Work

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

Year: 2026

Type: article

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.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2026.1913192