With winter in full gear and temperatures 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. Whether your plans this winter include heading to the mountains in Colorado or staying local and making a trip to Snow Creek to get in some snowboarding or skiing, it’s that time of the year when people are itching to get back outside to cure the cabin fever. The sense of action and thrill that comes with skiing and snowboarding may be what keep people coming back year after year, but it is unfortunately 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, but there is another commonly observed injury of the foot that is often overlooked. This is found most commonly in snowboarders and is thus referred to as the “snowboarder’s fracture.”
This fracture occurs in one of the ankle bones, known as the talus, 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 that serves as a point of articulation with the ankle as well as an attachment point for several important ligaments. Because the boots used in skiing are much more rigid and provide better foot and ankle support, more often knee and leg injuries are seen with this sport. In snowboarding, however, the boots are much more flexible and provide less support to the foot and ankle, leading to a higher number of these injuries.
In snowboarding, lateral talar process fractures typically happen in high impact situations to the lead (or forward facing) foot and occur while landing on a maximally dorsiflexed (upwardly flexed) ankle and everted (outwardly rolled) hindfoot. This mechanism may also occur in certain motor vehicle accidents, stepping in a hole, or falling from a height. These injuries will often present similar to ankle sprains, with rapid onset of pain and swelling to the outside of the ankle. Because these injuries occur very near the site of most ankle sprains, they can very easily be misdiagnosed as just that. A study by Mills and Horne found that these fractures were only correctly diagnosed 59% of the time. Due to the difficulty in visualizing the fracture on most standard X-ray angles, these injuries are commonly missed in urgent care centers and emergency rooms across the country. Often times to get a more accurate assessment of the injury, a CT scan may be necessary. It is essential to get a fast and accurate diagnosis, as delayed or neglected treatment may lead to worsening of the injury or further instability of the fracture, which might result in long-term arthritis, pain, and disability.
Once a proper diagnosis is attained, treatment options can vary widely depending on 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. Due to the increased risk of surrounding soft tissue damage, stiffness, and post-traumatic arthritis, oftentimes physical therapy, bracing, or custom orthotics will be helpful for retraining, strengthening, and achieving biomechanical control.
In summary, the lateral talar process “snowboarder’s fracture” has the potential to lead to serious long-term consequences if left untreated or misdiagnosed. 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 a fast and accurate diagnosis and formulate the treatment plan to get you back on your feet and back out on the slopes as soon as possible.
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.