As nights become chilly and days become blustery, our thoughts turn toward winter sports and often times the ski hill. As an orthopedic surgeon who specializes in disorders of the foot and ankle, once the ski season get rolling I often see patient’s who complain of pain in the anterior shins. The anterior shin pain that occurs in skiers and boarders is called boot or shin bang. Boot bang is a condition where the shin pushes or rubs against the boot every time you flex forward causing a bruise or contusion. This then hurts as pressure is applied to the area.
There are many purported causes of boot bang. Some of the most commonly described are poorly fitting boots, usually too big, skiing in a “backseated posture”, boots that are too stiff, and aggressive skiing and jumping.
If your boots that are too big, your foot and ankle can slide forward and backward. This motion results intermittent contact between the shin and the tongue of the boot resulting in a contusion. Another purported cause of boot bang is backseat skiing. This position pulls the shin away from the boot allowing the shin to “bang” in to the tongue again causing bruising. Ski boots that are too stiff can also cause boot bang. Skiing in a boot that is too stiff can effectively limit how forward you can get on your skis effectively forcing the skier into the back seat. Finally aggressive skiing through rough terrain can cause a lot of shock to your lower legs. Examples include: those bumps and moguls, hard pack snow, crusty snow “mashed potatos” conditions and jumping.
If you get boot bang and your shins become bruised, it will often hurt for a week or two. The difficulty lies in the fact that once this condition starts it is unlikely to resolve without taking a break from boarding or skiing. There are many purported remedies for boot bang, however there does not seem to be a consensus in the skiing or medical community as to the most effective cure. Specially designed or fitted ski boots are commonly recommended. When ski boot fit is not an issue, a cure is not always convenient as one would hope. Although taking nonsteriodal anti-inflammatories can be a method for skiing through the discomfort, rest is ultimately the most effective cure. If you start to get a bruise, ice it every night, avoid the painful activity, and consider modifying your boot. Have a great season and see you on the hill.
Dr. Jon Robinson
Fellowship Trained in Foot and Ankle Surgery, Lower Extremity Care