A specific sequence of movements is required to perform a dive in which normal function of the foot and ankle is crucial. Injury to either can render the diver unable to perform a specific part of the dive, limiting both dive selection and performance. Although the prevalence of foot and ankle injuries has been described in many sports, it has not been described for competitive diving. A review of the literature identifies only one case of a foot or ankle injury in a competitive diver. As such, we decided to survey senior registered competitive divers to evaluate the types of foot and ankle injuries, the manner in which they occur, and the time loss from the injury. Five hundred seventeen questionnaires were sent to senior competitive divers registered with the United States Diving Association. The diving regimen for this group consists of eight months of training per year with approximately 10 competitive events within a six-month period. The questionnaire requested information regarding the diver's injury, age, sex, dive type associated with injury, mechanism of injury, and outcome. Divers who reported injuries were contacted by telephone to obtain a more detailed description of the injury. When available, medical records and radiographs pertaining to the injury were reviewed. Dives are performed from a platform or springboard and can be grouped into forward, backward, reverse, inward, and twist dives. The starting position on the board is either facing front or back and the body rotates through the air in a forward or backward direction. While on the board, the diver goes through a series of movements called the take-off phase. This phase starts with the beginning of the springing motion and ends when the feet leave the take-off area. These movements vary depending upon the type of dive, but consist of the hurdle, press, and take-off. The hurdle is a jump from a one to a two foot take-off at the end of the board. The press is the depression of the springboard or, on the platform, the loading of the body weight onto the lower extremities prior to take-off. Take-off is the leaving of the diver's feet from the end of the board and before the diver begins the flight phase. The flight phase spans the time when the diver's body passes through the air. The body position during the flight phase can be identified as straight, pike, or tuck. The straight position is with the hips in neutral, knees in extension, and arms outstretched overhead. The pike position is with the hips flexed, knees extended, and arms outstretched or grasping the back of the knees. Tuck position is with the hips and knees fully flexed with the arms grasping across the front of the legs. The dive is completed when the diver enters the water. Of the 517 questionnaires sent to senior registered divers, 114 (22 percent) responded. Although the response rate may appear low, the experiences of these 114 divers still represent a broad collective of data that can be applied to the diving population at large. Of the 114 divers, 55 reported foot and ankle injuries. The average age of the 41 divers was 20.4 years (13 to 31 years of age) with an average diving career of 7.6 years (6 months to 21 years). Sixteen of the injured divers were men, 25 were women. Lateral ankle sprain and fractures were the most common injuries; of the fractures, metatarsal fractures were the most common. The injuries occurred in a variety of locations. Twenty-six occurred during springboard diving. Seven injuries occurred during dry land training and five occurred when the diver tested (checked) the board. Two injuries occurred on the platform. Fifteen injuries took place during actions not associated with a specific dive phase. These actions include overuse; double board bouncing; striking the pool deck, pool bottom, or pool gutter, and turning around on the board. Of the 26 springboard injuries, 17 occurred during the take-off phase, with the most during the press portion. The nine injuries during the flight phase were the result of accidental contact with the board. Of the five dive types, the reverse dive was most commonly associated with injury. The average time loss was 4.3 weeks (anywhere from 0 to 5 months) with the greatest time loss attributed to fractures. There was no long-term disability. The results of our survey indicate that the occurrence of foot and ankle injuries in competitive divers is greater than previously recognized, and lateral ankle sprains and fractures are the most common injuries. Although injuries appear more frequently with springboard diving, they also occur with platform diving. Most injuries occur during the press portion of the take-off phase, but injuries do occur in the flight phase when the diver's feet accidently hit the board. The reverse dive is most commonly associated with injury. Finally, the injuries sustained usually result in the loss of training time, but long-term disability is uncommon.
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