Winter is in full gear and temperatures are dropping! Many of us may choose to stay inside and keep warm, but for others, this means only one thing – time to hit the slopes. You may plan to head to the mountains or stay local. But either way, it’s that time of the year when people are itching to get outside to cure the cabin fever. The sense of action and thrill that comes with outdoor sports is what keeps people coming back, year after year. Unfortunately, it is also what keeps local urgent care and emergency rooms busy. Most of us are aware of the inherent risks of the sport, such as broken arms, legs, and knee injuries. However, an injury that is often overlooked, but frequently befalls, snowboarders is referred to as a “snow boarder’s fracture.”
This fracture occurs in one of the ankle bones, known as the talus. And they occur in a specific area called the lateral talar process. The lateral talar process is a triangular-shaped bony prominence on the outside of the ankle bone. It serves as a point of articulation with the ankle as well as an attachment point for several important ligaments. Boots used in skiing are very rigid and provide pretty solid foot and ankle support. So your chances of sustaining a knee or leg injury in skiing are not as high. In snowboarding, the boots are much more flexible and provide less support to the foot and ankle. This leads to a higher number of these injuries.
In snowboarding, lateral talar process fractures typically happen in high impact situations to the forward-facing foot. They occur while landing on a maximally dorsiflexed (upwardly flexed) ankle and everted (outwardly rolled) hindfoot. This mechanism may occur in other situations as well. Some of these include motor vehicle accidents, stepping in a hole, or falling from a height.
These injuries will often present similar to ankle sprains. There will be a rapid onset of pain and swelling to the outside of the ankle. Snow boarder’s fractures are often misdiagnosed as a common ankle sprain. A study by Mills and Horne found that an astounding 41% of the time these fractures were misdiagnosed! This misdiagnosis may be a result of the difficulty in visualizing these fractures on most standard X-ray angles. Oftentimes a CT scan is necessary to get an accurate assessment of the injury. It is essential to get a fast and accurate diagnosis. If treatment is delayed or neglected, the injury may worsen. And this may result in further instability, long-term arthritis, pain, and disability.
Treatment options can vary widely depending on the size, position, and extent of the fracture. In certain cases, such as those with only a small non-displaced chip fracture, immobilization in a cast is likely sufficient. Other times, surgical excision of the fracture fragment may be the best course of action. Or if large enough, the fracture will be fixated with pins or screws. These injuries run a large risk of damage to the surrounding soft tissue and causing stiffness and post-traumatic arthritis. Modalities to avoid these may include physical therapy, bracing, or custom orthotics. All of these practices will be helpful in retraining, strengthening, and achieving biomechanical control.
The lateral talar process “snowboarder’s fracture” has the potential to lead to serious long-term consequences. It is very important to diagnose these correctly and provide treatment. Fortunately, studies on this injury have generally shown favorable results when promptly and accurately diagnosed and treated appropriately. Our team of podiatrists at Kansas City Foot and Ankle are equipped with the latest technology, up to date knowledge, and conservative and surgical training. We will provide you with an accurate diagnosis and treatment plan to get you back on your feet – and back out on the slopes!
Miller, Stephen. Fractures of the Lateral Process of the Talus: Snowboarder’s Fracture. The Podiatry Institute. Ch. 23. 119-123.
Mills HJ, Horne G. Fractures of the Lateral Process of the Talus. Aust N Z J Surg. 1987;57:643-6.