ice skater pain 1st mtpj

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Hi all,
Any advice on treating ice skaters?

I have a 14 year old female ice skater whom is suffering with pain through her
1st mtpj. Functional hallux limitus. Very pronated.

Fitting her into a prefab orthotic for school and sports shoes appear to correct her well but most of the pain she gets occurs when she is ice skating.

Many other pods fit orthoses to skates ?

Red 3/4 vasyli Are great in other shoes but may be too firm in skates.

Any particular prefab recommendations? And general ice skating recommendations? Have read a little of the literature but would love to hear some practical experience.

Thanks!

 

I would be inclined to go for something like a full length Formthotic that contours better to the foot and you can offload the joint better (assuming that it needs off loading)

However, what is the actually problem? Sesamoiditis? etc?

Also see these threads:
http://www.podiatry-arena.com/podiatry-forum/tags/index.php?tag=/ice-skating/

 

It appears to be mild hallux limitus and seasoiditis.

 

So the variable may be the ice skating boots not the activity.

Have you seen the actual ice skating boot on her?
These boots have an extremely rigid upper and compression may be the underlying cause.

If fitted and laced correctly there is no movement in the boot at all, no real functional movement of the Hallux, as the sole plate is also rigid.

l would start be assessing the boots fit first including her lacing method and maybe add a 6mm heel lift, we use to do a lot of roller baled boots and a few ice skaters, similar issues.

*These boots can be expensive and width fittings are few and far between. These boot may have fitted well last year?

 

No I haven't seen the boots yet. They were being sharpened and yes they were fitted last year and may be getting small. I will have a look next week in terms of the rigidity and fit of the device.

Do you have any lacing pattern resources or suggestions you could post Boots and all?

Thanks

 

Its not so much a lacing pattern, rather the way they "tighten" the boots, some of them even have a metal hook with wooden handle to help pull the laces up tighter after the initial lacing.

You will be surprised how rigid the boot is if you have not seen one before.

 

Does it hurt more in the boots? Can you reproduce the pain on exam? Where does it hurt? In barefoot stance, does dorsiflexion of the hallux hurt, or increase the medial prominence of the first metatarsal head?

Eric

 

Painful in boots. She says when sitting in skates her feet go numb. All in all they are firm and a tight fit. Plantarflex strapping of 1st Ray seems to help in skates. Also painful with barefoot running. Dorsiflexion causes pain nonweightbearing and pain increases with dorsiflexion weight bearing. Orthotics help in joggers. (Vasyli 3/4 )

 

Where does it hurt when you do those things that hurt more? In the first MPJ or the sesamoids, or medial met head? All in the same location? By plantarflex strapping do you mean low dye strap that would plantar flex the metatarsal?

Are you familiar with the mechanics of the windlass mechanism?

Eric

 

Sounds more and more like it is the boot?

Then it's time for a process of simple elimination, ask her borrow or rent a boot 1 size or maybe even two sizes larger, as l dont know how badly fitted her boots are, trial and error will soon tell you.