Analyzing Ankle Injuries in the NFL: A Video-Based Investigation of the Impact of Artificial Turf on Injury Mechanisms

Purpose Artificial turf is increasingly used in professional football due to its economic and logistical advantages. However, concerns persist that certain turf types, especially slit-film, may alter biomechanics and increase the risk of lower extremity injuries. This study aimed to evaluate the mechanism and frequency of ankle and foot injuries across three surface types, natural grass, monofilament/dual-fiber (MFDF) turf, and slit-film turf, during the 2022–2023 NFL season. We hypothesize that slit-film turf will show a higher rate of ankle and foot injuries compared to other types of turf and natural grass. Methods A retrospective review of NFL injury reports and game footage was conducted to identify 78 in-game ankle and foot injuries. Injuries were classified by mechanism (contact vs. non-contact) and correlated with surface type. Statistical analyses including Mann-Whitney U, Chi-Square, and logistic regression were employed to assess associations. Results Slit-film turf exhibited the highest rate of contact injuries (85.7%) but the lowest rate of non-contact injuries (14.3%), contrary to the hypothesis and prior research. Natural grass had the highest proportion of non-contact injuries (46.4%). Statistically significant differences were found between surface type and injury mechanism (p = 0.015). Fatigue may contribute to injury prevalence, as the fourth quarter saw the highest injury rate (41%). Conclusion This study challenges the prevailing belief that artificial turf, particularly slit-film turf, increases non-contact injury risk. Instead, slit-film turf may predispose players to more contact-related injuries due to its rigid surface properties. Findings underscore the need for multi-season, biomechanically informed research to guide player safety policies.