Sprained Ankle… or Snowboarder’s Ankle?

Up to 28% of snowboard injuries are ankle related ^1-4. Although one particular fracture, which poses potentially serious long term ankle problems, is still commonly being misdiagnosed by many doctors. Here’s what to look for…

This educational article was written to inform snowboarders and instructors. It is not intended to replace professional medical advice, diagnosis or treatment… that would just be silly!

WHAT IS SNOWBOARDER’S ANKLE?

Lateral process of the talus location.

Medically speaking, snowboarder’s ankle is a fracture of the lateral process of the talus (LPT).

This tiny area of bone is located on the outer side of the ankle just above the heel bone (see diagram), of which the lateral process is the wedge-shaped protrusion that we’ve coloured yellow.

The term snowboarder’s ankle comes from this fracture being 15x more likely amongst snowboarding related ankle injuries than other ankle injuries ^3,5-7. Our sideways motion, soft (non-hard shell) boots and being strapped to the board are all factors that influence this higher rate ².

SO WHAT CAUSES THE FRACTURE?

Snowboarder’s ankle occurs as result of the foot being pushed up towards the shin (dorsiflexion) combined with a rolling inwards/outwards of the ankle (inversion ^5,7,8 / eversion ⁹) under sufficient force.

Dorsiflexion causes the Talus to become locked in place by the surrounding bones, the ankle roll then causes that specific small area (LPT) to be compressed by other bones. Add some force to the equation (e.g. landing off a jump or suddenly ending up in the back seat at speed ¹⁰) and you’ve got all the ingredients for a fracture in a very hard to spot place.

The sufficient force factor means snowboarder’s ankle is more common in intermediate – advanced riders than beginners. Lower level snowboarders comparably incur a higher rate of upper body injuries.

SYMPTOMS & DIAGNOSIS

Snowboarder’s ankle has similar symptoms to that of a badly sprained ankle and thankfully it’s statistically more likely you have the latter. Symptoms include:

• Extreme tenderness and sensitivity to pressure around the back of your ankle.
• Swelling to the area.
• A degree of bruising.

These symptom similarities make identifying snowboarder’s ankle more challenging, with between 33 – 41% of cases being missed on the initial inspection and diagnosed as a bad sprain ^5,11,12.

Team rider LGC’s swollen ankle from a fracture.

The good news is an x-ray will conducted at the time of injury should a broken bone be suspected, with obvious fractures identified and treated accordingly. So always seek medical advice/treatment at the earliest opportunity.

However it can be hard to identify snowboarders ankle on x-rays and doctors rarely see this fracture in the general population, so sometimes snowboarder’s ankle is only spotted once initial treatment for a bad sprain has failed.

If you’re still experiencing the same level of pain/symptoms a couple of weeks later, then get a medical professional to take another look. They’re likely to x-ray the area again or conduct a CT scan for a clearer picture.

TREATMENT & RISKS OF LATE DIAGNOSIS

Treatment varies depending upon the severity of the fracture. From 6 weeks in a cast to surgical realignment or removal of bones, usually followed up by physiotherapy. Should you require surgery then you’ll definitely want an orthopaedic surgeon with expertise in lateral talus fracture repair on hand with the tools!

In general 80% of people with this fracture make a return to pre-injury levels in their sport ^13,14. However if missed or improperly treated the outlook is poor ^5,7,15,16, with complications including chronic pain, joint instability, arthritis or loss of mobility ^11,12.

PREVENTION

No one single thing will completely remove the possibility of sustaining snowboarder’s ankle, although current research points to the following methods of helping reduce the risk:

• Balance exercises – wobble boards/platforms traning, help by strengthening the muscles in the ankle.

• Ankle brace – I’m not convinced how realistic fitting one inside your snowboard boot is! A neoprene supports maybe, but then you’d find more support from a stiffer pair of boots.

• Insoles – Providing your foot with the stable platform and joint alignment will always be beneficial, heaps of specialists out there can help with this.

• Lessons – Let an instructor see if there are ways to make your riding more efficient and effective to avoid these potentially dangerous positions.

FINAL THOUGHTS

The chances of suffering snowboarder’s ankle are low, but if a suspected bad sprain is still giving you grief weeks later then seek medical advice again. The long term side effects of missing this potential fracture won’t help your riding skills one bit!

This video explains the different fracture types in greater detail…

REFERENCES

1. Abu-Laban, R.B., 1991. Snowboarding injuries: an analysis and comparison with alpine skiing injuries. CMAJ: Canadian Medical Association Journal, 145(9), p.1097.
2. Davidson, T.M. and Laliotis, A.T., 1996. Snowboarding injuries, a four-year study with comparison with alpine ski injuries. Western journal of medicine, 164(3), p.231.
3. Kirkpatrick, D.P., Hunter, R.E., Janes, P.C., Mastrangelo, J. and Nicholas, R.A., 1998. The snowboarder’s foot and ankle. The American Journal of Sports Medicine, 26(2), pp.271-277.
4. Made, C. and Elmqvist, L.G., 2004. A 10‐year study of snowboard injuries in Lapland Sweden. Scandinavian journal of medicine & science in sports, 14(2), pp.128-133.
5. Murkherjee, S.K., Pringle, R.M. and Baxter, A.D., 1974. Fracture of the lateral process of the talus. J Bone Joint Surgery Br, 56B(2), pp.263-273.
6. Bladin, C. and McCrory, P., 1995. Snowboarding injuries. Sports Medicine, 19(5), pp.358-364.
7. Hawkins, L.G., 1965. Fracture of the lateral process of the talus. J Bone Joint Surg Am, 47(6), pp.1170-1175.
8. Fjeldborg, O., 1968. Fracture of the lateral process of the talus: supination-dorsal flexion fracture. Acta Orthopaedica Scandinavica, 39(1-3), pp.407-412
9. Funk, J.R., Srinivasan, S.C. and Crandall, J.R., 2003. Snowboarder’s talus fractures experimentally produced by eversion and dorsiflexion. The American journal of sports medicine, 31(6), pp.921-928.
10. Ng, E.S., O’Neill, B.J., Cunningham, L.P. and Quinlan, J.F., 2013. Snowboard, wakeboard, dashboard? Isolated fracture of the lateral process of the talus in a high-speed road traffic accident. BMJ case reports, 2013, p.bcr2013200357.
11. Heckman, J.D. and Mclean, M.R., 1985. Fractures of the Lateral Process of the Talus. Clinical orthopaedics and related research, 199, pp.108-113.
12. Tucker, D.J., Feder, J.M. and Boylan, J.P., 1998. Fractures of the lateral process of the talus: two case reports and a comprehensive literature review. Foot & ankle international, 19(9), pp.641-646.
13. Valderrabano, V., Perren, T., Ryf, C., Rillmann, P. and Hintermann, B., 2005. Snowboarder’s Talus Fracture Treatment Outcome of 20 Cases After 3.5 Years. The American journal of sports medicine, 33(6), pp.871-880.
14. Shakked, R.J. and Tejwani, N.C., 2013. Surgical treatment of talus fractures. Orthopedic Clinics of North America, 44(4), pp.521-528.
15. Mills, H. and Horne, G., 1987. Fractures of the lateral process of the talus. ANZ Journal of Surgery, 57(9), pp.643-646.
16. Perera, A., Baker, J.F., Lui, D.F. and Stephens, M.M., 2010. The management and outcome of lateral process fracture of the talus. Foot and Ankle Surgery, 16(1), pp.15-20.