A recent study published in the esteemed journal Rheumatology by Oxford University Press has revealed compelling evidence linking foot and ankle injuries sustained during professional football careers to a significantly increased risk of developing osteoarthritis post-retirement. This investigation, conducted among retired male professional footballers in the United Kingdom, further identifies that those players who regularly received corticosteroid injections for treatment of such injuries showed an even higher prevalence of osteoarthritis later in life. The implications of these findings could reshape the understanding and management of injury-related joint degeneration in high-impact sports.
Professional football is renowned for its high-intensity, fast-paced physical demands combined with frequent bodily collisions and rapid directional changes. This environment predisposes players to a range of traumatic injuries, particularly concentrated in the lower extremities. Among these, ankle sprains are the most frequent ankle injury, while fractures of the metatarsals dominate foot injuries. The dynamic nature of football—characterized by high-speed sprints, jumps, and abrupt turns—naturally elevates the possibility of acute trauma, especially during competitive matches rather than routine training sessions.
Joint injuries incurred under these conditions often trigger a cascade of biomechanical and biological responses that can degrade articular cartilage and compromise other integral joint structures. Such deterioration manifests clinically as pain, swelling, and ultimately osteoarthritis, a chronic degenerative disease marked by progressive cartilage loss, subchondral bone remodeling, and synovial inflammation. This disease not only diminishes quality of life through persistent discomfort but can also severely limit mobility and functional capabilities, proving to be a major source of disability in the aging athletic population.
While nearly one-quarter of professional male footballers experience significant foot or ankle injuries throughout their careers, the management of these injuries often includes the application of injection therapies designed to alleviate symptoms and expedite return-to-play. Common substances administered include corticosteroids, local anesthetics, platelet-rich plasma, and hyaluronic acid. However, the use of these treatments remains contentious within the medical community due to ambiguous evidence regarding their long-term efficacy and concerns about potential adverse effects on joint integrity.
Corticosteroid injections, in particular, are known for their potent anti-inflammatory effects, offering symptomatic relief that enables players to maintain competitive participation despite ongoing joint damage. Nonetheless, these injections may mask deeper structural harm by reducing pain and inflammation without addressing the underlying tissue degeneration. This concealment of injury severity potentially encourages continued high-impact activity, which could accelerate chondral degradation and hasten the onset and progression of osteoarthritis.
The research team, led by Professor Weiya Zhang of the University of Nottingham, conducted a comprehensive survey of 424 retired UK professional footballers between August 2020 and October 2021. Participants were queried on their history of clinically diagnosed foot or ankle osteoarthritis confirmed by a general practitioner, and whether they had undergone surgical interventions involving the forefoot or ankle after retirement from sport. The survey data were meticulously analyzed to investigate correlations between injury, treatment modalities, and subsequent osteoarthritis development.
Findings revealed a striking statistic: 73% of retired players diagnosed with osteoarthritis reported having sustained foot or ankle injuries during their playing careers. Even more notable, 75% of those with osteoarthritis indicated receiving corticosteroid injections for their injuries. The study highlighted a dose-dependent relationship, where multiple injections into the same ankle—often exceeding the recommended limit of four per season—were associated with an increased likelihood of osteoarthritis, suggesting a potentially deleterious effect of repetitive corticosteroid exposure on joint health.
However, the investigators prudently emphasize that causality cannot be conclusively established from this observational data. The association between corticosteroid injections and osteoarthritis risk may be confounded by injury severity, as players with more significant joint trauma are both more likely to receive multiple injections and to develop osteoarthritis. Nevertheless, the data raise critical questions about the long-term safety profile of frequent corticosteroid administration in high-impact athletes and underscore the need for caution in clinical decision-making.
Professor Zhang underscored the modifiable nature of this risk factor, stating that “a significant foot or ankle injury during a player’s career is a major, modifiable risk factor of osteoarthritis late in life.” This insight underlines the importance of injury prevention strategies, early detection, optimal injury management, and potentially reconsidering current protocols surrounding the judicious use of injection therapies to safeguard players’ joint health over the long term.
This case-control study contributes to the growing body of literature examining the intricate relationship between athletic injuries, treatment interventions, and the subsequent development of degenerative joint diseases. Its findings hold significant ramifications not only for professional athletes but also for sports medicine practitioners, orthopedic surgeons, and rehabilitation specialists aiming to balance effective injury management with the preservation of joint integrity and function.
With professional football’s unparalleled global popularity and the increasing awareness of sports-related musculoskeletal health, these findings warrant urgent attention and further research. Future studies are needed to elucidate the specific mechanisms by which corticosteroid injections may interact with joint biology under chronic mechanical stress and to define safer treatment paradigms that minimize long-term harm while optimizing performance recovery.
The full-length research article titled “Injury and local injection and the risk of foot/ankle osteoarthritis: a case-control study in retired UK male professional footballers” is scheduled for release at midnight on October 22, 2025. Interested parties can access the publication via the DOI link provided by Rheumatology, facilitating broader dissemination among clinicians, researchers, and the sporting community.
For direct correspondence and inquiries about this pivotal study, contact can be made with Professor Weiya Zhang at the University of Nottingham’s Faculty of Medicine & Health Sciences. Media requests and copies of the study can be obtained through Daniel Luzer at Oxford University Press.
In summary, this study elucidates the substantial risk that foot and ankle injuries pose in the etiology of osteoarthritis among retired professional footballers. It also critically highlights the complex and possibly unintended consequences of corticosteroid injection treatments in this vulnerable population. These insights call for refined clinical protocols and strengthened preventative strategies to ensure longevity and quality of life for athletes long after their playing days conclude.
Subject of Research: People
Article Title: Injury and local injection and the risk of foot/ankle osteoarthritis: a case-control study in retired UK male professional footballers
News Publication Date: 22-Oct-2025
Web References: https://doi.org/10.1093/rheumatology/keaf518
Keywords: Osteoarthritis, Sports, Sports medicine
Tags: biomechanical responses to traumacartilage deterioration in athletescorticosteroid injections effectsfoot and ankle injuries in footballhigh-impact sports injuriesinjury management in soccerjoint degeneration in sportslong-term effects of sports injuriesosteoarthritis risk in athletesprofessional football career impactprofessional soccer injuriesretired footballers health issues
