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Foot and ankle Osteoarthritis and Cognitive impairment in retired UK Soccer players (FOCUS): protocol for a cross-sectional comparative study with general population controls
  1. Shima Espahbodi1,2,
  2. Gwen Fernandes1,3,
  3. Eef Hogervorst4,
  4. Ahmed Thanoon1,2,
  5. Mark Batt2,5,
  6. Colin W Fuller6,
  7. Gordon Fuller7,
  8. Eamonn Ferguson8,
  9. Tobias Bast8,9,
  10. Michael Doherty1,2,
  11. Weiya Zhang1,2
  1. 1Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, UK
  2. 2Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, University of Nottingham, Nottingham, UK
  3. 3Population Health Sciences, University of Bristol, Bristol, UK
  4. 4NCSEM, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
  5. 5Sports Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
  6. 6Colin Fuller Consultancy Ltd, Loughborough, UK
  7. 7Centre for Urgent and Emergency Research, The University of Sheffield, Sheffield, UK
  8. 8Psychology, University of Nottingham, Nottingham, Nottinghamshire, UK
  9. 9Neuroscience@Nottingham, University of Nottingham, Nottingham, Nottinghamshire, UK
  1. Correspondence to Dr Shima Espahbodi; shima.espahbodi1{at}


Introduction Professional footballers commonly experience sports-related injury and repetitive microtrauma to the foot and ankle, placing them at risk of subsequent chronic pain and osteoarthritis (OA) of the foot and ankle. Similarly, repeated heading of the ball, head/neck injuries and concussion have been implicated in later development of neurodegenerative diseases such as dementia. A recent retrospective study found that death from neurodegenerative diseases was higher among former professional soccer players compared with age matched controls. However, well-designed lifetime studies are still needed to provide evidence regarding the prevalence of these conditions and their associated risk factors in retired professional football players compared with the general male population.

Objectives To determine whether former professional male footballers have a higher prevalence than the general male population of: (1) foot/ankle pain and radiographic OA; and (2) cognitive and motor impairments associated with dementia and Parkinson’s disease. Secondary objectives are to identify specific football-related risk factors such as head impact/concussion for neurodegenerative conditions and foot/ankle injuries for chronic foot/ankle pain and OA.

Methods and analysis This is a cross-sectional, comparative study involving a questionnaire survey with subsamples of responders being assessed for cognitive function by telephone assessment, and foot/ankle OA by radiographic examination. A sample of 900 adult, male, ex professional footballers will be recruited and compared with a control group of 1100 age-matched general population men between 40 and 100 years old. Prevalence will be estimated per group. Poisson regression will be performed to determine prevalence ratio between the populations and logistic regression will be used to examine risk factors associated with each condition in footballers.

Ethics and dissemination This study was approved by the East Midlands-Leicester Central Research Ethics Committee on 23 January 2020 (REC ref: 19/EM/0354). The study results will be disseminated at national and international meetings and submitted for peer-review publication.

  • Dementia

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  • Contributors SE drafted, revised, finalised the manuscript, and implemented (conducted) the study and NHS Trust collaborating centres. SE developed and designed the FOCUS Footballer Questionnaire and data collection tools. GF, MD, WZ conceptualised the study. All authors were involved in the design and development of the study protocols. SE, AT, EH and WZ collected data. All authors reviewed the draft and approved the final manuscript. WZ is the guarantor for the project.

  • Funding This work is supported by grants from Versus Arthritis, grant number (21595) and The Football Association (FA), grant number (not applicable).

  • Competing interests CF provides consultancy services to the English Premier League.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.