How To Evaluate Figure Skating Injuries

By Rachel A. Janowicz, DPM
Many skaters have various pathologies related to stiff boots. If the skater is practicing double and triple jumps, there is need for more support but not more than previously described. Contrarily, are the boots breaking down? If worn, crease lines are usually prominent along the medial and lateral upper. Tongue creases are common and not necessarily indicative of detrimental wear. • When were the blades last sharpened? Overly sharp blades stick and dull blades skid. Depending on the weight of the skaters, how much the skaters practice, the intensity at which they skate and their personal preferences, they should sharpen their blades every three weeks to three months with regular use. • If the boots are new, were the blades mounted correctly? A properly placed blade to a boot is like neutral position to an orthotic casting. If the skater is having a difficult time with the inside or outside edge of either skate after a sharpening or replacement, a professional should reevaluate the blades. Most training rinks have someone with expertise in this area or they can refer the skater to a local professional who has this experience. Some boot manufacturers do provide this service. • Is there indication for an orthotic? Orthoses for both the skates and street shoes are reasonable for any skater as skate boots lack arch support. Graphite or thin polypropylene with intrinsic posting and a thin top cover works best. Metatarsal pads or bars are also appropriate for skaters with histories of metatarsal head stress fracture, sesamoiditis or any metatarsalgia. Send tracings of the manufacturer’s insoles with the prescription and if possible, send an older pair of skate boots. The goal is to make a small enough device that is wide enough so the skater does not pronate into the gap between the orthotic and the medial aspect of the skate. • Is there rubbing from the boot causing soft tissue injury? If a boot modification is necessary, it is helpful to write down detailed instructions for the patient to take to the manufacturer regarding the location and suggested alteration. Marking the area with a pencil can be helpful. Pertinent Pearls Regarding Acute Injuries Out of 236 male and female figure skaters at four consecutive World Junior Figure Skating Championships, a study revealed 25 percent of female skaters and 27.9 percent of male skaters sustained some kind of acute skating injury over the course of their careers. The authors of the study found that acute injuries were semi-specific depending on the discipline of the skater involved.1 For instance, contusions and lacerations were common in ice dancing where the man and woman are required to stay close together while engaged in quick changes of direction and hand holds. These injuries were also common for those involved in pair skating, which requires high lifts and big throws. Other acute injuries included traumatic fracture of hands, wrists and arms as well as sprains and strains of shoulders, knees and wrists. Ankle sprains were the most frequently reported injury among all the skating disciplines.1 Interestingly, the researchers noted these injuries occurred most often during off-ice activities. In her article, “The Young Skater,” Angela Smith, MD, postulates that the skater spends so much time in a stiff boot that the peroneal muscles weaken. This is similar to what happens to muscles when in a cast for an extended period.2 When skaters subsequently engage in off-ice training, they are more likely to sprain an ankle. Boots that have worn out or boots without enough upper support may also be the culprit of an on-ice sprain, particularly if the skater engages in rigorous jumping. When it comes to the prevention and treatment of a figure skater’s acute ankle sprain, there is a two-pronged approach. One should emphasize improving muscle strength via balance and proprioception exercises, which the skater can integrate into an off-ice, cross-training regimen. Clinicians should also encourage skaters to wear a skate boot that provides adequate support while still allowing some ankle plantarflexion/dorsiflexion to promote intrinsic strength. Other acute skating injuries include Achilles tendon rupture (secondary to jumping), peroneal or posterior tibial tendon rupture, fracture and plantar fascial strain/rupture.

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