BOULDER, Colo. — At the International Extreme Sports Medicine Congress, Kenneth Hunt, MD, discussed the three most common foot and ankle injuries in extreme sports athletes.
Hunt said he most often saw calcaneal fractures because patients have hard landings during sports.
“[Often]times, [we] repair them surgically and then we see a lot of midfoot injuries or Lisfranc injuries [that] can happen because of the impact to the foot, the ground or a pedal,” he said.
He said most of these patients can get back to doing their desired activities once they heal.
Hunt noted that ligament injuries may result in acute or long-term issues, such as chronic instability. He said physicians should identify factors that indicate whether a patient is able to return to sport or whether there is chronic instability which may require balance testing and outcome scores assessment.
“We always approach [ligament injuries] initially with the standard RICE therapy — rest, elevation, ice,” Hunt said. “The majority of ligament injuries will get better with this technique. For those who do not get better, have significant instability or have associative lesions that will affect their outcomes, we will often have to take these patients to surgery.”
Syndesmotic injuries or high ankle sprains are common ligament injuries that can be identified with fluoroscopic imaging. Hunt said there is movement toward the use of flexible fixation devices such as suture buttons rather than screws, as buttons do not stiffen the ankle.
“The syndesmosis is out of position 20% of the time with screws, and we haven’t found a way to do that consistently intraoperatively; but with flexible fixation, there’s almost never any malreduction because it basically puts [the syndesmosis] back where it wants to go,” he said.
Achilles tendon ruptures take a long time to recover, around 9 to 12 months, according to Hunt. He said if orthopedic surgeons use the squeeze test, palpable gap test and the extensor lag test, they do not need to use MRI to identify these injuries. Achilles tendon ruptures can be treated either surgically or conservatively, although the trend is to treat athletes with surgery.
“Surgery is still the standard. There is a lower re-rupture rate, a higher rate of return to activity and work, and better strength and function. We are understanding this better and as surgical techniques are getting better, the risk of adverse events is getting lower,” Hunt said. – by Monica Jaramillo
Hunt K. Foot and ankle injuries – It’s not only snowboarder ankle. Presented at: International Extreme Sports Medicine Congress; June 1-2, 2018; Boulder, Colorado.
Disclosures: Hunt reports he receives research support from Acumed LLC and Smith & Nephew; is a paid consultant for Panther Orthopaedics; is a board or committee member for the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine and is a research committee member and is a board or committee member of the American Orthopaedic Foot and Ankle Society.