{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:59:27Z","timestamp":1787032767848,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11]]},"abstract":"\n Background:<\/jats:bold>\n Ankle-foot injuries are common in military personnel and substantially degrade function and force readiness. The purpose of this retrospective cohort study was to assess the incidence and contributing factors of traumatic ankle-foot fractures in the US military.\n <\/jats:p>\n \n Methods:<\/jats:bold>\n A population-based study of all service members in the US military was performed assessing the factors of sex, occupation, service branch, rank, and year on segmental tibia-fibula, rearfoot, and forefoot fracture incidence between 2006 and 2015. The Defense Medical Epidemiology Database was queried for the number of individuals with fractures of the tibia-fibula, rearfoot, and forefoot using\n International Classification of Diseases, Ninth Revision, Clinical Modification<\/jats:italic>\n on the initial medical encounter. Unadjusted relative risk (RR) calculations were performed assessing sex and occupation. A negative binomial regression assessed the adjusted factors of sex, branch, rank, and year.\n <\/jats:p>\n \n Results:<\/jats:bold>\n During this study, 95,540 enlisted service members (8.4 per 1,000 person-years) and 13,318 military officers (5.8 per 1,000 person-years) were diagnosed with ankle-foot fractures. In the adjusted analysis, sex was found to only be a significant factor in forefoot fractures (RR, 1.54), with female service members having a significantly higher risk. There were no significant sex-related differences observed in tibia-fibula or rearfoot fractures. US Navy and Air Force personnel had significantly lower risk of tibia-fibula fractures (RR range, 0.76\u20130.84) compared with the US Army. Forefoot fracture risk was significantly higher in the US Marine Corps (RR, 1.47) compared with the US Army. Officers had consistently lower risk for fractures in each segment (RR range, 0.68\u20130.77) compared with enlisted personnel. Enlisted engineers, aviation, and artillery\/gunnery compared to infantry, and ground\/naval gunfire officers had the greatest relative risk compared all other officer fields (RR range, 1.11\u20133.67).\n <\/jats:p>\n \n Conclusions:<\/jats:bold>\n Sex, occupation, branch, and rank were salient factors for macrotraumatic ankle-foot fractures. These findings can be used to inform and increase precision in medical planning and in the targeted development of preventive interventions.\n <\/jats:p>","DOI":"10.7547\/22-114","type":"journal-article","created":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T16:35:26Z","timestamp":1704818126000},"source":"Crossref","is-referenced-by-count":4,"title":["Macrotraumatic Fractures of the Multisegmented Ankle-Foot Complex in Military Tactical Athletes: A Cohort Study"],"prefix":"10.3390","volume":"113","author":[{"given":"John J.","family":"Fraser","sequence":"first","affiliation":[{"name":"Operational Readiness & Health Directorate, Naval Health Research Center, San Diego, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille P.","family":"Ryans","sequence":"additional","affiliation":[{"name":"United States Naval Hospital Okinawa, Okinawa, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"MacGregor","sequence":"additional","affiliation":[{"name":"Epidemiology and Information Management Support Department, Naval Health Research Center, San Diego, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cory F.","family":"Janney","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","series-title":"MSMR","first-page":"2","article-title":"Armed Forces Health Surveillance Branch: Absolute and relative morbidity burdens attributable to various illnesses and injuries, active component, U.S. Armed Forces, 2020","volume":"28","year":"2021","unstructured":"Armed Forces Health Surveillance Branch: Absolute and relative morbidity burdens attributable to various illnesses and injuries, active component, U.S. Armed Forces, 2020. 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MSMR 28: 6, 2021."},{"key":"B4","series-title":"Cardiopulm Phys Ther J","first-page":"22","article-title":"Physical therapy as a force multiplier: population health perspectives to address short-term readiness and long-term health of military service members","volume":"31","author":"Fraser JJ","year":"2020","unstructured":"Fraser JJ, Schmied E, Rosenthal MD, et al: Physical therapy as a force multiplier: population health perspectives to address short-term readiness and long-term health of military service members. Cardiopulm Phys Ther J 31: 22, 2020."},{"key":"B5","series-title":"Clin Rev Bone Miner Metab","first-page":"103","article-title":"Military fractures: overtraining, accidents, casualties, and fragility","volume":"16","author":"Wheeler AR","year":"2018","unstructured":"Wheeler AR, Wenke JC: Military fractures: overtraining, accidents, casualties, and fragility. Clin Rev Bone Miner Metab 16: 103, 2018."},{"key":"B6","series-title":"J Womens Health (Larchmt)","first-page":"586","article-title":"Sex differences in the incidence and risk of ankle-foot complex stress fractures among U.S. military personnel","volume":"31","author":"MacGregor AJ","year":"2022","unstructured":"MacGregor AJ, Fogleman SA, Dougherty AL, et al: Sex differences in the incidence and risk of ankle-foot complex stress fractures among U.S. military personnel. J Womens Health (Larchmt) 31: 586, 2022."},{"key":"B7","series-title":"J Sci Med Sport","first-page":"677","article-title":"Sex and occupation are salient factors associated with lateral ankle sprain risk in military tactical athletes","volume":"24","author":"Fraser JJ","year":"2021","unstructured":"Fraser JJ, MacGregor AJ, Ryans CP, et al: Sex and occupation are salient factors associated with lateral ankle sprain risk in military tactical athletes. J Sci Med Sport 24: 677, 2021."},{"key":"B8","series-title":"Int J Sports Phys Ther","first-page":"1313","article-title":"Fractures and chronic recurrence are commonly associated with ankle sprains: a 5-year population-level cohort of patients seen in the U.S. Military Health System","volume":"16","author":"Rhon DI","year":"2021","unstructured":"Rhon DI, Greenlee TA, Cook CE, et al: Fractures and chronic recurrence are commonly associated with ankle sprains: a 5-year population-level cohort of patients seen in the U.S. Military Health System. Int J Sports Phys Ther 16: 1313, 2021."},{"key":"B9","article-title":"Epidemiology\/Biostatistics Tools [Excel workbook]","author":"LaMorte WW","unstructured":"LaMorte WW: Epidemiology\/Biostatistics Tools [Excel workbook]. Available at: http:\/\/bit.ly\/Lamort3. Accessed August 3, 2019."},{"issue":"1","key":"B10","series-title":"J Stat Soft","article-title":"Regression models for count data in R","volume":"27","author":"Zeileis A","year":"2008","unstructured":"Zeileis A, Kleiber C, Jackman S: Regression models for count data in R. J Stat Soft 27: 1, 2008."},{"key":"B11","article-title":"Women in combat: issues for congress","author":"Kamarck KN","year":"2016","unstructured":"Kamarck KN: Women in combat: issues for congress. Congressional Research Service, 2016. Available at: https:\/\/sgp.fas.org\/crs\/natsec\/R42075.pdf. Accessed September 20, 2019."},{"key":"B12","series-title":"Joint Bone Spine","first-page":"595","article-title":"Osteoporosis in males and females: is there really a difference?","volume":"76","author":"Guggenbuhl P","year":"2009","unstructured":"Guggenbuhl P: Osteoporosis in males and females: is there really a difference? Joint Bone Spine 76: 595, 2009."},{"key":"B13","series-title":"Osteoporos Int","first-page":"1281","article-title":"The National Osteoporosis Foundation\u2019s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations","volume":"27","author":"Weaver CM","year":"2016","unstructured":"Weaver CM, Gordon CM, Janz KF, et al: The National Osteoporosis Foundation\u2019s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int 27: 1281, 2016."},{"key":"B14","series-title":"Eur J Sport Sci","first-page":"99","article-title":"Sex differences in the physical performance, physiological, and psycho-cognitive responses to military operational stress","volume":"22","author":"Conkright WR","year":"2022","unstructured":"Conkright WR, O\u2019Leary TJ, Wardle SL, et al: Sex differences in the physical performance, physiological, and psycho-cognitive responses to military operational stress. Eur J Sport Sci 22: 99, 2022."},{"key":"B15","series-title":"J Am Acad Orthop Surg","first-page":"344","article-title":"High-risk stress fractures: evaluation and treatment","volume":"8","author":"Boden BP","year":"2000","unstructured":"Boden BP, Osbahr DC: High-risk stress fractures: evaluation and treatment. J Am Acad Orthop Surg 8: 344, 2000."},{"key":"B16","series-title":"Mil Med","first-page":"705","article-title":"Physically demanding jobs and occupational injury and disability in the U.S. Army","volume":"175","author":"Hollander IE","year":"2010","unstructured":"Hollander IE, Bell NS: Physically demanding jobs and occupational injury and disability in the U.S. Army. Mil Med 175: 705, 2010."},{"key":"B17","series-title":"Eur J Sport Sci","first-page":"16","article-title":"Much work remains to reach consensus on musculoskeletal injury risk in military service members: a systematic review with meta-analysis","volume":"22","author":"Rhon DI","year":"2022","unstructured":"Rhon DI, Molloy JM, Monnier A, et al: Much work remains to reach consensus on musculoskeletal injury risk in military service members: a systematic review with meta-analysis. 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Aviat Space Environ Med 68: 1006, 1997."},{"key":"B20","series-title":"Am J Prev Med","first-page":"464","article-title":"Occupational and non-occupational injuries in the United States Army","volume":"33","author":"Tiesman HM","year":"2007","unstructured":"Tiesman HM, Peek-Asa CL, Zwerling CS, et al: Occupational and non-occupational injuries in the United States Army. Am J Prev Med 33: 464, 2007."},{"key":"B21","series-title":"Mil Behav Health","first-page":"151","article-title":"Gendered: a qualitative interpretive meta-synthesis of female service members at war","volume":"7","author":"Strong JD","year":"2019","unstructured":"Strong JD, Crowe BM, Bolton K: Gendered: a qualitative interpretive meta-synthesis of female service members at war. 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