Soccer Foot and Ankle Injuries: Turf Toe, Lisfranc Sprains, and Cleat-Related Problems

Soccer’s Impact on the Foot and Ankle

Soccer is the world’s most popular sport and places enormous demands on the foot and ankle. The combination of running (3–7 miles per match), kicking, directional changes, tackling, and playing on varied surfaces from natural grass to artificial turf creates a comprehensive injury profile affecting every structure from the toes to the distal tibia.

Foot and ankle injuries account for approximately 20–25% of all soccer injuries, with ankle sprains being by far the most common single injury type. However, several soccer-specific injury patterns warrant special attention due to their potential severity.

Turf Toe

Turf toe is a sprain of the plantar plate and ligaments at the base of the great toe — the first metatarsophalangeal (MTP) joint. It occurs when the great toe is forcibly hyperextended, typically when a player’s foot is planted on a hard surface and the forefoot collapses forward. Artificial turf (which is firmer and grips shoes more aggressively than natural grass) and flexible, low-cut soccer cleats that allow excessive toe bending are the primary contributing factors.

Turf toe ranges from Grade I (mild sprain, return to play within days) to Grade III (complete plantar plate rupture with joint instability, potentially requiring surgical repair). Underestimating turf toe severity leads to chronic instability and cartilage damage if the athlete returns to play too soon.

Lisfranc Sprain and Fracture

The Lisfranc joint complex — where the metatarsals meet the midfoot bones — can be sprained or fractured in soccer through various mechanisms: a tackle that catches the fixed forefoot, falling on a plantarflexed foot, or a direct kick to the midfoot. Soccer players are among the most commonly affected athletes because of the combination of high speed, physical contact, and planted cleats.

Lisfranc injuries are frequently misdiagnosed as simple midfoot sprains. Persistent midfoot pain, inability to bear weight, and pain with torsional stress to the midfoot all suggest Lisfranc involvement. Weight-bearing foot X-rays, and CT or MRI when X-rays are inconclusive, are essential. Displaced Lisfranc injuries require surgical fixation.

Ankle Sprains

Lateral ankle sprains in soccer occur most commonly from landing after jumping headers, stepping on an opponent’s foot during tackles, and planting the foot on uneven ground. The rapid directional changes required in soccer also create inversion stress during running. Soccer-specific ankle sprain prevention programs — including balance training on unstable surfaces and ankle taping or bracing during high-risk periods — have strong evidence for reducing recurrence.

Fifth Metatarsal Fractures

The fifth metatarsal is vulnerable to both avulsion fractures (where the peroneus brevis tendon pulls a fragment off the styloid process during ankle inversion) and Jones fractures (transverse fractures at the junction of the diaphysis and metaphysis). Jones fractures occur classically when a player pivots on the fixed outside of the foot. They have a high non-union rate and often require surgical fixation with an intramedullary screw for athletes who need reliable return to sport.

Cleat Considerations

Soccer cleat selection significantly influences injury risk. Firm ground cleats (FG) are appropriate for natural grass but create excessive grip on artificial turf, predisposing to knee and ankle injuries. Artificial ground (AG) and turf (TF) cleats have shorter studs with better surface distribution for synthetic surfaces. Players should match cleat type to their primary playing surface.

Low-cut soccer boots offer minimal ankle support — players with prior ankle sprains may benefit from ankle taping or a low-profile ankle brace during competitive play without sacrificing footwork mechanics.

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.