Waterskiing Safety – Foot and Ankle Injuries

Published on: August 19, 2024

What are the most common foot injuries in waterskiing?

It is true that, while being one of the most fun water sports on the planet – waterskiing does come with some risks, and those risks do include the possibility of foot injuries.

While these injury risks can be mitigated with strict safety practices and the proper equipment (hopefully to the point where they never happen) it’s still important to be able to recognize and identify these types of injuries as quickly as possible.

Ankle Sprains

An ankle sprain is a twisting or strain of the ankle joint after a fall or bad landing. Common symptoms include pain around the ankle joint, swelling, bruising, and difficulty walking or running. Ankle sprains can occur after a hard fall on a slalom or trick ski when the foot does not completely come out of the boot, or the boot does not release. Ankle sprains can also occur when landing or falling after going over the jump if the foot does not release from the ski or if the ski hits the ankle.

Tendon Injuries

A tendon injury can present as a simple ankle sprain, or can be as severe as a tendon tear or rupture

Commonly affected tendons included:
- Achilles tendon (on the back of the leg)
- Peroneal tendon (on the outside of the foot and ankle)
- Posterior tibial tendon (on the inside of the foot and ankle)

Signs and Symptoms:
- Pain, swelling, bruising
- Hearing a loud “pop” when the injury occurs
- Inability to move the foot or ankle or bear weight

How tendon injuries occur with waterskiing:
- Quick or hard get-up out of the water with increased strain on a tendon
- Bad fall or failure of boot or foot to release from ski

Fractures

It’s important to keep in mind that waterskiing does come with the possibility (not probability) of having an accident which can lead to a bone fracture.

Knowing your equipment and practicing safe skiing are the best way to avoid a situation where fractures can happen.

Here are the main types of fractures that can happen while waterskiing:

Stress fracture: A hairline break in the bone from increased stress on the area

Fracture: A break in the bone from a traumatic event such as a hard fall, boot not releasing, or hitting a hard object (such as a ski)

Fracture dislocation: A break in the foot or ankle bones with associated ligament tearing and dislocation of the ankle joint or foot joint. Caused by high impact events such as a hard fall at high speed with the boot not releasing or impact with a hard object.

Compound fracture: An open fracture with exposed bone and dislocated joint. Caused by a very high impact event such as a hard fall at a very high speed with the boot not releasing, or the ankle getting caught in the rope during a trick pass and the pinner failing to release for the skier, also can be sustained by a high impact jump injury.

First steps after a waterskiing foot injury

First Aid
- RICE method (Rest, Ice, Compression, Elevation).
- If there is extreme pain, deformity of foot or ankle, or if you are unable to bear weight, seek immediate medical attention.
Professional Diagnosis
- If pain persists after 24 hours, or if you have a serious injury, it is important to seek medical attention for a doctor evaluation and xrays.
- An xray may be taken to rule out a fracture. An MRI may be ordered to determine if you have a tendon or ligament injury.

Rehabilitation and Recovery

Ankle Sprains
- Rest, Ice and Elevate (RICE)
- Compression wrap or ankle brace
- Anti-inflammatory medications
- If ankle sprain is severe, X-ray and physical exam by doctor to rule out fracture
- Physical therapy
- Occasionally CAM boot immobilization is necessary with severe ankle sprain
- If pain does not improve with time, doctor may recommend MRI study to rule out ankle ligament tear
- Typical recovery timeline: 2-8 weeks depending on severity
Fractures
- X-rays to determine fracture type and severity
- CAM boot immobilization or Cast
- Surgery may be indicated if fracture is displaced. Surgery will be necessary if fracture is significantly displaced, dislocated, or a compound fracture.
- Physical therapy after fracture is healed to regain strength and flexibility
- Typical recovery timeline: 8-12 weeks until walking depending on severity of fracture
- Return to sports: 3-6 months depending on severity of fracture. May be up to a year if the fracture is severe and requires surgery.
- Precautions to take during recovery:
  - Listen to your doctor
  - Do not return to activity too soon or you will run into complications and your recovery may be longer
  - Physical therapy is very helpful to increase mobility and will help return to sports sooner
Tendon Injuries
- X-rays to determine if there is a fracture. MRI may be needed to rule out tendon tear.
- CAM boot immobilization if you have a tendon tear
- Surgery may be indicated if fracture is a significant tendon tear or tendon rupture
- Physical therapy after tendon is healed to regain strength and flexibility
- Typical recovery timeline: 8-12 weeks depending on severity of tendon injury
- Return to sports: 2-6 months depending on severity of tendon injury.
- Precautions to take during recovery:
  - Listen to your doctor
  - Do not return to activity too soon or you will run into complications and your recovery may be longer
  - Physical therapy is very helpful to increase mobility and will help return to sports sooner

Getting Back on the Water

Preparing to Waterski Again
- Clearance from a healthcare professional is essential. Your sprain, fracture, or tendon should be completely healed before returning to waterskiing.
- Protective gear and support may help on your initial return. Taping the ankle or foot for extra support or a protective neoprene sleeve may be helpful.
- Gradual reintroduction to waterskiing is very important. Start slow and gradually work back to your previous level. Allow your body and muscles time to get used to skiing again and start at a slower speed.
- Consider starting on two skis before progressing to one. Consider “shadowing” the buoys to allow your body to get use to the quick turn and pressure on the feet and ankles.

Preventing Future Injuries

Strength and Conditioning
- Exercises to strengthen feet and ankles are important for all sports, especially waterkiing.
- Importance of overall physical fitness. Establish a work out routine for overall physical fitness. Cardiovascular health is important as well as muscle strength. Consider cross training on days that you are not skiing.
- An off-season strength and conditioning program is of utmost importance. Consider the flow point method developed by Marcus Brown and Jenny Labaw: www.flowpointmethod.com
Proper Equipment
- Choosing the right waterskiing gear is important for injury prevention.
- Make sure that your ski or skis are the appropriate length for your body type and body weight.
- The safest binding is one that will allow your foot to completely release from the ski or skis after a hard fall. This helps to decrease risk of ankle sprain, fracture, and dislocation. Examples of quick release bindings or boots include:
  - Reflex waterski bindings: https://reflexwaterskiusa.com
  - Wiley Bindings: https://wileyski.com
  - Goode Powershell 5 System: https://goode.com
  - A toe plate system is recommended for the back boot of a slalom ski for quick release
Safety Tips
- Warm-up routine: Stretch, stretch, stretch!!! This will decrease risk for muscle and tendon injury
- Know your personal limits. If it does not feel right, or the boat is going too fast, just let go or signal the driver to slow down.
- Staying hydrated and well-nourished. Hydrating prevents muscle cramps and muscle injury. Protein will increase muscle stamina and improve healing after a injury.

6. Mental Resilience and Enjoyment

Maintaining a Positive Mindset
- Injuries can be very frustrating and downright depressing, especially in the middle of a competition season. If injury occurs, set a recovery goal and work towards that outcome. Make plans for the next season with future goals and achievements to work towards.
- Stay motivated during recovery. Start physical therapy and a strength and conditioning routine when you can not ski for a faster recovery.
- And remember, skiing is FUN! Keep a positive outlook during recovery and remember why you fell in love with the sport. You will be back at it before you know it!

Navigate Site