The common traumatic mechanism of the foot strap mandates high suspicion for a Lisfranc dislocation or fracture in any windsurfer with midfoot pain, especially if the pain is reproduced by passive pronation and abduction of the forefoot while the hindfoot is fixed. Weight-bearing radiographs in the anteroposterior and lateral planes plus a 30° oblique view should be obtained to look for the characteristic findings.

The x-ray findings for Lisfranc fracture can be subtle and are missed in as many as 20 % of cases [10] (Fig. 9.3 – collage). Comparison views of the other foot can help the clinician distinguish between subtle and normal x-ray findings. If initial radiographs appear negative, vigilance is still required because this injury may not always be evident on plain films. Continued midfoot pain and swelling and difficulty bearing weight 3–5 days post-injury demand further imaging, such as a computed tomography scan [11].

Some minor tarsometatarsal sprains may be treated nonsurgically with casts, but Lisfranc injuries usually require referral to an orthopedic surgeon. Most authors feel that surgical fixation is necessary to achieve precise anatomic reduction [10–13]. Early and accurate diagnosis is the best way to prevent long-term morbidity.

There are two case reports of injury to the lower leg due to foot fixation. A 27-year-old man fractured his lower leg, and an 18-year-old man sustained an ACL and MCL rupture during windsurfing. In both cases, the patients reported a twisting force on their legs and their feet being fixed in foot straps [14].

Foot straps have also been blamed for two cases of extensor digitorum longus tendonitis published in the windsurfing literature. The persistent loading that foot straps create across the midfoot during planing was the proposed mechanism [15]. In both cases, the surfers were positioning their straps across the metatarsophalangeal joints as opposed to the midfoot. Treatments with rest, nonsteroidal anti-inflammatory drugs, physiotherapy, and repositioning the feet with the straps across the midfoot were successful. The surfers returned to full activity.

Thus, there is some controversy regarding foot straps from an injury prevention perspective. Certainly, a quick release mechanism is desirable to prevent the described fracture and ligament injuries. However, ideal placement of the straps is less clear. Though any position comes with its inherent risks, it seems that placing the foot so that the strap crosses the metatarsophalangeal joint avoids a more severe acute injury such as the Lisfranc fracture while risking the development of a less severe condition such as extensor digitorum tendonitis.

The classic windsurfing injury of the upper extremity is a shoulder dislocation. The usual mechanism involves hanging on to the boom during a fall, which can anteriorly dislocate the humeral head. We have not seen a posterior shoulder dislocation from windsurfing.

On the scene, an attempt at reduction can be made before muscle spasm sets in but only if the care provider is experienced with shoulder injuries. It is important to perform a complete neurovascular exam of the injured limb, including an assessment of deltoid contraction, before reduction is attempted to determine if an associated axillary nerve injury is present. If reduction is not attempted, the arm should be immobilized in the adducted position before transporting the patient to emergency care.

Peripheral nerve injuries due to blunt trauma, acute stretch, and exertional compression have been reported in the literature.

In one case study, a 21-year-old male experienced a sharp daggerlike pain in his shoulder while uphauling. He later developed posterior shoulder muscle atrophy and weakness consistent with a suprascapular neuropathy. EMG study results at that time were not made available, but following 6 months of conservative therapy and rest, the patient was asymptomatic and returned to windsurfing without limitation [3].

A 3-year study by Cininglio et al. identified 23 windsurfers with exertional upper extremity pain, paresthesia, and weakness compatible with transient compression of the posterior interosseus nerve during windsurfing. All athletes complained of exertional weakness of the wrist extensor muscles. Symptoms were relieved by elbow flexion, wrist flexion, supination, and support with the contralateral hand. A retrospective analysis of the 23 athletes’ windsurfing positions noted that 19 held the boom with their forearms in pronation. All athletes were treated with 2 weeks of rest, given physiotherapy, massage, and ultrasound therapy. They were coached to hold the boom with the forearm in supination. The majority of the athletes reported complete alleviation. Symptoms eventually returned in only five athletes, and they were treated with casting of the elbow at 90° with the forearm supinated and wrist in neutral position for 10 days. One of the casted athletes had recurrent symptoms, and surgical exploration of his posterior interosseus nerve revealed fibrosis in the arcade of Frohse where it contacts the nerve [3].