Why Do Female Footballers Suffer More Knee Injuries Than Men?

Christophe Champs, founder of PODO Clinic and Workshop, looks at why female footballers struggle with knee injuries — and the importance of the right boots!

female football players on a pitch — There’s a rise in female footballers with ACL injuries — here’s why

Football is a physically demanding sport that’s mainly played on the forefoot, with knee bent, and with every muscle surrounding the knee working hard.

The Anterior Cruciate Ligament (ACL) is the main knee stabilising ligament — and injuries to this part of the knee are serious.

Studies suggest women are six times more likely to suffer ACL injuries compared to men, and 25% less likely to return after recovery, with ACL injuries causing 37 players to miss the Women’s World Cup last year.

ACL injuries occur in the men’s game too, but they are a significant concern in women's football.

Anatomical, biomechanical, hormonal and training factors play a part in women having a greater risk of ACL injury, as does footwear.

The boots worn by players contribute to the epidemic of ACL injuries in women’s football. Poorly fitted football boots that aren’t designed with a woman’s foot, gait or body in mind are a problem.

Let’s take a closer look at why female footballers suffer more knee injuries than men — everything you need to know.

Feet First

Most boots are designed for men — or are what brands call ‘unisex’ or ‘gender neutral’ — but there are many differences between the male and female foot.

On average, men have larger and wider feet compared to women, while women tend to have higher arches, and female toes are often longer in proportion to their feet compared to men.

Typically, a woman will have a lower foot volume, meaning her feet are less bulky, even if they are the same length as a man’s foot, and women have a narrower heel in relation to the forefoot, which can affect how their feet fit into shoes designed for the average male foot shape.

footballer with ball — Most football boots are designed for men — and ‘unisex’ boots don’t properly support female feet

Some manufacturers have worked on developing specific moulds or ‘lasts’ to construct the shape of their women's football boots – including a narrower heel cup and lower instep. However, others have a different view.

Last summer, the Women and Equalities Committee Chair, Caroline Nokes, wrote to football boot brands, including Adidas and Nike, questioning the lack of football boots designed specifically for women and girls.

One manufacturer boldly stated:

“We have a gender-neutral football approach to football footwear informed by our partnerships, industry experience, and research.”

Considering the differences between a man’s foot and a woman’s foot, a gender-neutral or unisex pair of boots is liable to be seriously detrimental for both men’s and women’s feet and biomechanics.

But there is more to consider than just the shape of a footballer’s foot…

Female Form

Women typically have a wider pelvis, which means a greater angle between the hip and knee, and this can place more stress on the knee joint and the ACL.

Women also tend to have more lax ligaments due to hormonal differences, particularly the influence of oestrogen, which can increase the risk of ligament injuries.

a huddle of female footballers — Female footballers deserve boots that support their performance on the pitch

Women often have less muscle mass around the knee compared to men, particularly in the quadriceps and hamstrings, which can provide less support and stability to the joint.

Differences in the way women move their hips and knees during athletic activities can contribute to a higher risk of ACL injury.

Bones Affect the Performance of Muscles

Any misalignment that affects either a bone or a joint will create a muscle imbalance, with one (group of) muscle(s) overworking and its opposite (group of) muscle(s) underworking.

This is why a player’s alignment, balance and posture must be optimised at every level of their body.

As our two feet are different, and everyone has a dominant leg, there is a naturally occurring misalignment, or asymmetry.

goalkeeper's legs covered in mud on a pitch

If you put your asymmetrical form into a pair of symmetrical football boots, it will inevitably put strain on your muscles, increasing your risk of injury.

Therefore, it makes sense to match your asymmetry, in your symmetrical pair of football boots, with an asymmetrical pair of orthotics.

Orthotics

PODO believes that custom-made orthotics should become a preventive measure for every woman playing football.

Orthotics are devices designed to support, align, correct or improve the function of the musculoskeletal system, particularly the feet, ankles and legs.

They’re commonly used to alleviate pain, enhance mobility and provide stability.

Orthotics can be bought off-the-shelf, but for best results, there needs to be a customised orthotic for each foot.

For custom orthotics to make a big difference, they should provide the following:

A tough layer under the forefoot, because non-reinforced shoe-soles encourage a problematic twist and turn under the forefoot, increasing knee instability
Customised supports – the foot’s medial, lateral and, sometimes, transversal arches must all be supported by moulding multiple thin layers directly onto the player’s foot. Because of the natural strength of the arch, and of both the intrinsic and extrinsic muscles, women will benefit a lot more from a thin support made to measure, particularly while going through hormonal changes
A custom-moulded narrower heel cup. This is because a wide and loose heel reduces the stability of the ankle and knee joints and reduces the engagement of the femur at a hip level

Custom orthotics might be as expensive as the boots themselves, but they can save a player from ACL, rehab and, quite possibly, loss of career due to injury.

Good muscle strength can be aided by good conditioning and stretching sessions, but don’t forget that muscles are still susceptible to pain, fatigue and injuries.

Not only that, women on average are shorter in stature than men, but the length of the football pitch is the same and they still play for 90 minutes every match.

This is where a properly designed pair of football boots, along with a properly moulded pair of orthotics, come in.

Both must be specifically fitted to each woman’s feet — and to the requirements for playing football.

Only then can the player feel secure physically and mentally, increasing her confidence and trust in her body.

So, Why Do Female Footballers Suffer More Knee Injuries Than Men?

Because of the number of knee injuries in women’s football, many experts have been looking at the physiology of female athletes.

I believe the examination of that physiology should start with the feet and biomechanics. Then, it needs to look at how footwear can support both.

It is challenging to design multiple models of boots that consider a player’s age, size, biomechanical needs, game intensity, past injuries, problems dealing with fatigue and recovery or even the impact of hormonal ups and downs on their body.

But, as much as shrinking a pair of male shoes will never provide us with a female version, developing ‘unisex football boots’ will simply undermine the problems female footballers currently face.

It will mislead the customer and put thousands of girls and women around the world at risk of injuries that will prevent them playing football in their future, whether they’re professional or play at an amateur level.

Christophe Champs orthotics — PODO Clinic and Workshop is dedicating 2024 to helping female athletes find the right boots

It also has the potential to create entirely new and significant problems in men’s football.

Unsuitable, damaged or ill-fitting shoes in general have a devastating impact on a patient’s biomechanics and their ankle, knee, hip and back health.

The consequences of those uneven wear patterns are just exacerbated in football boots, because playing football increases challenges to your body.

That’s why women’s foot morphology, biomechanics and their lower average body weight must be considered to really optimise the safety, agility and responsiveness of football boots.

At PODO, we are dedicating 2024 to helping women get the support their feet need. As part of our From the Ground Up campaign, we’re calling on clubs and players to join us on our journey.

We’re convinced that an improvement in both women’s orthotics and women’s boots will make a massive contribution to reducing ACL injuries.

About the Author

christophe champs of PODO Clinic and Workshop

Christophe Champs is an expert in Biomechanics, and the founder of PODO Clinic and Workshop.

Christophe works with patients to help correct postural and biomechanical issues that are causing pain or putting a client at risk of injury.

By testing both the moving gait and the still posture of a patient, Christophe can correct misalignment and asymmetry through creating custom-made orthotics to suit the exact needs of each individual.

Check out Christophe’s website, Instagram, Facebook, Twitter, LinkedIn or YouTube for more.

All images courtsey of Panpathic PR