Snowboarding Ankle Injuries

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Snowboarders tend to get more ankle injuries than skiers, and skiers tend to get more knee injuries than snowboarders
  • The “snowboarder’s fracture” is unique to ankle injuries in snowboarding
  • A fracture of the “lateral process of the talus” is sometimes missed on regular x-rays and it’s sometimes necessary to use specialized imaging to make a proper diagnosis
  • When treated early and properly this fracture will typically allow full return of sports participation but a missed diagnosis can result in significant problems

In this post I’m going to discuss a particular type of broken bone seen in snowboarding snowboardoften referred to as “the snowboarder’s fracture.” This particular fracture occurs in one of the ankle bones called “the talus”. A fracture in the lateral process of the talus is called the snowboarder’s fracture.

Patterns of injury are a bit different in snowboarding compared to skiing. Skiers tend to get more knee injuries than ankle injuries, and snowboarders tend to get more ankle injuries than knee injuries. One proposed reason for this difference is due to the less rigid boots used in snowboarding, which provide minimal protection to the ankle joint.

Most ankle injuries in snowboarding affect the lead leg. And about 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 don’t always show the fracture very well. If I’m suspicious for a snowboarder’s fracture and the x-rays look normal, I’ll often order a CAT scan as this can be a much more accurate way to diagnose this fracture.

Treatment of the snowboarder’s fracture depends on how big and how displaced the broken fragment is. For a small fracture that is in normal alignment, we can treat these without surgery. This typically means about 4 to 6 weeks of having the foot and ankle in a cast and no weight bearing on the leg. Large and displaced fractures are typically treated with surgery—the fragment is moved back into its normal position and screws are inserted to hold it in place. Recovery after surgery also includes a period of non-weight-bearing, followed by gradual restoration of motion, strength, and function of the ankle joint.

ssd.bannerOutcomes of snowboarder’s fractures are typically good if the injury is diagnosed early and appropriately treated.

Most athletes are able to get back to normal physical activity within 4 to 6 months. However, significant problems can result if this fracture is missed and appropriate treatment is delayed. These include non-healed bony fragments causing pain and poor function, as well as early arthritis of the joint, which can significantly limit movement of the foot. When a snowboarder presents with acute pain on the outer side of the foot or ankle after an injury on the slopes, it’s very important to see a skilled physician for a proper exam and appropriate diagnostic imaging to avoid missing this injury.

Tips for Keeping Your Feet Dancing Through the Holidays

By  Kelli Barton for Athletico

The Nutcracker is the most iconic holiday ballet performed by ballet schools and professional companies around the world.

Between December 10th and December 30th, the Joffrey Ballet Chicago will perform The Nutcracker 27 times. That’s an average of 1.2 shows per day! For optimal performance, it is crucial that dancers are proactive in preventing injuries from occurring and correctly manage injuries when they do occur. Foot and ankle injuries represent 34-62 percent of all injuries reported by dancers. Female ballet dancers are especially vulnerable to these injuries because of the increased demand put on the foot and ankle when dancing en pointe.

To help prevent dancing injuries from happening, consider the following tips:

Overuse Injuries
Overuse injuries are aches and pains that occur due to the repetitive nature of danceballet-dancing movements and lack of adequate rest. Examples of overuse injuries are stress fractures and tendinitis. Fortunately, the risk for these injuries can be decreased through appropriate rest, adequate warm up and nutrition.

 

Getting Appropriate Rest

Fatigue has been cited as a common reason for injuries in dancers as overall injury rates vary from 0.8 to 2.9 injuries per 1,000 hours of dance training. When fatigued, decreased trunk control and faulty lower extremity alignment results in increased demand on joints and ligaments to provide stability. While you may not be able to alter the amount of time you spend dancing, you can control what you do during time outside the studio. For example, active rest is preferred over complete rest, including gentle movements, stretching, as well as strengthening and stabilizing muscle groups. This helps avoid excessive stiffness throughout the body.

It is also important to note that fatigue-related injuries have been reported to increase when psychological stressors such as work or school conflicts are present. Since performances may induce additional stress, it is important to find strategies to appropriately rest your brain in addition to your body to stay healthy during this time.

Warming Up

An appropriate warm-up primes the body for optimal performance. Morrin et al found that a combination of static and dynamic stretching provided a significant change in hamstring flexibility as well as superior balance and vertical jump values in comparison to a static-only or dynamic-only warm up.

Static stretching involves holding a specific position for a period of time whereas dynamic stretching has an aerobic approach in which the body part is repetitively moved through its available range of motion. Examples of dynamic stretching include leg swings, alternating kick-to-buttocks and scissor jumps.

Good Nutrition

Low energy availability occurs when a dancer is not consuming enough food for the amount of energy expended during physical activity. Therefore, a dancer will need to eat more as the volume of dance participation increases.

Signs of low energy availability include fatigue, difficulty concentrating and loss of menstrual cycle. Consistently low energy availability can cause sub-optimal bone mineral density and place the dancer at increased risk for stress fractures. High caffeine intake, noted as greater than two cups of coffee per day, can also contribute to low bone mass density. For specific nutrition recommendations, please seek attention from a nutritionist in order to develop a plan based on your individual needs.

Acute Injuries

Acute injuries occur when a bone, ligament, tendon or muscle is extended past its capability or excessive force is placed onto a region of the body. Examples of acute injuries are ligament sprain and muscle strain.

When an acute injury occurs, the body releases chemicals to create an inflammatory response around the damaged structure. The inflammation assists with promoting new cell growth, defending the body against harmful substances, and disposing of damaged tissue. However, this process results in swelling, redness, warmth, pain and loss of function at the area of injury. The following steps should be taken after an acute injury:

“PRICED”

P: Protection

Relocate to a safe space away from additional danger such as fellow dancers continuing to perform and provide support to the region of injury.

R: Rest

Avoid painful movements with involved body part as continual stress may increase injury and delay healing.

I: Ice

Apply ice to the injured area for 20 minutes every 2 hours for the initial 2-3 days. Ice will decrease blood flow to the area, slow conduction of painful nerve impulses, decrease abnormal accumulation of fluid, and lower temperature.

C: Compression

Utilize an elastic compression bandage to wrap the area. If you experience sensation of pins/needles, numbness or change in skin color, the bandage is too tight. Start away from the heart using a figure 8 pattern with a gradual decrease in tightness as you pass the site of injury. Avoid gaps in bandage that expose skin as swelling will accumulate here.

E: Elevation

Raise the injury area above the heart to increase return of blood and therefore remove waste products away from the area.

D: Diagnosis

All acute injuries should be evaluated by a health-care professional for advice regarding appropriate next steps, especially if not resolved with “PRICE” or unable to bear weight. Choosing a health-care professional who has a specialty working with performing artists will be helpful to allow for a gradual, safe return to dance.

Basic First Aid for the Foot

Although blisters, cramping, split skin and bruising will not likely take you out of a performance, they can be a source of discomfort when participating in a higher volume of dancing.

Blister Blisters are caused by a combination of friction and moisture at bony prominences of the feet. It may be a sign that shoes should be re-sized as the structure of the foot can change over time. Petroleum jelly or tape placed on more vulnerable spots can decrease friction. In addition, using less absorbent material for tights or pointe shoe padding can decrease moisture. Blisters will heal independently and should avoid being popped due to risk for infection. If a blister does pop, it is important to cover with an antibiotic ointment and bandage that will stay secured in shoes.

Cramps A muscle cramp is a strong, painful tightening of a muscle that occurs involuntarily.  Another name that is commonly used to describe a cramp is a “Charley horse.” To avoid cramping, stay hydrated and perform an adequate warm up as well as cool down. Stretching the cramped muscle can assist with relieving symptoms faster.

Split Skin Split skin often occurs in the area of a callous, particularly on the ball of the foot. Prevent skin from splitting by using a fat-based balm such as coconut oil over areas of tough, dry skin. If a skin split does occur, be sure to keep the area clean to decrease risk for infection. There are some over-the-counter products that help to seal the split skin together to promote healing.athletico300x250

Bruising The best prevention for bruising is to wear padding and control descents to the floor during choreography. Avoid heating pads or warming topical creams, as this will bring more blood to the bruised region and delay healing.

By following the above recommendations, you are now ready to tackle the Nutcracker season injury free! If you experience an injury, please contact your physician or set up a screen with a performing arts physical therapist at a conveni ent Athletico Physical Therapy location.

Schedule a Complimentary Injury Screen

The Future of Ankle Bracing is Here

Get Into Your Comfort Zone

Exos Free Motion Ankle

The Exos™ Free Motion Ankle offers unparalleled comfort, support and ease of use. This anatomically formed ankle foot orthosis can be fit to a patient within 30 minutes to quickly alleviate pain and discomfort, restore mobility and prevent progression of a disease or deformity.

Posterior Tibial Tendon Dysfunction (PTTD)

  • Correct bony alignment and provide support in various planes of motion

Post-Trauma / Post-Op Rehabilitation

  • Arthritis
  • Weak ankles due to ligament damage and over stressed ligaments
  • High ankle sprains

Chronic Ankle Instabilities

  • Step down care following casting or walking boot
  • Controlled range of motion allows full-functional management and faster return to activities

Exos Free Motion Ankle is the first prefabricated Ankle Foot Orthosis that can be fully
customized and formed to the patient providing functional stabilization of the ankle- foot complex addressing bony abnormality, chronic instability and post-trauma rehabilitation.

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Ankles for Life Helps Raise Awareness of Ankle Injuries among Athletes

ankles-for-life-logoThe Midwest Orthopaedics at Rush foot and ankle physicians, Dr. George Holmes, Dr. Simon Lee, Dr. Johnny Linand Dr. Kamran Hamid, have created “Ankles for Life,” in conjunction with the Illinois Athletic Trainers Association (IATA). This program aims to raise awareness of ankle injuries among athletes, especially Achilles injuries, and the need for better prevention strategies. The foot and ankle section has noticed an estimated 300 percent increase in Achilles patients over a recent ten year period.

“The foot and ankle, which withstand a lot of pressure from the body, are areas most likely to be overlooked by athletes,” explains Kamran Hamid, M.D., MOR foot and ankle surgeon. “The good news is that proper injury prevention and strengthening exercises can make a big difference in keeping athletes’ feet and ankles healthy.”

Read more about this program and physicians’ comments in this Orthopedics This Week article.

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Treatment and Prevention of Ankle Sprains

Running Injuries – Part Eight

Ankle sprains happen when there is turning, twisting, or rolling movement of the foot that stretches the ligament surrounding the ankle beyond their normal range, tearing them in the process, and leading to severe swelling and pain.

This is a very common injury. In fact, roughly 25,000 people sprain their ankles on a daily basis, according to the American Academy of Orthopedic Surgeons. And runners are not an exception.

Female runner suffering ankle sprained injury.Symptoms

Ankle sprains manifest as tender pain in the ankles—especially when you walk or run on the injured foot. Other symptoms of ankle sprains include bruising, skin discoloration, swelling and restricted range of motion in the whole ankle area.

Fix it

The standard RICE method works like a charm with this injury. If you are going an ankle sprain, then you need to R.I.C.E it for at least a couple of days before you do any weight-bearing activities like running. You can also wrap or compress the ankle with an Ace bandage to ease the inflammation and speed up recovery.

Of course, how long should you rest depends on the sprain’s severity, so if the injury lingers for more than two weeks, then you might need to a see a physician for a more thorough action plan. In most cases, your physician might recommend tapping the ankle, an air case or an ankle brace to speed up recovery and/or prevent re-injury as you slowly return back to your running routine.

Prevent it

Ankle sprains will usually heal in one to two weeks, but if you have a bad history of the condition (read: you sprain your ankles a lot), then there are a few things you need to do to prevent that from happening. To bullet-proof your body against ankle sprains, start doing balance exercises to strengthen the muscles around your ankles and build prioperception—the awareness of your own body in space.

Once the pain subsides and you can run pain-free, you might consider strengthening the muscles surrounding your ankle with balance training exercise such as xxx and yyy to improve ankle stability and prevent a flare-up—especially if you have a bad history of the condition.

By David Dack for Runners Blueprint