Ankle injuries are surprisingly widespread in water skiing, and despite advances in boot technology, these mishaps continue to end some ski careers prematurely. Fortunately, the majority of water skiers eventually recover and return to the water. Making the correct diagnosis is the most important first step in any medical treatment plan, and ankle injuries are no different. Here are four of the most common injuries.
1. Ankle sprains: Ankle sprains are by far the most common injury. These typically occur when the ankle is plantarflexed (ankle pointing
away from the body) and inverted (foot turns to the inside). When this happens, the anterior talofibular ligament and calcaneofibular ligament (ligaments on the outside part of the ankle) are stretched or torn. If the ankle continues to rotate, the deltoid ligament on the inside of the ankle can be torn as well. Deltoid ligament injuries manifest with tenderness and swelling on the inside of the ankle and imply a more serious sprain. Such sprains are typically graded on a scale of one to three: grade one sprains imply a stretch of the ligament, grade two implies a partial tear and grade three implies a ruptured ligament. Thankfully, even completely torn ligaments can usually be treated non-operatively. Recurrent sprains, however, can lead to chronic instability and joint damage. A syndesmotic sprain, or “high ankle sprain,” is entirely different. It can occur in conjunction with a regular ankle sprain but implies an injury to the anterior tibiofibular ligament (the ligament between the two shin bones). Here, the mechanism is typically dorsiflexion (ankle pulled up) and external rotation (foot rotates to the outside). This injury often requires a period of non-weight-bearing rest and sometimes even casting; surgery is rarely necessary.
2. Lateral process of the talus fractures: Sometimes it is difficult to distinguish between a bad ankle sprain and a fracture of the lateral process of the talus. Often, the two injuries involve the same mechanism, and there’s typically lots of pain and bruising in front of the fibula bone’s tip. Doctors commonly miss these types of fractures, and sometimes they’re even missed in X-rays. For this reason, if the “sprain” does not get better with time or if the clinical exam is consistent with a fracture, a CT scan or MRI is often helpful. This fracture frequently requires surgery.
3. Achilles tendon ruptures: Achilles tendon ruptures can occur during a crash or when skiers violently kick off their skis. The patient describes feeling a “pop,” as if someone kicked him or her in the back of the ankle. There is surprisingly less pain than one would expect from the rupture of the body’s biggest tendon. If there is any question, doctors should use the Thompson’s test, where a patient lies on his stomach and bends his knee at a 90-degree angle and the calf muscle is gently squeezed. Any upward movement of the foot during the squeeze indicates the tendon is at least partially intact. If the foot doesn’t move, the Achilles is completely ruptured. You can always compare to the other leg. To repair the injury, surgery is often needed, and total recovery frequently takes up to one year.
4. Ankle fractures: Ankle fractures are uncommon, but they do occur. The most common mechanism is supination (foot cups inward) and external rotation (ski tip/ foot rotates to the outside). There is usually considerable pain, immediate swelling and moderate bruising, which all develop progressively. The skier is typically unable to bear any weight, and a trip to the emergency room usually follows. Most ankle fractures can be treated non-operatively in a cast or cast-boot, but unstable fractures need surgery to realign and hold the bones in proper position.