ANKLE & FOOT
Despite often rigid foot and ankle protection in boots, injuries are common on the slopes. They are also often seen slipping over when walking around the resort! The majority of injuries are from rolling the foot and ankle placing tortional forces through ligaments. Here are the main foot and ankle injuries that can occur during snow sports.ANKLE SPRAINS
When you roll your ankle the ligaments in the ankle are stretched or torn. Most frequently ligaments on the outside of the ankle but can also be on the inside or between the two bones that make up the top of the joint. If an x-ray shows the joint is intact then treatment can be in a fixed angle walking boot. Sometimes weightbearing x-rays are required for confirmation.
ANKLE FRACTURES
If the rolling motion is combined with a loading force, then the risk is that the bones around the ankle fracture. Different injury mechanisms cause different fracture patterns. As with most fractures and dislocations, the emergency management is to get the joint and bones back into position. Some fracture patterns then need definitive surgery with internal plate and screw fixation. There are many fractures that can be treated in a fixed angle walking boot rather than a plaster. Initial x-rays and further weight-bearing x-rays are important to decide the best type of non-operative management.
ANKLE DISLOCATIONS
If ligament ruptures or displaced fractured bone affect the stability of the ankle, the joint can dislocate. This required emergency reduction and usually surgery for internal plate and screw fixation. If the initial reduction is good, surgery may be delayed until ankle swelling settles.
SNOWBOARDER’S FRACTURE
There must be a good reason to name a fracture after snowboarding! This is a fracture of the lateral talar process. The talus makes up the bottom part of the ankle joint and the process (bony lump) on the lateral (outside) is where three ligaments attach (the lateral talocalcaneal ligament, and the anterior and posterior talofibular ligaments). Avulsion fractures occur when the ligaments forcefully pull on their attachment and in this case fracture through it. It is usually caused by landing a jump awkwardly or twisting the ankle upwards and outwards.
PERONEAL TENDON INJURIES
These tendons cross the outside of the ankle and attach in the midfoot. Injuries are often seen as avulsion fractures from the attachments. Once identified these can often be treated in a walking fixed ankle boot.
ACHILLES TENDON RUPTURE
Usually associated with an underlying inflammation of the tendon. Ruptures can occur when there is a sudden contraction of the calf muscle when running or missing a step. Treatment is usually in a specialist walking boot that keeps your ankle down so the ruptured tendon ends come together.
STRESS FRACTURES
These occur when the bone goes through a new repetitive stress before there has been time for the bone to remodel to take the additional forces. Any change to new impact activity places leg bones at risk.
SKIERS TOE
Despite the name this is seen in both skiers and snowboarders. It is a common injury where the repetitive force on your toe nail bed causes bleeding and the nail turns black. Its more often seen when boots are too tight. Elevate and ice can usually ease symptoms but if there is painful pressure then a making a needle hole in the nail can release this.
BLISTERS
Often a fairly minor blister can become a painfully frustrating injury! Clearly prevention is better than cure with correct fitting specialist socks and boots. Once formed, you don’t want an infection; blisters shouldn’t be popped, need to be kept clean, and should be protected with specialist padded plaster dressings.
