off-ice training has increased significantly over the
past five years.
•Off-ice programs should include core strengthening,
plyometrics, and attention to symmetry of limb flexi-
bility and strength, especially hip, ankle, and foot, as
well as cardiovascular fitness, including both aerobic
and anaerobic fitness. As the athlete spends more time
taking part in off-ice conditioning programs, it is
important to decrease the time spent on the ice.
MEDICAL ISSUES
MUSCULOSKELETAL ISSUES
GENERAL
- The incidence of injury in figure skating has been cal-
culated to range from 1.37 to 3 per 1000 h of training
(Kjaer and Larsson, 1992; Brock and Striowski, 1986).
The nature of injuries often varies with the skater’s dis-
cipline (Smith, 1997). - The musculoskeletal problems of skaters primarily
affect the lower extremity: the knee, foot, and ankles;
however, injuries to the hip, pelvis, and spine have
increased significantly as program difficulty has
increased over the past 10 years. At least half of all
injuries are attributed to overuse mechanisms) (Kjaer
and Larsson, 1992; Brock and Striowski, 1986) and
should be preventable with attention to optimizing
flexibility, symmetric strength, and power.
BOOT- ANDBLADE-RELATEDISSUES
- The boot and blade are the most important pieces of
equipment of the figure skater and are likely contrib-
utors to most injuries. - Boot stiffness, fit, alignment, and weight, as well as
blade mount and alignment are issues that can con-
tribute to injury.
LOWEREXTREMITY
Foot
- Malleolar bursitisis caused by boot pressure points
causing excessive compression and shear forces
between malleoli and boots. Both malleoli can be
affected. It is generally well tolerated, but can easily
become inflamed with minor irritation or boot
changes. These types of injuries are treated by operat-
ing on the boot, not the skater. Focal stretching/punch-
ing out of boot in rub areas, and/or padding placed to
distribute compressive forces around the malleoli will
typically alleviate the problem. Aspiration and subse-
quent injection with cortisone and a compressive wrap
is tempting, though infrequentlyindicated or benefi-
cial. Rarelyis surgery required.
•Apump bump or Haglund’s deformity of the cal-
caneal tuberosityis caused by a boot heel that is too
wide for the skater’s heel. This allows the skater’s heel
to slide up and down within the boot, resulting in
callus and bursa inflammation. For nearly all cases,
the skate fit should be addressed. It is important that
the heel of the boot be sufficiently narrow to prevent
up and down motion of the heel. This can be done
with padding medial and lateral to the Achilles tendon
region, paying special attention not to compress that
structure. Small heels lifts may also be helpful to hold
the calcaneal tuberosity firmly against the upper part
of the skate heel as it curves forward.- Tibialis anterior and extensor hallux tendinosis or
tenosynovitisare caused by repetitive dorsiflexion and
plantar flexion of the ankle, excessive compression of
crossing laces, and abnormal creasing of the boot
tongue across the anterior foot. Crepitus over the
tendon structure and nodules are not uncommon clini-
cal findings. To prevent anterior compression injuries,
the boot tongue should be in a neutral position or
slightly medial, especially when the boots are being
broken in. If the tongue is properly centralized, ante-
rior tendinitis can still occur, but it can be prevented by
padding the boot tongue with closed cell foam or ther-
moplastic material. A more flexible boot can be pre-
ventative. - Sinus tarsi pain is less common and is typically
caused by the break-in crease. - Achilles tendinosis, partial tears and nodules of the
Achilles tendon,can occur from compression of the
tendon with plantar flexion of the foot against the
boot, and can also occur during off-ice training with
running and jumping. The Achilles tendon is gener-
ally protected by the height of the boot heel, though in
some cases the posterior portion of the boot can be
inappropriately angled forward. Boot modifications
may be helpful. Ice dancers often have boots with low
cutout areas for the Achilles tendon to improve their
line and ability to bend their knees. This modification
may be helpful for any skater. - Other areas that can be irritated include the base of the
fifth metatarsal and the tarsal navicular. Metatarsal
stress fractures are caused primarily by jumping and
the position of the foot in the boot. Corns and calluses
on the toes are seen frequently. Typically these are all
issues that occur as a result of improper boot fit and
can be treated with donut pads, punching out the boot
and other modifications to the boot.
Ankle- Poor ankle proprioception, inversion, and eversion
strengths are significant issues among skaters due to
the stiffness of the boot and the many hours skaters
488 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS