Sex Differences in Foot and Ankle Sports Injury Rates in Elite Athletes: A Systematic Review and Meta-analysis of 25,687,866 Athlete Exposures.

Background: Female sports participation is at an all-time high, from amateur to professional levels. There has been recent media and scientific focus on the higher rates of injury to the anterior cruciate ligament and head injuries in female athletes compared with male athletes. A similar association has not been emphasized in the foot and ankle. Hence, this research aims to establish the rate of foot and ankle injury at the professional level in female athletes compared with their male counterparts. Purpose/Hypothesis: The purpose of this study was to understand the rate of foot and ankle injuries in professional and semiprofessional athletes. It was hypothesized that female athletes are injured at higher rates compared with their male counterparts. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, Ovid EMBASE, and Ovid MEDLINE were searched for relevant papers up until October 23, 2023. Papers reporting on rates of foot and ankle injuries in female professional or semiprofessional athletes were included, along with a male comparison group. A total of 2510 papers were screened. A meta-analysis was performed on 4 separate subgroups using common and random-effects models. Results: A total of 53 papers met the inclusion criteria, and a meta-analysis of proportions was performed. Of this total, 21 records reported absolute elite athlete numbers and 32 reported athletic exposures. Meta-analyses were performed on these 2 subgroups separately. The literature was found to have a high risk of bias. The rate of injuries to the foot and ankle in female athletes was higher than their male counterparts overall (log odds ratio). Professional female athletes had significantly more injuries compared with their male counterparts using a common-effects model (odds ratio, 1.52 [1.44-1.61]) Chi-square testing demonstrated significant heterogeneity. Conclusion: This systematic review and meta-analysis demonstrated that female athletes suffer foot and ankle injuries at professional and semiprofessional competition levels at higher rates than their male counterparts. The literature on this topic is limited to large observational studies with significant risk of bias and heterogeneity. The current research provided an understanding of the significant effects of foot and ankle injury rates, detailing the increased exposures that are present in female semiprofessional and elite sports.