficulty skills on floor and vault., Study Design: Cross-sectional study., Level of Evidence: Level 4., Methods: Anonymous surveys were distributed to current and former collegiate female gymnasts, aged 18 to 30 years, via coaches, athletic trainers, Twitter, and ResearchMatch. Information about Achilles tendon ruptures, gymnastics-related injuries, sport specialization, event/skills participation, and medication use were collected., Results: A total of 581 gymnasts were included. One hundred gymnasts (17.2%; 95% CI: 14.1%-20.3%) reported Achilles tendon ruptures during collegiate training or competition. Most ruptures (91%) occurred on floor exercise; 85.7% of these occurred during back tumbling-take-off. Compared with gymnasts without ruptures during college, a greater percentage of gymnasts with ruptures competed at a Division I program, trained elite, competed difficult vaults and floor passes before and during college, competed in all 4 events during college, identified as Black/African American, and used retinoid medications., Conclusion: Achilles tendon ruptures are more common in women's collegiate gymnastics than other sports. Competing at the elite level, performing difficult floor and vault skills, and competing in all 4 events may increase the risk for an Achilles tendon rupture. Potential nontraining risk factors include retinoid exposure and Black/African American race. Future studies regarding the mechanisms of Achilles tendon ruptures in female collegiate gymnasts are warranted., Clinical Relevance: Collegiate gymnasts who compete at the elite level, perform high levels of difficulty on floor and vault, and compete in all 4 events may be at increased risk for Achilles tendon ruptures.

Objectives: To determine whether differences in landing force and asymmetry of landing force exist between gymnasts at the time of data collection versus those that subsequently experienced an ankle injury 12-months later., Study Design: Prospective longitudinal observational design with baseline measures and 12 month follow up., Setting: British Gymnastics National Training Centre., Participants: Thirty-two asymptomatic elite level gymnasts from three artistic gymnastic squads (n = 15 senior female, n = 10 junior female and n = 7 senior male)., Main Outcome Measures: A modified drop land task was used to quantify measures of landing performance. Peak Vertical Ground Reaction Force (PVGRF) was used to measure landing force. The level of inter-limb asymmetry of landing force was calculated using the Limb Symmetry index (LSI). Other measures included injury incidence and percentage coefficient of variation (% CV)., Results: There was no statistical difference for landing force (p = 0.481) and asymmetry of landing force (p = 0.698) when comparing injured and non-injured gymnasts. Most participants (69%) demonstrated inter-limb asymmetry of landing forces., Conclusions: Our findings observed inter-limb asymmetry of landing force in injured gymnasts, although uninjured gymnasts also exhibited asymmetry of landing force. Both magnitude of landing force and inter-limb asymmetries of landing force failed to identify the risk of ankle injury., Competing Interests: Declaration of competing interest Lee Herrington is journal editor. No other authors have conflicts of interest to declare., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To establish normative data for weightbearing dorsiflexion (WBDF) in elite artistic gymnasts., Design: Quasi-experimental design with descriptive analysis (mean, SD, 95% CI). Use of independent t-test to analyse gender differences, and dependent t-test to analyse WBDF injured limb compared to contralateral uninjured limb., Setting: Data Collection at British Gymnastics Lilleshall National Sports Centre during national squad training camp., Participants: 55 Participants of the British Gymnastics National Artistic Squad (27 male and 28 female)., Main Outcome Measure: Weightbearing lunge test to measure WBDF using a digital inclinometer., Results: There was no significant difference (p > 0.05) for gender and WBDF, although females had less range and greater variability (female mean ± SD = 45.0°±6.8°, 95% CI 42.6°, 47.6°; male mean ± SD 45.6°±5.4°, 95% CI 43.7°, 47.6°). There was a significant difference (t[23] = -3.259, p < 0.05) for previous injury and WBDF (uninjured mean ± SD 47.4°±5.7°, 95% CI 45.0°, 49.8°; injured 45.1°±6.0°, 95% CI 42.6°, 47.7°)., Conclusions: Gymnasts with a unilateral injury history have significantly less WBDF in the injured limb compared to the contralateral uninjured limb. Females have less WBDF than males, however this was not significant. Further research is needed to establish if this deficit in WBDF after injury is an issue during gymnasts' landings., Competing Interests: Declaration of competing interest None., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Dislocation of the posterior tibial tendon is an uncommon condition. Although surgery is usually performed in most cases of posterior tibial tendon dislocation, postoperative repeat dislocation of the posterior tibial tendon has not been reported in the published data. We report the case of a 27-year-old male patient who experienced repeat dislocation of the posterior tibial tendon after a gymnastic landing, 44 months after initial retinaculum repair. For revision surgery, we reconstructed the flexor retinaculum in conjunction with deepening of the retromalleolar groove, because the groove was hypoplastic. He returned to competitive gymnastics and had not experienced subluxation or dislocation of the posterior tibial tendon at the 1-year follow-up examination., (Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Context:   Deltoid ligament sprains among collegiate student-athletes have not been extensively investigated. Research regarding the mechanisms, participation-restriction time, and recurrence of deltoid ligament sprains in collegiate student-athletes is lacking., Objective:   To describe the epidemiology of deltoid ligament sprains in 25 National Collegiate Athletic Association championship sports., Design:   Descriptive epidemiology study., Setting:   National Collegiate Athletic Association Injury Surveillance Program., Main Outcome Measure(s):   We analyzed deltoid ligament sprains recorded in the Injury Surveillance Program for the 2009-2010 through 2014-2015 academic years. Deltoid ligament sprain injury rates, rate ratios, and injury proportion ratios with 95% confidence intervals (CIs) were reported., Results:   During the study period, 380 deltoid ligament sprains were reported, resulting in a combined injury rate of 0.79/10 000 athlete-exposures (AEs; 95% CI = 0.71, 0.87). Most deltoid ligament sprains occurred in practices (54.2%, n = 206). However, the competition injury rate was higher than the practice injury rate (rate ratio = 3.74; 95% CI = 3.06, 4.57). The highest deltoid ligament sprain rates were in women's gymnastics (2.30/10 000 AEs; 95% CI = 1.05, 3.55), men's soccer (1.73/10 000 AEs; 95% CI = 1.14, 2.32), women's soccer (1.61/10 000 AEs; 95% CI = 1.13, 2.09), and men's football (1.40/10 000 AEs; 95% CI = 1.18, 1.62). Nearly half of all deltoid ligament sprains (49.7%, n = 189) were due to player contact, and 39.5% (n = 150) were non-time-loss injuries (ie, participation restricted for less than 24 hours). Only 8.2% (n = 31) of deltoid ligament sprains were recurrent., Conclusions:   The highest deltoid ligament sprain rates were in women's gymnastics, men's and women's soccer, and men's football. However, the rate for women's gymnastics was imprecise (ie, the CI was wide), highlighting the need for further surveillance of deltoid ligament sprains in the sport. Most deltoid ligament sprains were due to player contact. Future researchers should assess interventions that may prevent deltoid ligament sprains.

Purpose: About 70% injury of gymnasts happened during landing - an interaction between gymnast and landing mat. The most injured joint is the ankle. The current study examined the effect of mechanical properties of landing mat on ankle loading with aims to identify means of decreasing the risk of ankle injury., Method: Gymnastic skill - salto backward stretched with 3/2 twist was captured by two high-speed camcorders and digitized by using SIMI-Motion software. A subject-specific, 14-segment rigid-body model and a mechanical landing-mat model were built using BRG.LifeMODTM. The landings were simulated with varied landing-mat mechanical properties (i.e., stiffness, dampness and friction coefficients)., Result: Real landing performance could be accurately reproduced by the model. The simulations revealed that the ankle angle was relatively sensitive to stiffness and dampness of the landing mat, the ankle loading rate increased 26% when the stiffness was increased by 30%, and the changing of dampness had notable effect on horizontal ground reaction force and foot velocity. Further, the peak joint-reaction force and joint torque were more sensitive to friction than to stiffness and dampness of landing mat. Finally, ankle muscles would dissipate about twice energy (189%) when the friction was increased by 30%., Conclusion: Loads to ankles during landing would increase as the stiffness and dampness of the landing mat increase. Yet, increasing friction would cause a substantial rise of the ankle internal loads. As such, the friction should be a key factor influencing the risk of injury. Unfortunately, this key factor has rarely attracted attention in practice.

Unlabelled: Dislocation of the posterior tibial tendon (PTT) is a rare pathological process that occurs most often as a result of acute trauma. The injury involves forced dorsiflexion and eversion of the foot against a contracted posterior tibialis. Diagnosis of the injury is often difficult secondary to the rarity of the injury and its similarity with other benign injuries of the medial ankle. Routine diagnostic imaging often does not reveal the injury, and advanced imaging with magnetic resonance imaging or ultrasound to confirm the diagnosis is often required. The injury can be a result of an abnormal retromalleolar groove or a tear of the flexor retinaculum. Because nonoperative treatment frequently results in poor outcomes with continuing pain and progressive flat foot, operative treatment with repair of the flexor retinaculum with correction of the retromalleolar groove is the most described intervention. We report an acute case of PTT dislocation in a collegiate gymnast during competition and offer our technique for surgical correction in the setting of a partially torn, attenuated flexor retinaculum with plate buttressing of the PTT into its native uncorrected groove., Levels of Evidence: Therapeutic, Level IV: Case study., (© 2015 The Author(s).)

Studies regarding ankle and foot overuse injuries are quite diverse in research methodology, data reporting, and outcomes. The aims of this systematic review were to analyze the methodology of published studies regarding ankle and foot overuse injuries in different sports disciplines and to summarize epidemiological data of ankle and foot overuse injuries. Four electronic databases, PubMed (MEDLINE), EMBASE, CINAHL, and SPORTDiscus(®) were systematically searched up to June 2011. A total of 89 articles on 23 sports disciplines were included in this review. Soccer, running, and gymnastics were the most frequently studied sports. Achilles tendinopathy, plantar fasciitis, and stress fracture were the most frequently studied injuries. Study design and reporting methods were heterogeneous. Most studies suffered from a weak methodology and poor reporting. The most common weaknesses were lack of a clear case definition, describing assessment procedures and reporting sample characteristics. Due to methodological heterogeneity of studies, inter-sports and intra-sports comparisons and meta-analysis were not possible. Methodology of most studies on incidence and prevalence of ankle and foot overuse injuries is insufficient. Based on the results, we recommend authors to clearly define cases, describe assessment procedures and report sample characteristics adequately., (© 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Calcific myonecrosis is a late complication of a previous trauma which presents as a calcified fusiforme mass on an x-ray film. It is affecting mostly the anterior compartment of the lower leg. 43 cases have been reported in the literature and are reviewed. The current authors report a case of calcific myonecrosis with calcific tenosynovitis of the tibialis anterior muscle. Precipitated hydroxyapatite crystals were found by ultrasound-guided aspiration, the lesion was then treated by injection of corticosteroids and an anesthetic.

Background: Gymnastics is a competitive and popular sport that is started at an early age, and elite female gymnasts reach their prime in mid-teenage years. The level of intensity of practice and competition, the number of events, and the degree of difficulty of the maneuvers make gymnastics one of the most injury-producing sports., Methods: Over a 3-year period, 14 elite, female gymnasts were seen in one foot and ankle center. The mean age was 17 (range 14 to 21) years. All gymnasts sustained acute or sub-acute injuries to the foot or ankle requiring surgery. The mechanism of injury, the type of injury, operative repair, and followup were recorded., Results: There were five Lisfranc fracture-dislocations, and five talocalcaneal, two multiple metatarsal, one medial malleolar, one phalangeal, and one sesamoid fracture. All injuries had operative repair. One gymnast with a Lisfranc injury was able to return to full competition; all others with a Lisfranc injury retired from gymnastics, were lost to followup, or graduated from college. One gymnast with a talar osteochondral injury was not able to return to competition but all other injured gymnasts were able to return to gymnastics at the same level or higher., Conclusion: Elite female gymnasts can sustain significant injury to the foot and ankle region. In our study, Lisfranc injuries were most likely career-ending.

Objectives: To record the incidence of lower limb injuries (acute and overuse syndromes) in Greek artistic gymnasts in relation to the event and exercise phase., Methods: A total of 162 gymnasts (83 male and 79 female athletes) participating in the Greek artistic gymnastic championships were observed weekly for the 1999-2000 season., Results: Ninety three (61.6%) acute injuries and 58 (38.4%) overuse syndromes were recorded. The most common anatomical location was the ankle (69 cases, 45.7%), followed by the knee (40 cases, 26.5%). The rate of mild injuries was 26.6% (25 cases), that of moderate injuries was 44% (41 cases), and that of major injuries was 29% (27 cases). The incidence of injury to the ankle and knee was significantly higher in the floor exercise, especially during the landing phase, than in the other events., Conclusions: By its nature, gymnastics predisposes to acute injuries, but up to 75% are mild or moderate. Special attention should be paid to the floor exercise, especially the landing phase.

Stress fracture of the medial malleolus is rare and not reported in children. We report a case of a 15-year-old elite gymnast with open physes sustaining a medial malleolar stress fracture. The patient was treated initially by rest and gradually returned to sport with full recovery. Two months later she developed a complete fracture of the medial malleolus of the same side. This was treated surgically by open reduction and internal fixation with a cancellous screw and soon after the operation she returned to full activities. Emphasis is given to the suspected mechanism which led to this unique fracture and to the hormonal aspects in the professional adolescent gymnast. We recommend surgical treatment of stress fracture of the medial malleolus especially for elite athletes, leading to early recovery and return to sports activities.

If ankle proprioception can be determined to be impaired, then treatment can be more specifically directed toward correcting the proprioceptive deficit, thereby improving functional ability. The purpose of this study was to determine if collegiate level gymnasts with unilateral, multiple ankle sprains (ie., chronic ankle sprains) had decreased ability to detect passive plantar flexion of the ankle (ie., decreased ankle proprioception) and to determine if balance deficits existed during one-legged stance. Eleven gymnasts participated in 30 passive movement trials (15 movement and 15 nonmovement) presented randomly on both the injured and noninjured sides. The nonmovement trials consisted of either no movement of the ankle or passive movement of the ankle into 5 degrees of plantar flexion. Luce's choice theory determined that subjects were not biased in responding to a "yes" in perceiving movement or no movement during the movement/nonmovement trials of passive plantar flexion. Subjects were better able to detect movement during movement trials with their uninjured ankles than their injured ankles. Subjects also performed single 30-second trials of one-legged standing on each leg, with eyes open and with eyes closed. Subjects reported better balance when standing on the uninjured ankle during the one-legged stance conditions. Although our results cannot be extrapolated to balance abilities during complex gymnastic routines, they do suggest that physical therapy assessment includes passive detection of joint position as well as single-legged stance tests, and that perhaps rehabilitation programs incorporate sports-specific balance activities for such injuries.

Women's gymnastics athletes in the National Collegiate Athletic Association (NCAA) constitute a unique population of NCAA athletes given the nature and dynamics of the sport. Routine examination of women's gymnastics injuries is important for identifying the evolving burden of injuries in this sport. Exposure and injury data collected in the NCAA Injury Surveillance Program during 2014–2015 through 2018–2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics; injury rate ratios were used to examine differential injury rates. The overall injury rate was 8.00 per 1000 athlete-exposures; injury incidence was greater in competitions than in practices (injury rate ratio = 1.84; 95% CI = 1.48, 2.29), though practice injury rates increased during 2015–2016 through 2018–2019. Most injuries were classified as strains (16.5%), sprains (16.4%), and inflammatory conditions (12.3%), with overuse injuries prevalent among practice injuries (22.5%). Concussions (8.4%) were the most commonly reported specific injury. The increasing trend in practice injury incidence is noteworthy although competition injury rates were higher overall. Findings also suggest that the etiologies of overuse injuries and inflammatory conditions as well as the biomechanical aspects of concussions warrant further attention. [ABSTRACT FROM AUTHOR]

Background: Foot and ankle injuries comprise a significant proportion of all injuries sustained by National Collegiate Athletic Association (NCAA) athletes. In particular, sports that combine jumping and rapid changes in direction are associated with increased lower extremity injuries. Purpose: To describe the epidemiology of foot and ankle injuries in men's and women's jumping sports, including NCAA men's and women's basketball, women's volleyball, and women's gymnastics, during the 2009-2010 through 2013-2014 seasons. Study Design: Descriptive epidemiology study. Methods: Injury-surveillance data were obtained from the NCAA Injury Surveillance Program for the 2009-2010 through 2013-2014 seasons. Injuries were examined by mechanism, activity during injury, and participation restriction time. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios, and risk ratios with 95% CIs were calculated. Reported sex differences were calculated for men's and women's basketball. All 95% CIs not containing 1.0 were considered statistically significant. Results: A total of 1136 players sustained foot and ankle injuries (483 male and 653 female) over 612,680 AEs. These injuries resulted in a combined rate of 1.85 per 1000 AEs (95% CI, 1.75-1.97). Ankle sprains were the most common injury (63.7%), with lateral ligamentous complex injuries making up 77.1% of all ankle sprains. The most common foot injury varied based on sport and sex. Ankle injury rates were higher in male versus female basketball players (injury rate ratio, 1.33 [95% CI, 1.13-1.57]), but foot injury rates did not differ. Among basketball and volleyball players, player contact during jumping was the most common injury mechanism. Female gymnasts had higher overuse injury rates than other athletes (0.49/1000 AEs [95% CI, 0.30-0.74]; P < .002). Overall, female basketball players were 1.81 times more likely to sustain an overuse injury than male basketball players (95% CI, 1.02-3.20; P ¼ .02). Conclusion: The most common foot and ankle injury sustained in collegiate jumping sports was a lateral ligamentous complex ankle sprain. Injury-prevention programs focusing on ankle flexibility, strength, and proprioception may help to alleviate the injury burden and lessen severity. Improving the anticipation of contact during jumping and landing may reduce injury rates and increase player safety. The increased prevalence of overuse injuries in female collegiate athletes competing in jumping sports necessitates further investigation to reduce injury rates through prevention and training programs. [ABSTRACT FROM AUTHOR]

Gymnastics is a sport requiring grace, strength, and flexibility, resulting in a wide variety of injuries. This article is an overview of the sport of gymnastics and associated injury trends in the artistic gymnastics population. Injury rates in gymnastics range from 1.08 to 50.3 per 1000 h of exposure. More injuries occur in competition versus practice. Fewer injuries occur in recreational gymnastics than competitive gymnastics. The most common injury in gymnastics occurs in the lower extremity, and is an ankle sprain, followed by knee internal derangement. However, in men's gymnastics the most common gymnastics injury occurs in the upper body (specifically the shoulder). The most common skills causing injury to a gymnast are front/back handsprings and saltos/flips. Unique injuries commonly seen when caring for the young gymnast include spondylolysis, ostoechondritis dissecans of the capetillium and talus, Gymnast wrist, Grip lock, Osgood-Schlatter, patellofemoral syndrome, Sever's disease, and ankle sprains. Research efforts should focus on injury rates after the 2006 rule change, injury prevention, men's gymnastics injury patterns, concussions, hip injuries, and ACL injuries in gymnasts. [ABSTRACT FROM AUTHOR]

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HISTORY: 12 yo F presents for right ankle injury and persistent pain. Patient suffered a subacute injury to her right ankle approximately 6 months prior. Reports no specific injury but notified significant discomfort along the lateral right ankle during gymnastics. Patient was evaluated in the ED and x-rays were negative, and was treated with crutches and a Cam walking boot. Patient completed physical therapy with minimal improvement. Patient reports sharp pain with ambulation. Failed physical therapy, home exercise program, ASO brace, and Naproxen BID. Worsening significantly over the past 2 months and now unable to bear weight without significant pain. No systemic symptoms such as anorexia, malaise, weight loss, or night sweats. PHYSICAL EXAMINATION: Inspection reveals no obvious erythema, ecchymosis, bony deformity, or asymmetry. Slight swelling just distal to the lateral maleolous compared to the left side. TTP present at the peroneal tendons as they cross distal to the lateral maleolous. ROM full. Strength 5/5. Proximal Fibula nontender. Kleigers neg. Calcaneal Squeeze neg. Longitudinal arch mostly intact. Transverse arch intact. Normal pulses. Normal sensation. DIFFERENTIAL DIAGNOSIS: 1. Post-traumatic peroneal tendinitis 2. Sinus Tarsi Syndrome 3. Osteochondritis dissecans 4. Tarsal coalition 5. Infectious arthritis 6. Bone tumor 7. Osteomyelitis TESTS AND RESULTS: - MRI Right Ankle: Large, aggressive-appearing destructive heterogeneous calcaneal lesion with cortical breakthrough with lateral as well as medial soft tissue components. Mass also extends into the subtalar joint. Lesion is concerning for osteosarcoma, Ewing sarcoma, or osseous lymphoma. Lesion measures 6.5 x 3.3 x 3.5 cm. - Biopsy with I&D: Pathology consistent with chronic osteomyelitis. Cultures uninformative. FINAL WORKING DIAGNOSIS: Chronic Recurrent Multifocal Osteomyelitis of the Right Calcaneus TREATMENT AND OUTCOMES: 1. Clinic follow up with Ortho and Infectious Disease 2. Antibiotic treatment with Keflex x 4 months. Pain medication prn. 3. Required repeat biopsy and I&D after failed outpatient antibiotic therapy. Repeat bacterial and fungal cultures all negative. Broad spectrum antibiotic treatment with Clindamycin & Ciprofloxacin. 4. Started to weight-bear at 5 months.5. Full weight-bearing at 6 months. [ABSTRACT FROM AUTHOR]

Presents an abstract of the study `Evaluation of Kinesthetic Deficits Indicative of Balance Control in Gymnasts With Unilateral Chronic Ankle Sprains,' by D.M. Forkin, C. Koczur et al, published in the `Journal of Orthopedics and Sports Physical Therapy' in 1996.