Common Foot and Ankle Injuries Among Division I Women Tennis Players

With over 87 million players around the world, tennis is a popular sport that continues to grow internationally. Among those players, 41% of the participants are women, who range from novice to experienced levels.¹ In the United States, some elite women tennis players compete at the National Collegiate Athletic Association (NCAA) Division I level. Due to their rigorous training and busy competition schedule, these highly technical athletes require unique attention to their injuries, especially foot and ankle injuries.  

In tennis, there is constant biomechanical stress on the complex foot and ankle anatomy. Based on current research, the most common tennis injury is the ankle sprain.² However, many studies done on tennis injuries focus on the whole body. There has been no study to date focused on foot and ankle injuries among Division I women’s tennis players. In addition, current foot and ankle research on collegiate athletes references diagnoses from team physicians with an MD or DO degree rather than podiatric physicians with a DPM degree. The purpose of this study is to reveal the incidence, type, and extent of foot and ankle injuries and who diagnoses foot and ankle injuries within Division I women’s tennis.

Details on the Study Set-Up

NCAA Division I women tennis players received invitations to self-report injuries that occurred during their collegiate career through a Google form survey. The criteria for contacting a school was listing in the Next College Student Athlete list of Division I women’s tennis teams.³ Those asked to complete the survey were athletes who have competed or who currently compete for a Division I women’s tennis team between 2019 and 2024. The survey asked if the athlete suffered from a foot and/or ankle injury during their collegiate tennis career. If the athlete indicated an injury or injuries, the athlete then provided details on the incidence, type, and extent of up to three foot and ankle injuries. The form provided options of common tennis injuries to help guide the student-athletes, including ankle sprain, Achilles tendonitis, plantar fasciitis, turf toe, stress fracture, peroneal tendonitis, subungual hematoma, Achilles tendon tear, and “other” for any injury not listed. The athletes also reported the profession of who diagnosed the injury.

Notable Findings From the Data

One hundred nine student-athletes from 35 NCAA Division I women’s tennis teams responded to the survey. Out of 109 participants, 67 athletes suffered from a foot and/or ankle injury from collegiate tennis. The most common injury was the ankle sprain (48). This was followed by Achilles tendonitis (18), plantar fasciitis (18), stress fracture (9), turf toe (4), and subungual hematoma (3). The most common diagnosticians of these injuries were athletic trainers (47) and physicians with a MD or DO degree (17). Only 3 injuries reported were diagnosed by a physician with a DPM degree.

Commentary

With this survey-based research, there were limitations. There are a total of 265 NCAA Division I women’s tennis teams, and only 35 teams were accounted for in this exercise.³ Student-athletes self-reported the data, so there is a chance of participant bias or lack of knowledge on the injuries. Lastly, there was no question asked about if a podiatric physician was available or offered to the student-athlete during injury.

Because more than half of the collegiate women tennis players suffered from foot and ankle injuries, understanding common injuries is vital to improve training and recovery plans in collegiate athletics going forward. The ankle sprain being the most common foot and ankle injury in this cohort is consistent with previous studies done on tennis injuries. The incidence of Achilles tendonitis and plantar fasciitis recognizes the need for attention towards other types of soft tissue pathology. Regarding who diagnoses the injuries, in my observation, there needs to be more podiatric physician involvement given the DPM specialty and training in foot and ankle biomechanics. Knowledge of these injury patterns can aid to narrow the cause of foot and ankle injuries within women’s tennis and could ultimately help guide targeted future treatment, strength and conditioning techniques, and footwear for high-performing athletes. Future research is needed to better understand strategies to reduce ankle sprains and soft tissue overuse syndromes or trauma within tennis and reveal the prevalence of podiatric physicians involved in collegiate sports as a whole.

Ms. Sabile is a Doctor of Podiatric Medicine Candidate at Samuel Merritt University - College of Podiatric Medicine in the Class of 2027. She is Secretary of her school’s chapter of the American Academy of Podiatric Sports Medicine and Vice President of her school’s chapter of the American Association for Women Podiatrists. She is Journal Club Vice President and President of the Student Body Association at SMU.

References

1.    International Tennis Federation. Global Tennis Report 2019 A Report on Tennis Participation and Performance Worldwide. International Tennis Federation; 2019.  
2.    Robison HJ, Boltz AJ, Morris SN, Collins CL, Chandran A. Epidemiology of injuries in National Collegiate Athletic Association Women’s Tennis: 2014–2015 through 2018–2019. J Athl Train. 2021;56(7):766–772. https://doi.org/10.4085/1062-6050-529-20
3.    NCSA College Recruiting. Women’s D1 Tennis Schools: A complete list. Published September 11, 2023. Accessed November 12, 2024.