California Podiatric Medical Association
Your feet shouldn't hurt
SACRAMENTO, Calif. (PRWEB) February 23, 2018
The dazzling, death-defying, jaw-dropping, eye-popping gold medal performances of snowboarders Chloe Kim and Shaun White at the 2018 Olympics has many a snowboarder anxious to hit the slopes. Unfortunately, the rush to try new tricks frequently means a lack of preparedness, which in turn can increase the risk of injury, including snowboarder’s ankle.
Snowboarder’s ankle (so named because the injury occurs 15 times more in snowboarders than the general population)1 is the common term for a fracture of the Lateral Process of the Talus (LPT), which often occurs during a high-impact event, such as a car collision or a hard fall from high up.
“Located in the ankle, the Talus is a small bone set between the heel bone (calcaneus) and the two bones of the lower leg (tibia and fibula). This complex assembly of bones, ligaments, and tendons forms the primary connection between the lower leg and foot, which allows the foot to move up and down, thus making it vital to mobility. Because of the Talus’ importance in ankle movement, a fracture can often result in significant loss of range of motion and function of the foot and ankle. In addition, a Talus fracture that does not heal properly can lead to serious life-long complications, including impairment of foot function, early onset of arthritis, and chronic pain,” says podiatric foot and ankle specialist Thomas J. Elardo, DPM, a board certified podiatric physician and surgeon in private practice in the Silicon Valley cities of San Jose and Los Gatos, California.
“The cause of the prevalence of the fracture of the Talus bone in snowboarders continues to be debated. In all likelihood, the probable cause is the convergence of both the biomechanics of, and equipment required for, the sport.
“First-up, there is the unnatural sideways biomechanical motion of snowboarding. This is combined with boots that are strapped to the board, which offer no quick release upon falling. And then there are the boots. Snowboard boots are different from the rigid boots worn in downhill skiing. Snowboarders’ boots are softer and suppler, allowing for those thrilling jumps and amazing acrobatics. The more flexible construction of snowboarding boots also means that they are less protective on those hard landings from high up - leading to higher rates of foot and ankle injuries, including snowboarder’s ankle. Whenever there is enough force to break a bone, there is likely damage to ligaments and tendons as well.”
Dr. Elardo offers the following tips to stay on the snowboard and off the injury couch:
● Prevention. Prevention is the first step in avoiding injury,” said Elardo. “Make sure you have properly fitted equipment, and that it is in good working order. If you are new to the sport take some lessons from an experienced snowboard instructor.
● Support. The excessive motion and instability of the foot and ankle within the softer snowboarding boots could be minimized with custom orthotics, which can help stabilize the foot, minimize stress, and improve overall foot function thereby helping to prevent foot and ankle injuries.
● Strengthening and Conditioning. Don’t forget to include feet and ankles in your strength and conditioning regime. Simple, yet effective and inexpensive, exercises for the foot and ankle include: wobble boards (which also help with balance), heel cord stretches, tennis ball rolls, towel stretches (both pointing and flexing the foot), calf raises, marble pickups (with toes), ankle rotations, and foot flexors.
● Warm up. Don’t forget to warm up before hitting the slope. It takes muscles, joints, and ligaments longer to warm up in cold weather, making them more prone to injury. Warm up first with a brisk 10- or 15-minute walk, followed by 15 minutes of gentle, fluid stretching - no pulling or bouncing. Yoga is great for stretching the entire body, which helps prevent muscle pulls and tears and readies the muscles and ligaments for the exertion required by the constant flexing of the joints demanded by snowboarding.
● Don’t Overdo It. Know when to call it a day. Trying to get one more run in at the end of the day when you’re tired is a recipe for injury.”
Elardo acknowledges that despite all the precautions and preparedness that snowboarder’s ankle can still happen, for which early diagnosis and treatment are critical for positive outcomes.
“The damage that can result from snowboarder’s ankle is often not limited to the foot and ankle. The body will attempt to compensate for reduced foot function, which can lead to vital changes to the biomechanics of the foot and the way one walks, which in turn puts additional stress on the knees, hips, and spine. “That arthritic knee could be the result of an old ankle injury that was not properly treated,” Elardo continued.
“On top of that, snowboarder’s ankle is notoriously difficult to diagnose. Its initial onset of symptoms is very similar to those of a badly sprained ankle, which include extreme pain, tenderness and sensitivity to pressure around the ankle, swelling to the area, and bruising.
“The early stages of treatment are similar to how we treat an ankle sprain: the RICE method is applied:
● Rest. Rest and protect the injured or sore area. Stop, change, or take a break from any activity that may be causing your pain or soreness.
● Ice. Cold will reduce pain and swelling. Apply an ice or cold pack right away to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. After 48 to 72 hours, if swelling is gone, apply heat to the area that hurts. Do not apply ice or heat directly to the skin. Place a towel over the cold or heat pack before applying it to the skin.
● Compression. Compression, or wrapping the injured or sore area with an elastic bandage, will help decrease swelling. Don't wrap it too tightly, because this can cause more swelling below the affected area. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage.
● Elevation. Elevate the injured or sore area on pillows while applying ice and anytime you are sitting or lying down. Try to keep the area at or above the level of your heart to help minimize swelling.
“A nonsteroidal anti-inflammatory (NSAID) like aspirin, ibuprofen or naproxen sodium may help to relieve pain and swelling.
“If you are still experiencing the same symptoms and level of pain (or worse) a couple of weeks later see a podiatric foot and ankle specialist right away. It can be hard to identify the fracture, even on x-rays, and since the injury is rarely seen in the general population it can be misdiagnosed, which is why health care professionals should seek help from podiatric foot and ankle physicians and surgeons to help ensure a proper diagnosis.
“A podiatric physician and surgeon is likely to conduct a CT scan to get a clearer picture of the affected area. If after obtaining a history of the injury I am suspicious for a snowboarder’s fracture and the initial x-rays look normal, I’ll often order a CT scan, as this can be a much more accurate way to diagnose this fracture.
“Once identified as snowboarder’s ankle, treatment of the fracture will depend on how large and how displaced the broken fragments are. A small fracture that is in normal alignment can usually be treated without surgery. This typically means about 4 to 6 weeks of having the foot and ankle in a cast and on crutches with no weight bearing on the leg. However, large and displaced fractures are typically treated with surgery. Sometimes this is highly problematic as the multiple fragments of bone can be like putting together the pieces of a difficult jigsaw puzzle in an area that has a quarter of all the bones in the human body (the foot and ankle).
“Once the fragments are put back into their normal position, screws and plates are inserted to hold it in place. Recovery from surgery can be prolonged. No weight or walking on the injured ankle for 8 to 12 weeks. Once the bones are healed, exercise and physical therapy can be started to aid in the gradual restoration of motion, strength, and function of the ankle joint.
“Outcomes of snowboarder’s fractures are typically good if the injury is diagnosed early and appropriately treated,” Elardo concluded.
To find a licensed local podiatric physician please visit http://www.calpma.org.
Founded in 1912, the California Podiatric Medical Association (CPMA) is the leading and recognized professional organization for doctors of podiatric medicine (DPMs). DPMs are podiatric physicians and surgeons, also known as podiatrists, qualified by their education, training and experience to diagnose and treat conditions affecting the foot, ankle and structures of the leg.
CPMA, KEEPING CALIFORNIANS ON THEIR FEET – HEALTHY, ACTIVE AND PRODUCTIVE
1 Snowboarder’s Ankle
Kramer IF, Brouwers L, Brink PR, Poeze M.
British Medical Journal, 2014 Oct 29