How To Evaluate Figure Skating Injuries
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.
Bursitis, hammertoes, Sever’s disease and plantar fasciitis (especially in skaters with tight posterior leg muscles or increased longitudinal arches) are other chronic pedal conditions that have been linked to figure skating.3 It is not currently known whether hallux valgus, limitus or rigidus are directly correlated to skating or its equipment. However, painful bursa and neuritis can form over deformities due to the rigidity of the boot. Again, heat-molding of the boot by the manufacturer and/or padding is appropriate.
Why Off-Ice Conditioning Is So Important
A skater uses a variety of muscle groups to execute the most difficult of triple jumps down to the placement of a finger and facial expression. Combining proper technique with adequate strength and flexibility can reduce the risk of injury. Such conditioning begins off-ice, where skaters should incorporate into their training a regimen of strengthening and stretching as well as cardiovascular work. However, any mature athlete understands the benefits of rest and one should recommend to the skater to have one day a week away from strenuous physical activity in order to allow for recuperation.
A special consideration for skaters is the environment in which they train. Ice arenas are damp and cold, and elite skaters frequently train in the early morning. Properly warning up off and on the ice is important prior to and after practice. Skaters should also do this after resurfacing of the ice or breaks. Older skaters should be particularly cognizant of the need for proper stretching and warming up in order to prevent injury.