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Peer-reviewedCC BY 4.0Frontiers in Public Health

Incidence and characteristics of foot and ankle injuries among pilgrims during Hajj

  • Ghadah Alsaleh1,2
  • Bander Balkhi3
  • Lamis Alabdullatif2
  • Hala Aljishi2
  • Fahad Alamri2
  • Anas Khan4
  • Fatemah Alsaleh5
5 affiliations
  1. 1Emergency Department, Neom Hospital
  2. 2Global Center for Mass Gathering Medicine, MOH
  3. 3Department of Clinical Pharmacy, College of Pharmacy, King Saud University
  4. 4Department of Emergency Medicine, College of Medicine, King Saud University
  5. 5Imam Abdulrahman Alfaisal Hospital MOH
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Abstract

Background: The Hajj pilgrimage represents one of the largest recurrent mass gatherings globally, posing unique injury-related public health challenges. Foot and ankle injuries are particularly common due to prolonged walking, crowd density, and environmental exposure.

Methods: Methods: A retrospective observational study was conducted during Hajj 1444H, including approximately 1.8 million pilgrims. Injury data were extracted from healthcare facilities. Missing data were addressed using a distribution-based stochastic imputation approach designed to preserve the observed distribution of the available data. Incidence rates were calculated per 100,000 pilgrims.

Results: A total of 943 foot injuries were identified (incidence: 52.4 per 100,000 pilgrims; 95% CI 49.1–55.8). Males accounted for 74.1% of cases and adults aged 31–64 years represented 50.2%. Superficial injuries were most common (57.3%), followed by ankle/foot injuries (14.8%) and fractures (8.2%). In an exploratory complete-case analysis, the overall distribution of injury categories differed by sex; however, this analysis included only 443 records and contained several sparse categories.

Conclusion: Foot injuries during Hajj are common and largely preventable. Demographic findings should be interpreted cautiously because of substantial missingness and the unverifiable Missing At Random assumption. Targeted preventive strategies remain essential to reduce healthcare burden during mass gatherings.

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Cite

BibTeXRIS
BibTeX
@article{alsaleh2026incidence,
  title = {{Incidence and characteristics of foot and ankle injuries among pilgrims during Hajj}},
  author = {Ghadah Alsaleh and Bander Balkhi and Lamis Alabdullatif and Hala Aljishi and Fahad Alamri and Anas Khan and Fatemah Alsaleh},
  journal = {Frontiers in Public Health},
  year = {2026},
  month = oct,
  doi = {10.3389/fpubh.2026.1913192},
  url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1913192/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Incidence and characteristics of foot and ankle injuries among pilgrims during Hajj
AU  - Ghadah Alsaleh
AU  - Bander Balkhi
AU  - Lamis Alabdullatif
AU  - Hala Aljishi
AU  - Fahad Alamri
AU  - Anas Khan
AU  - Fatemah Alsaleh
PY  - 2026
DA  - 2026/10/19
JO  - Frontiers in Public Health
DO  - 10.3389/fpubh.2026.1913192
UR  - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1913192/full
AB  - Background: The Hajj pilgrimage represents one of the largest recurrent mass gatherings globally, posing unique injury-related public health challenges. Foot and ankle injuries are particularly common due to prolonged walking, crowd density, and environmental exposure.  Methods: Methods: A retrospective observational study was conducted during Hajj 1444H, including approximately 1.8 million pilgrims. Injury data were extracted from healthcare facilities. Missing data were addressed using a distribution-based stochastic imputation approach designed to preserve the observed distribution of the available data. Incidence rates were calculated per 100,000 pilgrims.  Results: A total of 943 foot injuries were identified (incidence: 52.4 per 100,000 pilgrims; 95% CI 49.1–55.8). Males accounted for 74.1% of cases and adults aged 31–64 years represented 50.2%. Superficial injuries were most common (57.3%), followed by ankle/foot injuries (14.8%) and fractures (8.2%). In an exploratory complete-case analysis, the overall distribution of injury categories differed by sex; however, this analysis included only 443 records and contained several sparse categories.  Conclusion: Foot injuries during Hajj are common and largely preventable. Demographic findings should be interpreted cautiously because of substantial missingness and the unverifiable Missing At Random assumption. Targeted preventive strategies remain essential to reduce healthcare burden during mass gatherings.
SN  - 2296-2565
ER  -