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In the absence of long,
sunny days, winter sports provide the exercise active
Americans otherwise couldn't get without being cooped up
in a gym. High speeds attained on skis and skates make for
exhilarating sports, but expose the body to injuries.
Healthy feet and ankles, which act together as
accelerators, steering, brakes, and shock absorbers in
winter sports, are not only crucial to success in
competition, but also help keep the body upright and out
of the emergency room. Any problems with the foot or ankle
could have serious repercussions for winter sports
participants.
Preventing Cold Feet
Without warm, dry clothes, any wintertime outdoor
activity is a potential health risk. Proper
footwear--insulated, waterproof boots or shoes--is as
important as coats, hats, or gloves in the outdoors during
the winter.
Socks are also important. Podiatric physicians recommend a
single pair of thick socks made of acrylic fibers, or a
blend including them, that "wick" away moisture caused by
perspiration in the boot.
Feet soaked in snow should get back indoors quickly. In
sub-freezing temperatures, soaked feet are in immediate
danger of frostbite, a serious, painful condition that can
result in loss of toes or fingers.
Impact Trauma
In skiing, particularly at an intermediate or advanced
level, high speeds and force of gravity place tremendous
levels of impact trauma on the lower extremity, especially
on steep and bumpy runs.
Skating also puts tremendous stress on the ankle. Hockey
players change direction at speeds near 30 miles per hour,
and even casual figure skating requires quick turns and
stops negotiated by the lower extremity.
If any preexisting foot conditions, such as corns,
calluses, bunions, or hammertoes are present, see a
podiatric physician, a specialist of the foot and ankle,
for evaluation before buckling or lacing up. A medical
examination is also important if you have any preexisting
circulatory problems, such as Raynaud's Disease or
diabetes.
Before taking to the ice or slopes in cold weather, it's
important to loosen up the muscles by stretching.
Stretching helps to prevent muscle pulls and tears, and
prepares the muscles for the flexing required by the
constant "forward lean" stress of skiing and skating.
Ski Boots and Skates: A
Perfect Fit, Please
Podiatric physicians specializing in sports medicine
say properly fitted ski boots and skates are the single
most important factor in safe and successful skiing and
skating. Without a snug (but not too tight) and accurate
fit, the pressure exerted by the constant forward motion
and lateral movement of skiing and quick turns of skating
will surely result in discomfort or injury.
If boots and skates are too loose, toes quickly get
irritated in the toe box. If they are too tight, pressure
leads to blisters and abrasions that result in a host of
painful problems and keep you indoors or, worse,
compromise control and lead to an accident.
Tight footwear also may inhibit circulation of the blood
vessels of the lower extremity and cause cold feet, which
both compromises performance and presents danger in the
cold.
Ski boots are available in a forward-entry variety, a
rear-entry style for easier entry and more comfort, or
"hybrids" which incorporate both designs. Modern systems
of cables and buckles make it possible to alter the boots
to a near-perfect fit.
With ice skates, proper fit is equally important. Do not
put children in hand-me-downs; skates that are too large
or too small will cause blisters, inflammation of the
foot, or nail irritation. The lack of proper ankle support
in a too-large skate will leave the ankle susceptible to
sprains, strains, or fractures. Whatever the style, skates
should be laced snugly, using all the eyelets.
If you are not sure your ski boots or skates fit properly,
or if an apparently proper-fitting pair still hurts, take
them to a podiatric physician, who can evaluate the fit
and make recommendations to improve both comfort and
performance on the ice or slopes.
Cross-Country Skiing and Winter Running
Cross-country skiing is quite distinct from downhill.
An excellent way to maintain cardiovascular fitness in the
winter, cross country involves the entire body and
requires different equipment.
Cross-country footwear is more like a bicycle shoe than a
downhill boot. Bound to the ski only at the ball of the
foot, cross-country boots should not irritate the balls of
the feet.
As with running in winter, proper stretching is vital
before cross-country skiing. In cross country, the heel
goes up and down constantly. Without proper loosening up
first, the motion can result in painful Achilles
tendinitis and plantar fasciitis, among other problems. A
podiatric physician can recommend proper stretching
exercises.
Dedicated runners hate to give up their passion during the
winter months. Remember, however, that muscles take longer
to warm up in the cold, and the body is much more
susceptible to muscle pulls and tear injuries. Again,
proper stretching is essential.
Whether consciously or unconsciously, runners may change
their foot-strike pattern to protect themselves, which can
lead to muscle strain or other overuse injuries. To
increase traction, runners may land on slippery surfaces
with the whole foot instead of the natural rolling action
of the heel-to-toe strike. Lateral slippage could result
in a painful groin pull.
It's best to avoid running on icy areas, but if that's
impossible, podiatric physicians give a qualified
endorsement to use of spikes slipped over running shoes.
Spikes, however, have their own problems, so don't use
them in winter if you're not familiar with their use on a
running track.
Even though your feet are in motion while running, they're
still susceptible to frostbite in thin nylon running
shoes. Feet will sweat while running, and cold will
permeate the thin material, inviting the condition. If
shoes are too tight, there is an even greater chance of
frostbite.
Biomechanics of Winter
Sports
Keeping the ankle perpendicular to the ground and
straight up and down while skiing brings out the best
performance. Users of custom orthoses (shoe inserts)
should transfer them to skis and skates to help maintain
the best possible position.
Skiers with minor biomechanical imbalances may encounter a
frustrating phenomenon known as "edging," in which the ski
rolls to the inside or outside edge, inhibiting control
going down the slopes.
Ski boots and skates can be "canted" internally to adjust
the relationship between the boot and leg. For cases of
rolling-in of the foot, or pronation, or rolling-out (supination),
caused by flat feet or high arches, cants may be applied
directly to the skis or within the boot. This improves
edging and enhances performance and control, making the
sport safer and more enjoyable.
Ski shop technicians can work in conjunction with
podiatric physicians on specific biomechanical adjustments
to improve performance and safety.
Ice skates do not come in as many shapes and sizes as ski
boots. Common side-to-side wobbling in the heel area can
be remedied with "shims," or pads, in the heel. Shims can
also be added to the counter area, or middle of the skate,
for a more snug fit.
Snowboarding
In recent years, skiers have shared the slopes with
more snowboards--wide single skis that zigzag down the
slopes. The feet are loosely bound perpendicular to the
board.
No special footwear is required for snow boarding, but
podiatric physicians say large, sturdy, insulated boots
flexible enough to accommodate the twisting of the lower
body are best to safely control the board. Most popular
with young people, snowboarding has become a bona fide
alpine sport, and more snowboarders will share the slopes
with skiers in the future.
Problems to Watch For
Frostbite. It's
impossible to overstate the importance of understanding
symptoms of frostbite. Skin-color changes, from blue to
whitish, can't be seen under a boot, but if toes are
extremely cold for a prolonged period, feel burning or
numb, there is a danger of frostbite. People with a
history of frostbite often get it again in the same place.
New battery-powered heated ski boots are effective in
preventing its occurrence. New exothermic packs are also
effective in keeping the extremities warm and preventing
frostbite.
Blisters. Friction in winter sports footwear often
causes blisters. Do not pop a small blister, but if it
breaks on its own, apply an antiseptic and cover with a
sterile bandage.
Neuromas. Enlarged benign growths of nerves between
the toes, called neuromas, are caused by friction in tight
footwear and can result in pain, burning, tingling, or
numbness. Neuromas require professional treatment,
including an evaluation of skates and boots.
Sprains and strains. The stress of skiing and
skating can result in sprains and strains of the foot and
ankle. They can be treated with rest, ice, compression,
and elevation (RICE). If pain persists, seek medical
attention.
Subungal Hematoma. Pressure in the toe box of a ski
or skate can cause bleeding under the toenail known as a
subungal hematoma. Such a condition should be treated by a
podiatric physician to prevent the loss of a toenail.
Bone Problems. Bunions and tailor's bunions, bony
prominences at the joints on the inside or outside of the
foot, often become irritated in ski boots or skates. Pain
at these joints may indicate a need for a wider or
better-fitting boot. Other preexisting conditions, such as
hammertoes, and Haglund's Deformity (a bump on the back of
the heel) can be irritated by an active winter sports
regimen. If pain persists, consult a podiatric physician.
Fractures caused by trauma require immediate medical
attention.
Tips
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Start easy and build up your
distances slowly.
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Don't forget to stretch
regularly.
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Use sport specific shoes.
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Fit your shoes with the
socks that you plan to wear during your running.
Your podiatric physician/surgeon has been trained
specifically and extensively in the diagnosis and
treatment of all manners of foot conditions. This training
encompasses all of the intricately related systems and
structures of the foot and lower leg including
neurological, circulatory, skin, and the musculoskeletal
system, which includes bones, joints, ligaments, tendons,
muscles, and nerves. |
