Articles devoted to surfing injuries in the medical literature are scarce. A study by Nathanson et al1
discovered that fractures accounted for 8% of surfing injuries and 37% of all surfing injuries were to the lower limbs. They found that the majority of injuries were caused by the surfer’s own board. They did not comment on any significant ankle injuries.
Zoltan et al2
determined that surfers were most likely to be injured by their own board. They commented that protective shielding either on the board or surfer might prevent some of the injuries. They found that the use of the leash reduced the injury caused by stray boards hitting surfers.
A review of professional surfing injuries sustained in competitions from 1999 to 2005 found that the size of the wave and type of sea bed being surfed over increased the risk of injury to the surfer.3
Imaging of the injured ankle can sometimes be problematic, as illustrated by this case. MRI is widely accepted as the modality of choice when it comes to acute ankle injuries. This is because it allows bone and soft tissue to be imaged in detail.4
The utilisation of defined MRI sequences has resulted in an increased sensitivity and specificity for accurate diagnoses when compared to normal MRI scans of the ankle.5
Plain radiographs may offer some value in the diagnosis of bony spurs in cases of ankle impingement. In patients who have anteromedial impingement, these radiographs can often be falsely negative. Oblique plain films used in a study by, Van Dijk et al6
found that they added little in the diagnosis of anterolateral spurs compared to normal lateral views. There is evidence that ultrasound can be beneficial in tiny fractures of the ankle as a result of “ankle sprain”.7,8
It is important to note that these studies looked primarily at acute ankle injuries while the injury in this case report is a chronic injury.
A study from The Netherlands9
suggests that the distal fascicle of the anterior inferior tibiofibular ligament as a cause of tibiotalar impingement syndrome should be considered as a cause for impingement in the stable ankle joint with normal radiographical findings.
The so-called “snowboarder’s ankle” is thought to be due to an injury to the lateral talus, which may be similar to this case although the mechanism of injury is different to that sustained by the surfer in our case. One hypothesis for this is the fact that snowboarding boots are softer than those worn while skiing. A study by Delorme et al10
confirmed that using stiffer boots reduced the amount of movement at the ankle joint.
This case illustrates the importance of equating mechanism of injury to pathology in terms of aetiology and the forces and demands upon a surfer’s ankle. It also demonstrates the importance of combining multiple imaging modalities in terms of achieving a diagnosis; relying heavily on a single modality may not be sensitive or specific enough in cases such as these.
- It is important to think of the mechanism of injury.
- There is a need to consider the benefits of various modalities of investigation.
- Clinical examination is important in any investigation.