• Overuse injuries. These most often occur in adolescents or children just before the peak growth spurt. In soccer, chronic traction injuries are most typical around the pelvis or in the lower limbs.
The occurrence of calcaneal apophysitis (Sever's disease) is thought to be due to reduced flexibility of the Achilles, posterior tibial, and peroneal tendons. Patients present with heel pain and have a positive Achilles squeeze test on physical examination. The diagnosis is a clinical one, and the treatment is symptomatic.
Patellar tendinitis (jumper's knee) results from repetitive overloading of the extensor mechanism of the knee. Patients present with anterior knee pain. Inflammatory change in the tendon close to its insertion in the patella can progress to tears or tendon degeneration. Most players heal with conservative treatment, though tendon rupture is managed surgically.
• Rare injuries. Many of these injuries occur as a result of direct contact with either other players or equipment. Death following splenic rupture during a soccer match has been reported once.11 Testicular injury (Figure 4) is extremely unusual.19 The most severe soccer injuries occur when goalposts that have not been stabilized and/or fixed correctly collapse on top of children (Figure 5).2,20
