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Tackling the “Epidemic” of Knee Injuries in Women Football

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Injuries to the anterior cruciate ligament (ACL) happen in men’s football, but in the women’s game players are six times more likely to suffer this type of injury compared to men, and 25% ess likely to return after recovery. ACL is the main knee stabilising ligament and damage to it can keep players out of the game for months, perhaps a year depending on the severity of the injury. ACL injuries caused 37 players to miss the Women’s World Cup last year. 

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 has a role in the epidemic of ACL injuries in women’s football. Poorly fitted football boots – that are not designed with a woman’s foot, gait, or body in mind – are a problem. 


If we are to tackle ACL injuries, then we need to do so “from the ground up” – we need to start with the feet. 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 of 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.

This means that footwear needs to be customised for female players; for best results, there needs to be a customised orthotic for each foot.


Custom-made or off-the-shelf, orthotics are designed to support, align, correct, or improve the function of the musculoskeletal system, particularly the feet, ankles, and legs. They are commonly used to alleviate pain, enhance mobility, and provide stability.

Although the solution starts with the feet, the answer is not a one-size-fits all, as there are multiple factors that contribute to the reasons a woman might suffer an ACL injury. This makes the problem more complex with a number of factors to consider. 

Using a biomechanics approach, we can address and, if necessary, modify structural and postural factors to help a player avoid ACL (and other) injuries. Factors, such as the width of the pelvis (women generally have wider pelvises than men), or bow-leggedness all play a part, so we adapt and work around variations, assessing each of them to integrate the uniqueness of a player into their unique treatment plan.

Other factors such as a foot/ankle over-pronating, a knee rolling inwards or being pushed outward or pelvic tilting—all of which are among the most common sources of injuries – are addressed, from the ground up, by applying the rules of biomechanics, and crafting a pair of asymmetrical orthotics. 


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. This underpins our approach to ensuring the risk of muscle damage is dramatically reduced. 

Since your two feet are different, and everyone has a dominant leg, there is a naturally occurring misalignment, or asymmetry. 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. These are not the orthotics that you can buy off-the-shelf, they must be custom made. PODO believes that this should become a preventive measure for every woman playing football.


Good muscle strength can be aided by good conditioning and stretching sessions, and this can help in creating magic on the field. 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, 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, at a foot level, and mentally, thus increasing her confidence and trust in her body. 


Some manufacturers have seriously 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. And it is challenging to design multiple models 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 her 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, 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 are professional or play at an amateur level. It also has the potential to create entirely new and significant problems in men’s football.

Because stores are facing the challenge of having to stock extra insoles specifically designed for women in football when the demand is actually pretty low, it is time for the clinics to step in with custom orthotics. 


Custom orthotics might be as expensive or, indeed, even more expensive than the boots themselves but they can save a player from ACL, rehab and, quite possibly, loss of career.

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, 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. 

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 are calling on clubs and players to join us on our journey. We are convinced that an improvement in both women’s orthotics and women’s boots will make a massive contribution to reducing ACL injuries.

Christophe Champs is an expert in biomechanics and the founder of Podo. Christophe corrects postural and biomechanical issues to alleviate pain and prevent injury for clients. 

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