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Podiatric Management in Ice Skating Understanding the Biomechanics of This Sport Can Help You Better Treat Skaters

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Podiatric Management in Ice Skating Understanding the Biomechanics of This Sport Can Help You Better Treat Skaters SPORTS PODIATRY Podiatric Management in Ice Skating Understanding the biomechanics of this sport can help you better treat skaters. By R. Neil Humble, D.P.M. lated geographical location. A close makes it likely that all podiatric prac- cousin to ice skating is in-line skat- titioners will benefit from a funda- This article is the second in a seven- ing, which is a similar biomechanical mental understanding of the man- part sports podiatry series written by agement of this athletic population, members of the American Academy of regardless of practice location. Podiatric Sports Medicine. This sport- Both walking and Ice skating involves three disci- specific series is intended as a practical plines: figure skating, speed skating “how-to” primer to familiarize you with skating are biphasic and power skating. It is power skat- the specific needs of patients who partici- movement patterns that ing that defines the unique skating pate in these sports, and the types of in- patterns and mechanics of locomo- juries and treatment challenges you’re consist of periods of tion seen in ice hockey. The princi- likely to encounter. single and double-limb ples of podiatric biomechanics can be applied to all of these skating ce skating in all its various forms support. disciplines, as many of the mechan- has shown increased popularity ics of foot position and balance are Iworld wide. Olympic speed skating similar. For the purposes of this ar- champions are coming from areas of activity and is another common ticle, however, I will focus on the warm climate and ice hockey teams recreational and fitness endeavor. biomechanics of power skating. are starting up in almost every popu- The increasing popularity of skating Continued on page 50 www.podiatrym.com NOVEMBER/DECEMBER 2003 • PODIATRY MANAGEMENT 49 Ice Skating... that may arise, it is first helpful to center of gravity move in an opposite compare power skating with the direction to the weight bearing skate. Biomechanics more commonly understood The acceleration in power skat- Power skating in hockey in- biomechanics of walking. Both ing is divided into two unique volves skating forward, backward walking and skating are biphasic stride patterns, the first three and with multiple directional movement pat- strides and the changes as the game evolves. It is terns that consist fourth stride, this ever-changing movement pat- of periods of sin- known as the tern that makes this activity diffi- gle and double- typical skate cut.2 cult to study from a biomechanical limb support. By The most common foot The first stride standpoint. It is forward accelera- comparison, it is and lower extremity pattern usually tion and striding, however, that are the support phase involves the first the most consistent and studied as- of walking that injury patterns seen in three strides. It pects of power skating. The podi- becomes the skat- ice hockey are acute lasts approxi- atric assistance in foot and lower ing glide. One as- mately 1.75 sec- extremity balance on top of a nar- pect of skating traumatic events. onds, involves row balance point, the skate blade, that makes it continual posi- will allow a practitioner to assist in unique in the sup- tive acceleration both improved performance and port phase is that and has a negligi- overuse injury patterns. the friction on the ble or non-exis- In order to better understand performance surface is much less tent glide phase.3 It is during this the biomechanics of power skating than that seen in most walking activ- stride pattern that the skater often and the clinical injury perspectives ities. As a result there are decreased appears to be “running” on his/her posterior linear skates. shear forces with The second stride pattern often touchdown due to begins on the fourth stride and is decreased friction considered the typical skate cut.2 and decreased ante- This stride pattern consists of peri- rior linear shear ods of positive and negative accel- forces in the late eration and involves three phases. midstance to It starts with a glide during single propulsion stage. limb support which imparts nega- This low friction tive acceleration.4 It continues with surface will neces- propulsion during single limb sup- sarily impart a need port which is accomplished by ex- to abduct the foot ternal rotation of the thigh and the by external hip ro- initial extension movements of the tation at propul- hip and knee.5 This stride pattern sion.1 The center of concludes with propulsion during gravity therefore double limb support. During this does not progress in phase the second limb acts as a bal- a linear sinusoidal ance point to complete propulsion Figure 1: Ice hockey, power skating. path over the foot through full knee extension, hyper- as seen in walking, extension of hip and plantar flex- but rather the ion of the ankle. skater and his/her Continued on page 52 50 PODIATRY MANAGEMENT • NOVEMBER/DECEMBER 2003 www.podiatrym.com Circle #112 Ice Skating... Figure 4: Clinical Injury Perspective Skate Anatomy Without a doubt the most com- mon foot and lower extremity injury patterns seen in ice hockey are acute traumatic events. However, for the purposes of this article we will focus on the more common presenting problems in an office setting. There is, first, the common dermatologic conditions seen in this patient popu- lation. Second, there are the intrinsic foot-to-boot injuries that can be pre- cipitated from the nature of the unique footwear, and last, there are the specific biomechanically-pro- duced clinical injury patterns that may arise from overuse. A general understanding of skate anatomy and fit is necessary for a full understanding of the impact of com- mon podiatric pathologies, as well as for an understanding of the biome- chanically-produced overuse injuries seen in the skating population. There is first the skate boot that is rigid for protection and support. Continued on page 52 52 PODIATRY MANAGEMENT • NOVEMBER/DECEMBER 2003 www.podiatrym.com Circle #5 Ice Skating... boot itself. The attachment of the for heel lifts and wedges as they blade housing to the boot can be a are sandwiched between the hous- Sewn skates generally fit one to point of biomechanical input. This ing and boot. Lastly is the narrow one and a half sizes smaller than housing can be moved medial to blade, which can also be adjusted one’s regular shoe size. Skates need lateral, or anterior to posterior on for biomechanical effect. It is rock- to fit snugly and toes should the boot. Its standard position is ered front to back and is hollow “feather” the toe cap. All boots to hold the blades centrally under ground on the bottom surface to have a heel raise that may be from the heel to continue forward create a medial and lateral edge or five degrees to nine degrees but under the second metatarsal head bite angle. The blade acts as a bal- can vary from one manufacturer to and further forward through the ance point and as little as one inch another. Next is the blade housing second digit. The blade housing is all that normally contacts the that is riveted or screwed onto the can also act as an attachment site ice surface. As mentioned above, skates need to fit snugly, and as such many skaters wear their skates without socks for a better “feel.” This prac- tice should be discouraged due to the dermatological consequences from both friction and hygiene. Blis- ters, corns, callouses, tinea pedis, onychomycosis, and verrucae are common in this patient population. Use of general podiatric principles along with a thin, well-fitting per- formance sock with both hy- drophilic and hydrophobic proper- ties will decrease friction within the boot and improve hygiene. If thin enough, it will still allow the “feel” needed for performance. The specificity of the footwear and its need for a performance fit can also cause friction and pressure injuries at the interface between common structural foot deformities and the boot. Common podiatric pathologies such as hammertoes and bunions are a painful dilemma in this footwear and are treated in the usual fashion. Haglund’s defor- mity, however, is an especially dif- ficult problem for skaters. Other than traditional podiatric treatments one may alleviate the skate counter pressure with internal or external heel lifts, accommoda- Continued on page 55 54 PODIATRY MANAGEMENT • NOVEMBER/DECEMBER 2003 www.podiatrym.com Ice Skating... tive adhesive felt padding within the skates, or expansion of the heel counter by a local skate shop. A well-posted custom foot orthotic can also decrease the movement of this prominence within the skate. The tight fit of skates can also in- crease the incidence of Morton’s neuroma and dorsal superficial compression neuropathies. Figure 6: Haglund’s deformity and counter expansion. Proper boot structure, along with the necessary biomechanics of skating, can decrease the frequency of complaints from certain patholo- gies. Hallux limitus, Achilles ten- donopathy and plantar fasciitis are all less commonly a problem dur- ing skating activities. Biomechanically-produced overuse foot and ankle clinical in- jury patterns can clearly be identi- fied in ice skating. The narrow blade or balance point creates need for strenuous eccentric muscle con- trol and proprioceptive skills to as- sist in balance over this small bal- ance point. As a result, general foot fatigue from strain of the small in- trinsic muscles of the foot are com- mon. As well as the intrinsic mus- cle strains, there are the extrinsic tendonopathies that can occur in the posterior tibial tendon and the peroneal tendons and muscles as a reaction to the need for balance.
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