Skin Conditions in Figure Skaters, Ice-Hockey Players and Speed Skaters

Abstract

Figure skaters, ice-hockey players and speed skaters experience a range of dermatologic conditions and tissue-related injuries on account of mechanical trauma, infectious pathogens, inflammatory processes and environmental factors related to these competitive pursuits. Sports medicine practitioners, family physicians, dermatologists and coaches should be familiar with these skin conditions to ensure timely and accurate diagnosis and management of affected athletes. This review is Part I of a subsequent companion review and provides a comprehensive review of mechanical dermatoses experienced by ice-skating athletes, including skater's nodules and its variants, pump bumps, piezogenic pedal papules, talon noir, skate/lace bite, friction bullae, corns and calluses, onychocryptosis, skater's toe and skate blade-induced lacerations. These injuries result from friction, shear forces, chronic pressure and collisions with surfaces that occur when athletes endure repetitive jump landings, accelerated starts and stops and other manoeuvres during rigorous training and competition. Ill-fitting skates, improper lacing techniques and insufficient lubrication or protective padding of the foot and ankle often contribute to the development of skin conditions that result from these physical and mechanical stresses. As we will explain, simple measures can frequently prevent the development of these conditions. The treatment of skater's nodules involves reduction in chronic stimulation of the malleoli, and the use of keratolytics and intralesional steroid injections; if malleolar bursitis develops, bursa aspirations may be required. Pump bumps, which result from repetitive friction posteriorly, can be prevented by wearing skates that fit correctly at the heel. Piezogenic pedal papules may be treated conservatively by using heel cups, compressive stockings and by reducing prolonged standing. Talon noir usually resolves without intervention within several weeks. The treatment of skate bite is centred on reducing compression by the skate tongue of the extensor tendons of the anterior ankle, which can be accomplished by use of proper lacing techniques, increasing pliability of the skate tongue and using protective padding, such as Bunga Pads™. Anti-inflammatory medications and cold compresses can also help reduce inflammation. Friction bullae are best managed by careful lancing of painful blisters and application of petrolatum or protective dressings to accelerate healing; preventative measures include the use of well fitting skates, proper lacing techniques and moisture-wicking socks. Corns and calluses are similarly best prevented by the use of well fitted skates and orthotic devices. Symptomatic, debridement reduces the irritant effect of the thick epidermis, and can be accomplished by soaking the area in warm water followed by paring. Application of creams with high concentrations of urea or salicylic acid can also soften callosities. Cases of onychocryptosis benefit from warm soaks, antibiotic ointments and topical steroids to reduc...

Exostoses of the Bony Pyramid of the Nose: A Review About an Adaptive Response to Mechanical Stimuli Exerted by In-Flight Oxygen Masks

“…The optimization of the fit of an athlete's sports gear is another known preventive measure of adverse mechanical pressure effects in athletes. In iceskaters, an improved fit of the skates proved to be a lowcost, highly efficient preventive measure [4]. A close fit instead of a loose fit with less room for movement of the heel in the skate resolved most of the symptoms.…”

“…Space around the heel instead of a closely fitting skate allows for vertical movement of the heel and subsequent development of friction symptoms. The skin conditions in ice-skating athletes are called mechanical dermatoses (see Table 1) [4,5]. In persons that wear spectacles, acanthoma fissuratum of the nose, also called spectacle frame acanthoma, may arise when the fit of spectacles is suboptimal.…”

“…For example, mechanical dermatoses may arise on the feet of ice-skating athletes due to chronic collision with the inner surface of the skate [4]. Swimmers may develop soft tissue hyperplasia underneath their goggles in response to the pressure and friction exerted by these goggles [3].…”

“…Violin and viola players may develop a skin condition called a ''fiddler's neck'' [57 Peachey], and bespectacled persons may develop the previously discussed acanthoma fissuratum [6]. In athletes and musicians, it is acknowledged that the skin disorders that arise in response to pressure exerted by sports gear or musical instruments can be prevented by padding the vulnerable areas [4]. Violin players, for example, can replace the violin's rigid wooden chin rest by a pliable foam chin rest.…”

Skin Conditions of Baseball, Cricket, and Softball Players

“…5) [120,121]. Hemorrhagic macules appear on the lateral borders of the heel, middle of the foot, soles, or toes.…”