Sex and occupation are salient factors associated with lateral ankle sprain risk in military tactical athletes.

OBJECTIVES: To assess the risk of lateral ankle sprain (LAS) in male and female tactical athletes across different military occupations in the US military. DESIGN: Retrospective cohort. METHODS: The Defense Medical Epidemiology Database was queried for the number of individuals with ICD-9 diagnosis codes 845.00 (sprain of ankle, unspecified) and 845.02 (calcaneofibular ligament sprain) on their initial encounter from 2006 to 2015. Relative risk (RR) and chi-square statistics were calculated assessing sex and occupational category on LAS risk. RESULTS: 272,970 enlisted males (27.9 per 1000 person-years), 56,732 enlisted females (34.5 per 1000 person-years), 24,534 male officers (12.6 per 1000 person-years), and 6020 female officers (16.4 per 1000 person-years) incurred a LAS. Enlisted females in all occupational groups were at significantly higher risk for LAS than their male counterparts (RR 1.09-1.68; p<0.001), except for Engineers (p=0.15). Female officers had consistently higher risk for LAS in all occupational groups (RR 1.10-1.42; p<0.001) compared with male officers, except Ground/Naval Gunfire (p=0.23). Contrasted with Infantry, enlisted tactical athletes in the Special Operations Forces, Mechanized/Armor, Aviation, Maintenance, and Maritime/Naval Specialties were at lower risk (RR 0.38-0.93; p<0.001), Artillery, Engineers, and Logistics Specialties were at higher risk (RR 1.04-1.18; p<0.001), and Administration, Intelligence, and Communications were no different (p=0.69). Compared with Ground/Naval Gunfire officers, Aviation officers were at significantly lower risk (RR, 0.75; p<0.001), and Engineers, Maintenance, Administration, Operations/Intelligence, and Logistics officers were at higher risk (RR, 1.08-1.20; p<0.001). CONCLUSIONS: Sex and military occupation were salient factors associated with LAS risk.

Interobserver Analysis of Standard Foot and Ankle Radiographic Angles.

Standard foot and ankle radiographs have long been studied and averages formulated in an attempt to provide a common framework for understanding the relationships of the foot and ankle, not only for surgical planning but also to determine normal versus abnormal relationships. The authors describe 8 angles measured on 100 patients by up to 18 observers (4 attending physicians, 12 residents, and 2 students). This study validates the previously documented normal angles using a significantly larger observer group as well as a greater number of analyzed angles. Additionally, this study reveals the tibio-second metatarsal angle on the calcaneal axial view is not a reliable radiographic angle for evaluation of foot and ankle deformity. Intraclass correlation coefficients were also analyzed, which displayed variability in measurements based on level of training, with residents being the most accurate, followed by attending physicians and then students. Foot and ankle radiographs are essential for surgical planning, and understanding normal versus abnormal is key before any surgical planning can be accurately performed.