Take Two: Common Winter Sports Injuries

1. Frostbite: Frostbite occurs when there is decreased blood flow and decreased heat delivery to the toes, but can also affect the fingers, nose and ears. Ice crystal formation takes place in the affected areas and depending on the severity of the injury can involved tendons, nerves, muscles or even bone. Symptoms include numbness, tingling, burning or loss of sensation to the area and color changes may be noted. Prognosis depends on the extent of the injury and determining this may takes weeks. In some cases amputation may be necessary or in less traumatic cases, increased prevention for reoccurrence is the only treatment. To prevent frostbite, make sure to take frequent hot-chocolate breaks from being out in the cold temperatures and investing in foot warmers to be placed between your socks and your boots will also be helpful!

2. Ankle Fractures: Ankle injuries, including sprains, strains and fractures are very common in the winter months as icy and snowy conditions lead to increased incidence of falls. According to Lauge-Hansen, an Ankle Fracture classification system, there are 4 main categories of ankle fractures classified by the position of the foot and the motion that takes place as the fracture occurs. The most common ankle fracture is classified as “Supination External Rotation” fracture (SER); meaning there is inward rotation of the ankle while the leg and body move in the opposite direction. In the most severe SER ankle fractures the tibia and fibula (bones of the leg) are broken and the ligaments surrounding the ankle are ruptured resulting in dislocation of the ankle joint. Patients suffering this type of injury will need surgical intervention to realign and stabilize the bones with internal hardware (pins and screws) in addition to repairing the ruptured ligaments. Be prepared for at least 6 to 8 weeks of complete immobilization. Preventing ankle fractures starts with wearing winter boots that have suitable traction on the bottom. Watch where you walk, and if it’s not necessary to leave the house during icy conditions, stay home and watch you’re favorite holiday movie!

3. Calcaneal (Heel) Fractures: Calcaneal fractures are less common than other type of the injury to the foot, but in the event that they do occur, they are severely debilitating. This type of injury is caused by a high impact vertical force that can occur after jumping out a window or more realistically, a fall from a ladder while hanging holiday decorations and lights! Calcaneal fractures present with severe pain and “Mondors Sign:” severe bruising of the heel that extends to both the medial (outside) and lateral (inside) areas of the foot. Due to mechanism of injury, patients often suffer associated injuries including spinal fractures. The treatment for Calcaneal fractures is much the same as that for Ankle fractures: surgical repair is necessary with the use of internal hardware and long periods of immobilization. Make sure that when you are hanging decorations this holiday season, you have a helper with you that can stabilize the ladder you’re climbing, preventing a fall.

As mentioned last week, taking preventative measures will decrease the incidence of injury, especially during the winter months. Consult your Podiatrist if you have any concerns or need suggestions for selecting appropriate “winter gear.” If you do experience a traumatic injury, get yourself to the Emergency Room as soon as possible, or call your Podiatrist for an emergency appointment.

Weekend Winter Warriors

Thanksgiving marks the beginning of many holiday traditions including pick-up football games, hanging holiday lights and family ski trips. It is during this time of year that injuries commonly see in athletes playing high impact sports are seen in the everyday business man or woman: the “weekend warrior” type of individual.

The injuries that make the newspapers are unfortunately the more life-threatening injuries, but those suffered in the lower extremity can also be quite detrimental to a person’s quality of life. Over the next two weeks, I will break down some of the common injuries experienced in the winter months, how they are treated, and what can be done to prevent them.

1. 5^th Metatarsal Fractures: This is a fracture of a long bone in the forefoot that connects to the 5^th toe. This type of fracture is typically associated with an inversion ankle sprain, which occurs when the foot flexes downward and the ankle rolls inward. Inversion ankle sprains can occur with normal activities such as walking, and are common in pick-up sports such as football and basketball. There are five types of 5^th metatarsal fractures, but the most commonly seen is an Avulsion Fracture. Avulsion fractures occur when the tendon (proneus brevis) attached to the base of the 5^th metatarsal bone, sharply contracts during an inversion sprain and avulses, or pulls off a piece of bone. Treatment includes RICE* and immobilization for 4-6 weeks in a below knee cast, where the patient should remain non-weight bearing. Prevention for this type of injury can include strength training with a physical therapist as well as strapping or bracing of injury prone ankles prior to athletic activities.

2. Boot-top Fractures – Fractures of the Tibia from Ski Boots: “Boot-top” injuries occur when skis do not release from the ski boots during collisions. The skiers body continues forward while the boots remain fixed to the snowy surface. The tibia and often times the fibula (the bones of the leg) will fracture when enough force is applied. This type of injury often requires reduction, meaning the bone pieces need to be realigned, and often times surgery is required in order to stabilize the bone. The patient will be immobilized for at least 6 weeks in a below knee cast, where the patient must remain non-weight bearing. Taking care to have properly fitted and adjusted ski boots can help decrease the risk of “Boot-top Factures,” along with ensuring that the boot release is appropriate for the level of skill of the skier. Ski lessons for beginners are also a must!

Although these types of injuries are relatively rare, you should be aware of them and take preventative measures to ensure your safety! If you do experience injury to the lower extremity make sure to seek medical attention immediately, whether that be by going to the Emergency Room or by calling your Podiatrist to make an immediate appointment.

Don’t forget to check back next week for more “Winter Warrior” injuries explained!

*RICE: Rest, Ice Compression and Elevation