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Football blades a cause for concern

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					642                                                                                                                  Br J Sports Med 2004;38:642–644




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                                                                                                         References
                 LETTERS
                                                                                                          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
                                                                                                            2002;19:239–41.
 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
                                                                                                            1993;27:263–7.
 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; matthall50@yahoo.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




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