642 Br J Sports Med 2004;38:642–644
1 Abernethy L, McNally O, MacAuley D, et al.
Sports medicine and the accident and
emergency specialist. Emerg Med J
If you have a burning desire to respond to a
paper published in BJSM, why not make 2 Changes in sports injuries to children between
use of our ‘‘rapid response’’ option? 1983 and 1998: comparison of case series.
Log onto our website (www.bjsportmed. J Public Health Med 2001;23:268–71.
com), find the paper that interests you, 3 Chan KM, Yuan Y, Li CK, et al. Sports causing
and send your response via email by most injuries in Hong Kong. J Sports Med
clicking on the ‘‘eLetters’’ option in the box
4 Brizuela G, Llana S, Ferrandis R, et al.
at the top right hand corner. Biomechanical design of football boots:
Providing it isn’t libellous or obscene, it effect of studs on performance and injury
will be posted within seven days. You can prevention. www.isb98.uni-konstanz.de/
retrieve it by clicking on ‘‘read eLetters’’ on Figure 2 Laceration to left leg. topic5.html.
our homepage. 5 Watson AW. Sports injuries in school gaelic
football: a study over a season. Ir J Med Sci
left knee sustained after a tackle. The lacera- 1996;165:12–16.
tion was 8 cm in length and extended down 6 Orchard J. Is there a relationship between ground
and climatic conditions and injuries in football?
to muscle but had not involved the knee
Football blades: a cause for capsule (fig 2). The wound was thoroughly
Sports Med 2002;32:419–32.
7 Sawdon-Smith R. Is it time to give blades the
concern irrigated, debrided, and closed with sutures. boot? www.readingrefs.org.uk.
Sporting injuries have always contributed a The second involved a 28 year old man who
significant proportion of the workload of the was involved in a tackle with a player
emergency department.1 The number is wearing football blades; as a result of the
increasing considerably2 for several reasons. tackle the leather uppers of the football boot Recidivism in sports related
A burgeoning range of sporting activities were torn with a ragged laceration measur-
combined with increased disposable income ing 5 cm over the dorsum of the foot. The injuries in primary care
and leisure time has led to greater participa- laceration was irrigated, debrided, and Involvement in top sports challenges the
tion.2 Consequently research and develop- sutured. body’s physical faculties to the limit. Sur-
ment aimed at enhancing performance has Sporting injuries presenting to the emer- passing these limits may cause sports related
escalated. gency department are common, and, over the injuries. However, these injuries occur among
One such development is the use of last decade more interest has focused on participants of all sports at large. Once a
‘‘blades’’ instead of the more traditional studs prevention. One aspect of this is footwear sports related injury has manifested itself,
on football boots. Unlike the traditional design. Chan et al3 showed a direct correlation subsequent recovery incorporates a real
round peg-like studs, the new blades mea- between footwear and both performance and probability of future relapse.
sure up to 3 cm long and are shaped to rates of injury. A similar study showed that The expansion of an aging population
contour the foot (fig 1), providing enhanced boots with a greater number of studs were participating in non-organised sports is
stability to the standing foot when kicking. associated with poorer performance compared likely to produce an increase in the number
Since they were first endorsed by high profile with those with fewer, primarily because of of patients presenting to the family doctor
figures such as David Beckham, the appeal to inferior traction with the ground.4 A large with sports related injuries and possible
the younger generations has increased to the proportion of football injuries are ligamentous relapses.1 To gain a better understanding of
extent that many junior players use such and involve either the knee or the ankle,5 thus the concept of recidivism, a Medline litera-
footwear. shoe-surface traction is the specific variable ture search on relapses of sports related
The traditional studs can cause a range of most likely to correlate with injury incidence.6 injuries in primary care was performed. This
injuries, from minor lacerations (the most These theories led directly to the development general search produced no references, but
common) to more complex punched out soft of the blade to replace the traditional stud on a sports specific search yielded two publica-
tissue injuries. The cases described below football boots to improve shoe-surface trac- tions on relapse in sports related injuries.
highlight the potential severity of injuries tion. For this reason a large number of pro- Sports related injuries are known to recur in
sustained as a result of direct contact with a fessional footballers use blades, and as a result equestrian sports2 and in soccer players
football blade. the appeal to amateur players of all ages is (strains and sprains).3
The first case involved a 14 year old boy high. As the number of players using such Information about the prevalence of
with a laceration to the medial aspect of the footwear increases, the number of injuries recidivism was obtained from a randomised
resulting directly from blades is increasing controlled trial conducted to study the care
also. Concerns are now being raised in the provided by family and sports doctors in
media as to the safety of such blades, 230 patients with non-acute sports related
especially in more junior grades of football.7 injuries to the lower extremity. This study
In certain countries there are moves to ban took place in three northern regions in
such blades because of safety concerns.7 the Netherlands between September 2000
These cases highlight the severity of and May 2002 and involved the participa-
lacerations that can result from tackles with tion of 83 family doctors. A non-acute
boots fitted with blades. In the second case sports related injury was diagnosed as an
report, the blade was actually sharp enough injury that originated at least two weeks
to penetrate the leather uppers of the boot before consultation of the family doctor.
before lacerating the skin. Although stud Data on all participating patients contained
injuries have presented to the emergency in the primary care data base were
department for many years, we should be scrutinised to determine if these patients
increasingly aware of the potential dangers of consulted the doctor again for a new or
this design of stud, especially in junior levels other sports related injury in the year after
of competition. inclusion.
In 7.4%, a new sports related injury
M J Hall, P Riou
prompted patients to revisit their doctor in
Correspondence to: Derriford Hospital, Plymouth PL6 the year after inclusion. In 4.5% of the cases,
8DH, Devon, UK; email@example.com the injury was related to the original one but
not considered a relapse, which was found to
Figure 1 Football boot with blades. doi: 10.1136/bjsm.2004.012245 occur in 2.2% of the cases. In this cohort, it