How To Evaluate Figure Skating Injuries

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By Rachel A. Janowicz, DPM
What You Should Know About Chronic Injuries Lipetz and Kruse say the foot is the most common location of injury to a figure skater, and that most of these foot injuries are overuse injuries.4 Dubravcic-Simunjak, et. al., note that stress fractures are the most frequent chronic injuries in female skaters. Stress fractures of the most common sites — the metatarsals, tibia, fibula and navicular — can occur in both the take-off and landing extremity.1 This suggests that skaters not only place a high level of force on the landing leg but also exert a significant amount of force to vault into the air in order to achieve sufficient height, rotation and distance across the ice. In support of the effect these forces have on adolescent figure skaters, Oleson, et. al., found that lower bone mass secondary to young age and the prolonged wearing of a stiff skating boot did not contribute to these types of injuries.5 Stress fractures and other injuries may actually feel better in the skates while being made worse by them. A stiff boot is like a short cast and a skater with an injury such as a metatarsal stress fracture may experience minimal or no pain while engaged in lower intensity skating. This creates a false sense of wellness or improvement in the skater’s mind. However, the injury is likely to worsen with rigorous practice. Particularly when one is treating a young skater or one such patient with an enthusiastic parent, it may be preferable to utilize a non-weightbearing cast over a removable Cam walker or stiff-soled shoe for a period of time in order to keep patients off the ice until the injury has healed. How Boot Fit Can Contribute To Injury Skate boots can cause and exacerbate soft tissue conditions. For instance, when skaters use a new or excessively stiff boot, there may be insufficient ankle dorsiflexion, which causes forward leaning and an eccentric load on the back leg in an attempt to maintain the center of gravity over the skate rocker. With continuous forward canting, the skater must maintain excessive knee flexion and ankle dorsiflexion to maintain balance. This can strain the posterior elements and contribute to Achilles injury or tendonitis. These are common in skaters, especially those who are predisposed to these conditions.6 Over-training, poor technique and the mechanical pressure and rubbing of a stiff posterior upper against the Achilles can also cause tendonitis (see “Treating Tendinitis Conditions Related To Boots” below).4 Contrarily, if the boot is too loose and the heel is allowed to move up and down excessively (more than 1/2 inch), Haglund’s deformity or retrocalcaneal bursitis may occur.2 If the boots are relatively new, advise the skater of the etiology of the condition so the manufacturer can perform any necessary posterior upper modifications such as stretching, molding or the addition of extra padding. Another posterior ankle/leg soft tissue injury caused by boot fit is irritation or dermal thickening of the lower posterior leg due to repeated plantarflexion. However, one can easily remedy this by adding a modification called a dance back. To do so, one would remove a portion of the posterior-superior upper and insert a soft, closed-cell foam material. The manufacturer can do this during or after boot fabrication. The manufacturer can also “punch out” other areas of boot irritation such as those over bony prominences. Padding can also be used for such problems. Clinicians can recommend moleskin, felt and silicone devices such as Bunga Pads (Absolute Athletics) to the skater. The boot manufacturer and ice arena pro shops usually carry these materials. Skate boots can also cause abrasions, blisters and ganglion cysts. As an example, a 13-year-old female skater presented in my office with a large ankle joint ganglion cyst just anterior to the lateral malleolus. The skate boot was secondhand and excessively stiff. There was no bend to the upper with forceful effort. There had been no modifications for malleoli or bony prominences. I proceeded to aspirate the ganglion and used a corticosteroid injection followed by compression. I advised the skater that she needed new boots or, at the very least, her current pair would have to be molded to accommodate pressure points. The skater missed her follow-up but related that she felt “fine” during a phone conversation two months after treatment. She had obtained new boots.

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