Telemark skiing is an increasingly popular wilderness activity. Little is known, however, about the injuries incurred during modern telemark skiing. To determine the incidence and types of these injuries we carried out a prospective analysis of injured telemarkers over three ski seasons from November 1994 through May 1997 at the Mount Hood Meadows ski area medical clinic in Oregon. Injured telemark skiers presenting to the clinic were asked to fill out a one-page survey, and a diagnosis was provided by the clinic physician or nurse. During the 1995-1996 and 1996-1997 ski seasons, skiers were counted at the ski lifts to determine the proportion of telemark skiers, alpine skiers, and snowboarders using the lifts. Using these proportions and the total ticket sales for the year, the number of downhill skiers, snowboarders, and telemarkers over the season were estimated, and injury rates were calculated. During the three ski seasons, 33 injuries were identified in 28 injured telemarkers. Of the study participants, 75% (21) were male. The average age was 33.1 years. Self-described intermediate and advanced telemarkers accounted for 74% of the injured. In 96% of the injuries, the skier was performing a telemark turn. Powder snow or heavy, wet snow conditions were reported most often. Lower-extremity injuries were most common, accounting for 42.5% (14) of the total. Seven of the lower-extremity injuries were ankle injuries, and four were knee injuries. Upper-extremity injuries comprised 24.2% (8) and head and facial injuries 21.2% (7) of the total. The least number of injuries occurred in the spine, 12.1% (4). Release plates were used by 8 of 28 skiers and only released in two instances. Telemark skiers comprised 0.9% of skiers counted at the lifts during the 1995-1996 season and 1.8% in 1996-1997. Injury rates/1000 skier days in 1995-1996 were 3.3 (95% CI: 3.27, 3.35) for downhill skiers, 4.1 (95% CI: 3.32, 5.22) for telemark skiers, and 6.8 (95% CI: 6.54, 7.00) for snowboarders. Injury rates/1000 skier days in 1996-1997 were 3.1 (95% CI: 3.05, 3.15) for downhill skiers, 1.7 (95% CI: 1.44, 2.11) for telemark skiers, and 5.6 (95% CI: 5.39, 5.78) for snowboarders. We conclude that telemark skiers comprise only a small proportion of skiers at a lift-served area. Lower-extremity injuries were most common, followed by upper-extremity and head and facial injuries. Injury rates for telemarkers are comparable to those for alpine skiers.