It would be quite easy but I suspect rather dull to reel off a list of all the trauma we see following our yearly pilgrimage to the snow. There is plenty written about various common simple fractures.

Foot and ankle trauma is not that common whilst skiing or snowboarding simply because the combination of a rigid boot and bindings generally protects the foot. All the energy tends to be transferred to the other joints. That’s why my knee colleagues are so busy.

The common fractures and the dramatic fracture are easy to diagnose and are generally picked up locally at the resort or at the local trauma centre. They are usually managed well locally, but prompt review on your return with a foot and ankle specialist is a good idea.

If, however you are reading this little blog, in pain, unable to ski / board with an injured foot that has been diagnosed as a sprain or bruising then please read on. 

A sprain is simply a torn ligament. A ligament is a fibrous structure that holds two bones together. Ankle sprains are of course common, but not common within the confines of a ski or snowboarding boot. The boot and bindings are usually so stiff, that the amount of movement needed to tear a ligament is fairly unlikely. 

There are 2 injuries however that we do see that are often missed.

One is a fracture of the Talus bone, commonly known as a Snowboarders fracture. The other a rupture of the ligaments that hold the ankle and leg together, known as a Syndesmosis injury.

 The mechanism of injury is the key. A ski boot or boarding boot / bindings, positions the foot and ankle in a slight dorsi flexed position. Dorsi flexion is when your centre of gravity is pushed forward over the foot. You are leaning forward and the weight is pushing through the front of your foot. This is a very stable position for the ankle, since the Talus bone is wedged in between the Tibia (the shin bone) and the Fibula (slender outer bone).This is a great position for skiing since it  feels strong and stable, and allows you to load a edge and carve. If however you hit a unexpected depression, (such as when in powder), or if you miss time a landing thing can go wrong.  The recoil of the ski/ board and your ongoing forward momentum will thrust the ankle and foot into further dorsi flexion. Essentially your ski –boot – foot will be pushed upwards and in this position the Talus is essentially crushed between the foot and the leg.

One of 2 injuries then happen. If you continue to flex forward, falling to the outside the outer side of talus eventually breaks. This is called a lateral process fracture or a “Snowboarder fracture”.

If you fall forward and rotate as you do so then the huge rotational force generated can rupture the ligaments holding the fibula and tibia together resulting in a Syndesmosis injury.  

Both are often misdiagnosed because patients can often walk, albeit with pain. X rays often initially look normal to casual inspection. Patients are advised rest and elevation.

Unfortunately both need prompt treatment and a period of absolute rest, initially at least in a plaster or boot to get a good result.

If your tale of woe fits this pattern and your injury seems more than a simple sprain, then prompt review is needed on your return.

Next time Ioan Tudor Jones talk a little more about how to diagnose such injuries and how we treat them.

 

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