By Alexander Golant, MD
Despite being a relatively young sport, snowboarding has rapidly grown in popularity in recent years with an estimated 8.2 million people participating. Most common snowboarding injuries include those to the upper extremities, specifically to the wrist and hand. In terms of lower extremity injuries, compared to skiers, snowboarders sustain fewer knee but more ankle injuries. It has been proposed that this is due to the less rigid boots used in snowboarding, which provide minimal protection to the ankle joint.
Ankle injuries make up approximately 15 percent of all snowboarding injuries, with most affecting the lead leg. Approximately half of all ankle injuries in snowboarding are fractures. The “snowboarder’s fracture” occurs because of sudden upward movement of the foot, combined with the foot turning inwards. This injury typically occurs when landing from a jump. Pain is present on the outer side of the foot and ankle, and is often associated with swelling, bruising and significant tenderness to touch. Unfortunately, this injury is often missed, because regular X-rays do not always show the fracture very well. A CT scan may be helpful in making the diagnosis.
Treatment of the snowboarder’s fracture depends on how big and how displaced the broken fragment is. Minimallydisplaced or non-displaced fractures can be treated non-surgically, with 4 to 6 weeks of cast wearing and no weight-bearing on the leg. Large and displaced fractures are typically treated with surgery—the fragment is reduced into its normal position and screws are inserted to hold it in place. Small fragments which are broken into many little pieces may sometimes be removed. Recovery after surgery also includes a period of non-weight-bearing, followed by gradual restoration of motion, strength, and function of the ankle joint.
Outcomes of snowboarder’s fractures are typically good if the injury is diagnosed in a timely fashion and appropriately treated. Most athletes are able to get back to physical activity within 4 to 6 months. However, significant complications may result if this fracture is missed and appropriate treatment is delayed. These include non-healed bony fragments causing pain and dysfunction, as well as early arthritis of the joint, which can significantly limit movement of the foot. When a snowboarder presents with acute pain on outer side of the foot or ankle after an injury on the slopes, it is imperative that a careful physical examination is administered by a trained medical professional, and appropriate diagnostic imaging is ordered, so as to avoid missing this injury.
The other ankle injuries in snowboarders include ankle sprains, as well as soft-tissue inflammation due to repetitive friction between the boot and the ankle, or from compression by the binding straps. Most sprains can be treated with a period of protected weight-bearing (using an ankle brace or a special boot), combined with a rehabilitation program to gradually regain motion and strength. Non-traumatic soft-tissue inflammation typically resolves with a period of rest and abstaining from snowboarding, but if it persists or recurs, surgical treatment may be necessary. For more information on preventing skiing/snowboarding injuries visit www.stopsportsinjuries.org/skiing-andsnowboarding-injury-prevention.
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This article originally appeared in In Motion, an official wellness publication by The American Orthopedic Society For Sports Medicine in conjunction with AOSMI.