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I have a new patient who presented with a sensation in the lateral lower leg described as 'like a hair being constantly pulled' accompanied by pins and needles wenever she tried to achieve an 'outside edge' when ice skating. This began when she put some 'over the counter' arch supports (Superfeet) in her boots to try and correct her tendency to 'roll her foot in' that appeared to her to be stopping her from achieving a 'good outside edge'. She came along to see if I could design a better orthotic that would not provoke this sensation but give her the balance she required. RCSP 3 deg everted, NCSP 5 degrees inverted, Non weightbearing forefoot to rearfoot position 1-5 is forefoot valgus but 2-5 is 'inverted' . Sorry to quote these non pc terms - but at least we all understand them! I built up some chairside insoles that balanced the foot using a 'milking stool' model they looked and felt good in the skates off the ice -but when she tried them same old problem started straight away. Any ideas from anyone who treats ice skaters?

 

Penny
I have dealt with a few ice skaters in the past and found orthoses to be little use in treating mechanical issues. Their in boot/on ice mechanics are so far removed form their normal gait that our mechanical concepts have little relevance. I came accross one skater who got in contact with a gentleman who specialised in adjusting the blade on the skates to counteract the skaters mechanics. They apparently move the blade around the outsole of the skate dependant on the anomaly that needs to be corrected. The most common movement is either medially or laterally rather than angling the blade. I would suggest getting in contact with an ice skate manufacturer or supplier in the area that may have details of such a tradesman.

Trent

 

If the patient has a medially deviated STJ axis, then moving the blade medially on the boot sole will balance the pronation/supination moments to prevent the skater from continually using their invertors to keep the skating blade flat on the ice. If there is a laterally deviated STJ axis, then moving the blade laterally will prevent the skater from constantly needing to use their peroneals to keep a flat blade on the ice.

In this skater, it sounds as if the peroneal nerve is being irritated somehow. Check the superior edge of the boot to make sure it isn't tight and cutting into the distal calf and irritating one of the nerves of the lower leg. An inverted orthosis with a medial heel skive (or Blake inverted orthosis) with a 2-5 forefoot extension may be helpful. In addition, as noted above, it is helpful in ice skating to shift the blade medially or laterally since the mechanical effect is much more pronounced with only millimeters of blade shifting required to produce quite profound effects.

I believe Daryl Phillips, DPM was experimenting moving blades medially or laterally over 15 years ago with the US figure skating team since he was using my STJ axis palpation technique at the time to determine the best blade location. Neil Humble, DPM, of Calgary, Canada also uses STJ axis location to determine blade placement (Neil has coauthored some very good research with Anne Mundemann and Benno Nigg on orthosis biomechanics). Neil wrote a very nice article on treating skaters for Podiatry Management a few years ago where he discusses how STJ axis position affects blade positioning and treatment of skaters and how he uses inverted orthoses to treat skaters. http://www.aapsm.org/humble-skatinga.pdf

Hope this helps.

 

Thank you Trent and Kevin for your valuable input here. This skater has had her blade moved already so this strategy is already under consideration - this fits in with your experience. I will do some more work with her and report back. Thank goodness for Podiatry Arena! this level of prompt high quality input is amazing!