The wear and tear of 26.2: dermatological injuries reported on marathon day

Demographics, culture and participatory nature of multi-marathoning-An observational study highlighting issues with recommendations

OBJECTIVES

The defining achievement of a multi-marathoner is completing 100 marathons. This study aimed to comprehensively document the phenomenon of multi-marathoning, addressing its demographics, culture and participatory nature, filling a gap in peer-reviewed research on the topic. Additionally, it aimed to provide recommendations for multi-marathon governing bodies, event organisers, health professionals and participants to address identified issues.

METHODS

A global survey was distributed to participants and individuals interested in multi-marathoning. It was distributed with support from major national and international multi-marathon clubs through their social media channels, email groups and newsletters. The survey was conducted anonymously and online.

RESULTS

The survey garnered responses from 830 participants across 40 countries, with an average marathon completion count of 146.54 (SD 201.83) per respondent. Gender distribution showed 60.69% men, 39.3% women and 0.1% gender variant/non-conforming. Respondents' average ages were 51.6 (SD 9.96) years for men, 48.83 (SD 9.15) years for women and 35.00 (SD 8.76) years for gender variant/non-conforming. As participants age, social and travel motivations surpass competitiveness. A majority (57%) of respondents had at least one contravention to the pre-participation screening questionnaire PARQ-+ and 67% reported taking pain relief medication around events. Notably, 93% of respondents reported multi-marathoning as beneficial for their mental health.

DISCUSSION

Multi-marathoning accommodates older athletes, but a significant gender imbalance exists in participation levels. Long-term health implications warrant attention from governing bodies, event organisers, health professionals and participants alike. Multi-marathoners should seek medical advice before participation, utilise modern equipment for health monitoring and optimise training accordingly.

CONCLUSION

Recommendations include encouraging diversity at events, ensuring event directors have well-resourced health plans and promoting participants' proactive health management before and during their involvement in the sport. This study not only advances our understanding of multi-marathoning as a sport but also contributes to theoretical frameworks such as SDT and HBM.

Toe Box Shape of Running Shoes Affects In-Shoe Foot Displacement and Deformation: A Randomized Crossover Study

BACKGROUND

Long-distance running is popular but associated with a high risk of injuries, particularly toe-related injuries. Limited research has focused on preventive measures, prompting exploration into the efficacy of raised toe box running shoes.

PURPOSE

This study aimed to investigate the effect of running shoes with raised toe boxes on preventing toe injuries caused by distance running.

METHODS

A randomized crossover design involved 25 male marathon runners (height: 1.70 ± 0.02 m, weight: 62.6 + 4.5 kg) wearing both raised toe box (extended by 8 mm along the vertical axis and 3 mm along the sagittal axis) and regular toe box running shoes. Ground reaction force (GRF), in-shoe displacement, and degree of toe deformation (based on the distance change between the toe and the metatarsal head) were collected.

RESULTS

Wearing raised toe box shoes resulted in a significant reduction in vertical (p = 0.001) and antero-posterior (p = 0.015) ground reaction forces during the loading phase, with a notable increase in vertical ground reaction force during the toe-off phase (p < 0.001). In-shoe displacement showed significant decreased movement in the forefoot medial (p < 0.001) and rearfoot (medial: p < 0.001, lateral: p < 0.001) and significant increased displacement in the midfoot (medial: p = 0.002, lateral: p < 0.001). Impact severity on the hallux significantly decreased (p < 0.001), while impact on the small toes showed no significant reduction (p = 0.067).

CONCLUSIONS

Raised toe box running shoes offer an effective means of reducing toe injuries caused by long-distance running.

Influence of changes in foot morphology and temperature on bruised toenail injury risk during running

Despite runners frequently suffering from dermatologic issues during long distance running, there is no compelling evidence quantitatively investigating their underlying injury mechanism. This study aimed to determine the foot morphology and temperature changes during long distance running and reveal the effect of these alterations on the injury risk of bruised toenail by measuring the subjective-perceived hallux comfort and gap length between the hallux and toebox of the shoe. Ten recreational runners participated in the experimental tests before (baseline), immediately after 5 and 10 km of treadmill running (12 km/h), in which the foot morphology was measured by a 3D foot scanner, the foot temperature was detected by an infrared camera, the perceived comfort was recorded by a visual analogue scale, and the gap length in the sagittal plane was captured by a high-speed camera. Ball width became narrower (106.39 ± 6.55 mm) and arch height (12.20 ± 2.34 mm) was reduced greatly after the 10 km run (p < 0.05). Foot temperature increased significantly after 5 and 10 km of running, and the temperature of dorsal hallux (35.12 ± 1.46 °C), dorsal metatarsal (35.92 ± 1.59 °C), and medial plantar metatarsal (37.26 ± 1.34 °C) regions continued to increase greatly from 5 to 10 km of running (p < 0.05). Regarding hallux comfort, the perceived scores significantly reduced after 5 and 10 km of running (2.10 ± 0.99, p < 0.05). In addition, during one running gait cycle, there was a significant increase in gap length at initial contact (39.56 ± 6.45 mm, p < 0.05) for a 10 km run, followed by a notable decrease upon reaching midstance (29.28 ± 6.81 mm, p < 0.05). It is concluded that the reduced ball width and arch height while increased foot temperature during long-distance running would exacerbate foot-shoe interaction, potentially responsible for bruised toenail injuries.

Friction Blisters of the Feet: A Critical Assessment of Current Prevention Strategies

Friction blisters are a common injury of the feet sustained by individuals participating in sporting, recreational, and military activities. The high incidence of friction blisters brings into question the effectiveness of common prevention strategies. The purpose of this article was to review current evidence for established blister-prevention strategies and to explore how these interventions address the factors that cause friction blisters. Preventive strategies, focusing on previously overlooked elements of the blister-causing mechanism, are proposed. Areas of future research that are much needed to reduce this common skin injury in active individuals are outlined.

Friction Blisters of the Feet: A New Paradigm to Explain Causation

Friction blisters on the feet commonly occur when individuals engage in active pursuits such as running, hiking, and military training. The high prevalence of blisters in active individuals underscores the fact that the pathomechanics of this condition are not fully understood. The traditional blister causation paradigm revolves around heat, moisture, and friction. In reality, foot friction blisters are caused by repetitive shear deformation. The 3 fundamental elements of blister-inducing shear deformation are (1) motion of bone, (2) high friction force, and (3) repetition of the resulting shear events. Rubbing at the skin surface is not a mechanism for friction blister formation. To that end, prevention of the friction blister continues to be an elusive quest for both the patient and the treating clinician. In this article, we aimed to highlight the limitations of the long-held blister-causation paradigm and offer a new explanation.

Influence of blistering lesions on foot functionality in hikers

BACKGROUND

Friction blisters are formed by abrasion from frictional forces on the upper layer of the epidermis and can make physical activity an uncomfortable experience. To our knowledge, no previous studies have considered how these injuries affect the functionality of the foot. For this reason, the main aim of this study was to evaluate foot function in hikers, with or without blisters.

MATERIAL AND METHODS

This case-control study examined 298 hikers who walked the Camino de Santiago long-distance trail (in northern Spain); 207 had one or more blistering foot lesions and 91 had no blisters. Sociodemographic and clinical variables were collected, and the number of blisters and their locations on the foot were recorded. All participants self-completed the Foot Function Index (FFI) questionnaire, in their native language.

RESULTS

Pain and disability were significantly greater among the hikers with blisters (pain p=<0.001; disability p = 0.015). However, there were no significant differences in the limitation of physical activity between those with blisters (case group) and the control group (p = 0.144). Neither was there any correlation between the number of blisters and pain, disability or limitation of activity. However, the location of the lesion did influence foot functionality. Blisters on the metatarsal heads were more limiting and caused greater pain (right foot p = 0.009; left foot p = 0.017), greater disability (right foot p = 0.005; left foot p = 0.005), greater limitation of activity (on right foot p = 0.012) and more loss of foot functionality (right foot p = 0.002; left foot p = 0.007).

CONCLUSION

The hikers with blisters experienced reduced foot functionality in terms of pain and disability. The number of blisters was not related to foot functionality. Blisters located on the metatarsal heads caused the greatest increase in pain, disability and limitation of activity.

Changes to breast structure and function across a woman's lifespan: Implications for managing and modeling female breast injuries

BACKGROUND

Female breasts change throughout a woman's life in response to fluctuating hormonal influences. Individuals managing active women and those modeling female breasts must understand these structural and functional changes across a female's lifespan because these changes affect breast injuries sustained by women.

METHODS

We initially review female breast structure and function and then describe how breast structure changes across a woman's lifespan. Key studies about direct contact and frictional breast injuries are then summarized. Limitations of current breast injury research, gaps in knowledge about breast injuries incurred by specific populations, and the lack of breast injury models are also highlighted.

FINDINGS

With minimal anatomical protection, it is unsurprising that breast injuries occur. Although research about breast injuries is scant, direct contact during blunt force trauma to the anterior chest wall and frictional breast injuries have been reported. There is a lack, however, of research documenting the incidence and severity of breast injuries incurred in occupational settings and in women's sports. Therefore, to design effective breast protective equipment, we recommend research to model and investigate the mechanisms and forces involved in breast injuries, particularly injuries sustained during sport.

INTERPRETATION

This unique review summarizes how female breasts change over a woman's life span, with implications for breast injuries sustained by females. Knowledge gaps about female breast injuries are highlighted. We conclude by recommending research required to develop evidence-based strategies to improve how we classify, prevent, and clinically manage breast injuries sustained by females.

SUMMARY

We review changes to the breast across a woman's lifespan, highlighting implications for managing and modeling female breast injuries.

A Novel Method to Measure the Static Coefficient of Friction for Socks

Mechanical testers have commonly been used to measure the frictional properties of socks. However, the friction values may be susceptible to the level of stretchiness of tested fabrics or human variability. Thus, the aim of this study was to propose a novel method that enables friction measurement of socks in a sock-wearing condition with less human variability effects. Five socks with different frictional properties were chosen. Three experimental ramp tests were performed with an artificial structure shaped like the foot-ankle complex (last) and a ramp tester to quantify the static coefficient of friction (COF) at the foot against sock, at the sock against an insole, and the foot wearing socks against the insole, respectively. The angle where the last slipped while the ramp surface was gradually inclined was used to compute the static COF values for each sock. The reliability was 0.99, and COF values ranged from 0.271 to 0.861 at the foot-sock interface, 0.342 to 0.639 at the sock-insole interface, and 0.310 to 0.614 in the third test. Socks with different frictional properties were successfully distinguished each other. Thus, the suggested protocol could be a reliable option for measuring the static COF values in the tension similar with it found in a sock-waring condition with reduced effects of human variability.

Blisters and Calluses from Rowing: Prevalence, Perceptions and Pain Tolerance

Background and Objectives: Rowing is a sport that involves constant gripping, pulling/pushing, and rotational movements of the hands, in a cyclic periodic manner with every stroke, with hundreds of strokes being taken within a short period of time. Dermatological issues on rowers’ hands (fingers and palms) in the form of blisters and calluses are common knowledge within the community, but their prevalence and the rower’s perceptions and pain tolerance to them has never been systematically evaluated. This work addresses these lacunae. Materials and Methods: Analysis of data collected from a survey on a sample of competitive (117) and noncompetitive rowers (28) who row on-water (total 145). Results: It was found that approximately 69% of rowers participating in this study have calluses on their hands for most of their time (considered by them as not painful). The incidence of blisters was found to be lower (but perceived as more painful). Their incidence was found to be fairly independent of the frequency and intensity of training, but they seem to affect most rowers equally at the beginning of season or during a change of position (nonconditioned hands). Blisters and calluses were reported to be mainly located on the proximal phalanges and metacarpo-phalangeal joint area of both hands, i.e., on the lower parts of the fingers and the upper inner palms. Conclusions: Rowers demonstrated a sense of acceptance of these dermatological issues, even a sense of pride in what they represent. The incidence of blisters becoming infected was estimated to be so low that most rowers would not have encountered such serious, albeit rare, consequences.

Sports Medicine-Related Breast and Chest Conditions-Update of Current Literature

ABSTRACT

This article reviews the most up-to-date evidence-based recommendations pertaining to breast and upper chest conditions, specifically for the sports medicine physician. Because of the unique circumstances of the team physician, they can see a wide breadth of pathology. Athletes may not have a primary care physician and may prefer to present to their team physician for breast and upper chest conditions. It is often more comfortable and convenient for athletes to seek treatment in the team setting. Therefore, it is important that the medical professional be aware of not only common pathology but also of that which is rarer. Any delay in evaluation can result in unnecessary morbidity and lead to complications or extended time lost from sport. Consequently, it also is important to facilitate an atmosphere encouraging early presentation and workup.

Sports Dermatology: Skin Disease in Athletes

There are numerous disorders of the skin that occur in athletes. These include infections, mechanical injury, and inflammatory skin diseases such as dermatitis, urticaria, and others. This paper discusses some of the most common athletic skin diseases.

The Occurrence, Causes and Perceived Performance Effects of Breast Injuries in Elite Female Athletes

Female breasts are vulnerable to direct blows or frictional injuries during sport; however, little research has investigated breast injuries experienced by female athletes. This study aimed to investigate the occurrence, causes and perceived performance effects of breast injuries in elite female athletes across a wide range of sports. A custom-designed survey was distributed to female athletes aged over 18 years who were competing nationally or internationally in their chosen sport. The survey included questions about breast injuries sustained during training and competition and any perceived performance effects of these injuries. 504 elite female athletes from 46 different sports completed the survey. 36% of participants (n = 182) reported experiencing breast injuries and 21% (n = 37) perceived that their breast injury negatively affected their performance. Contact breast injuries were reported by significantly more athletes involved in contact or combat sports and by athletes with larger breasts or a higher body mass index. Frictional breast injuries were reported by significantly more older athletes or those with larger breasts. Less than 10% of participants who experienced breast injuries reported their injury to a coach or medical professional and only half used any prevention strategies. Athletes, coaches and medical professionals associated with women's sport need to be made aware of the occurrence and potential negative effects of breast injuries. It is critical to normalise conversations around breast health so that athletes can be encouraged to report and, when necessary, receive treatment for breast injuries. Further research is also required to better understand factors that affect breast injuries in sport in order to develop evidence-based breast injury prevention strategies.

Mountain Biking Injuries

With the increasing popularity of mountain biking, also known as off-road cycling, and the riders pushing the sport into extremes, there has been a corresponding increase in injury. Almost two thirds of acute injuries involve the upper extremities, and a similar proportion of overuse injuries affect the lower extremities. Mountain biking appears to be a high-risk sport for severe spine injuries. New trends of injury patterns are observed with popularity of mountain bike trail parks and freeride cycling. Using protective gear, improving technical proficiency, and physical fitness may somewhat decrease the risk of injuries. Simple modifications in bicycle-rider interface areas and with the bicycle (bike fit) also may decrease some overuse injuries. Bike fit provides the clinician with postural correction during the sport. In this review, we also discuss the importance of race-day management strategies and monitoring the injury trends.

The enemy of the feet: blisters in ultraendurance runners

BACKGROUND

Blisters are the most common dermatologic problem in ultraendurance runners. Their incidence, localization, pain scores, and risk factors in field conditions are poorly understood.

METHODS

We conducted an observational field-based cohort study during the 5-day multistage 2010 and 2011 Al Andalus Ultimate Trail (219 km). Daily postrace data on blister frequency, localization, severity, and preventive measures from 50 ultramarathon runners were collected through the direct interview technique.

RESULTS

After 4 days of running (182 km), blisters occurred in 76% of the participants (P < .001 versus stage 1) compared with 34% after day 1, 54% after day 2, and 72% after day 3 (P < .001 versus stage 1). Most of the blisters formed on the toes (65%) (P < .001), followed by blisters on other locations of the foot: the ball of the foot (16%), heel (14%), and sole (5%). Blisters were more painful toward the end of the race, and those on the sole and heel tended to be the most painful, although this did not reach statistical significance. Prophylactic measures studied (type and fabric of socks; application of antiperspirants, talcum powder, or lubricant to feet; and prophylactic taping) did not show any reduction in blister rates. The only predictive marker for reduced blister incidence was previous ultramarathon experience in men (r = -0.44, P < .05).

CONCLUSIONS

Blisters are extremely common in multistage ultramarathon races. Race experience in male ultramarathon runners is associated with reduced blister rates.

Paper Tape Prevents Foot Blisters: A Randomized Prevention Trial Assessing Paper Tape in Endurance Distances II (Pre-TAPED II)

OBJECTIVE

To determine whether paper tape prevents foot blisters in multistage ultramarathon runners.

DESIGN

Multisite prospective randomized trial.

SETTING

The 2014 250-km (155-mile) 6-stage RacingThePlanet ultramarathons in Jordan, Gobi, Madagascar, and Atacama Deserts.

PARTICIPANTS

One hundred twenty-eight participants were enrolled: 19 (15%) from the Jordan, 35 (27%) from Gobi, 21 (16%) from Madagascar, and 53 (41%) from the Atacama Desert. The mean age was 39.3 years (22-63) and body mass index was 24.2 kg/m (17.4-35.1), with 31 (22.5%) females.

INTERVENTIONS

Paper tape was applied to a randomly selected foot before the race, either to participants' blister-prone areas or randomly selected location if there was no blister history, with untaped areas of the same foot used as the control.

MAIN OUTCOME MEASURES

Development of a blister anywhere on the study foot.

RESULTS

One hundred six (83%) participants developed 117 blisters, with treatment success in 98 (77%) runners. Paper tape reduced blisters by 40% (P < 0.01, 95% confidence interval, 28-52) with a number needed to treat of 1.31. Most of the study participants had 1 blister (78%), with most common locations on the toes (n = 58, 50%) and heel (n = 27, 23%), with 94 (80%) blisters occurring by the end of stage 2. Treatment success was associated with earlier stages [odds ratio (OR), 74.9, P < 0.01] and time spent running (OR, 0.66, P = 0.01).

CONCLUSION

Paper tape was found to prevent both the incidence and frequency of foot blisters in runners.

Injury and Illness Rates During Ultratrail Running

This study aimed to describe injury/illness rates in ultratrail runners competing in a 65-km race to build a foundation for injury prevention and help race organizers to plan medical provision for these events. Prospectively transcribed medical records were analysed for 77 athletes at the end of the race. Number of injuries/illnesses per 1 000 runners and per 1 000-h run, overall injury/illness rate and 90% confidence intervals and rates for major and minor illnesses, musculoskeletal injuries, and skin disorders were analysed. A total of 132 injuries/illnesses were encountered during the race. The overall injuries/illnesses were 1.9 per runner and 13.1 per 1 000-h run. Medical illnesses were the most prominent medical diagnoses encountered (50.3%), followed by musculoskeletal injuries (32.8%), and skin-related disorders (16.9%). Despite the ultra-long nature of the race, the majority of injuries/illnesses were minor in nature. Medical staff and runners should prepare to treat all types of injuries and illnesses, especially the fatigue arising throughout the course of an ultratrail run and injuries to the lower limbs. Future studies should attempt to systematically identify injury locations and mechanisms in order to better direct injury prevention strategies and plan more accurate medical care.

Sports Dermatology: Part 1 of 2 Traumatic or Mechanical Injuries, Inflammatory Conditions, and Exacerbations of Pre-existing Conditions

Competitive athletes endure extreme bodily stress when participating in sports-related activities. An athlete's skin is particularly susceptible to a wide array of repetitive physical and environmental stressors that challenge the skin's protective function. Many unique dermatoses are well-known to the serious athlete due to countless hours of intense physical training, but are frequently unrecognized by many healthcare professionals. Sports dermatology is a distinctive, budding field of dermatology that focuses on dermatoses frequently encountered in athletes. Athletic skin problems are notoriously infectious in nature due to the inherent environment of close-contact physical activity. Nonetheless, other skin conditions can manifest or worsen with recurring mechanical or traumatic injury or exposure to environmental hazards. Additionally, sports-related activities may exacerbate other pre-existing dermatological conditions that may possibly be unknown to the athlete or clinician. The objective of this two-part review is to arm the astute physician with the fundamental knowledge of the range of dermatological conditions distinct to the competitive athlete. Knowledge of these cutaneous conditions in the context of specific sporting events will permit the clinician to manage these unique patients most effectively. Part one will focus on traumatic or mechanical injuries, inflammatory conditions, and exacerbations of pre-existing conditions frequently seen in athletes.

Sports-related dermatoses among road runners in Southern Brazil

BACKGROUND

Road running is a growing sport. OBJECTIVES: To determine the prevalence of sports-related dermatoses among road runners.

METHODS

Cross-sectional study of 76 road runners. Assessment was performed by means of a questionnaire, interview, and clinical examination. The chi-square and linear trend tests were used for analysis.

RESULTS

Most athletes were men (61%), aged 38±11 years, who ran mid- or long-distance courses (60.5%) for 45 to 60 minutes (79%), for a total of 25-64 km (42.1% ) or more than 65 km (18.4%) per week. The most prevalent injuries were blisters (50%), chafing (42.1%), calluses (34.2%), onychomadesis (31.5%), tinea pedis (18.4%), onychocryptosis (14.5%), and cheilitis simplex (14.5%). Among athletes running >64 km weekly, several conditions were significantly more frequent: calluses (p<0.04), jogger's nipple (p<0.004), cheilitis simplex (p<0.05), and tinea pedis (p<0.004). There was a significant association between the weekly running distance and the probability of skin lesions. Of the athletes in our sample, 57% trained before 10 a.m., 86% wore clothing and accessories for sun protection, 62% wore sunscreen, and 19.7% experienced sunburn. Traumatic and environmental dermatoses are common in practitioners of this outdoor sport, and are influenced by the weekly running distance.

CONCLUSION

In this group of athletes, rashes, blisters, sunburn, and nail disorders were recurrent complaints regardless of running distance. Calluses, athlete's foot, chapped lips, and jogger's nipple predominated in individuals who ran longer routes.

Lesões desportivas e cutâneas em adeptos de corrida de rua

INTRODUÇÃO: A corrida de rua é uma modalidade em expansão e tem sido utilizada como lazer, esporte ou prática competitiva.OBJETIVO: Verificar frequência de lesões desportivas e cutâneas em atletas de corrida de rua. Material eMÉTODOS: Estudo transversal de 220 atletas de corrida de rua com questionário e observação clínica. Análise pelos testes t, Mann-Whitney, Qui-quadrado e correlação de Spearman.RESULTADOS: Predominaram atletas do sexo masculino, adultos, praticantes de corrida de longa distância, que treinam em média 45 a 60 minutos com frequência de 2 e 3 vezes por semana e têm participação variável em competições. As principais lesões relatadas foram dor no joelho (30,4%), distensão/estiramento muscular (16,7%), tendinites (10,1%), dor nos quadris (7,3%) e dor na coluna (7%), sem diferenças estatísticas entre os gêneros. Houve associação significativa entre quilômetros percorridos em treino e lesões musculares nos homens (p = 0,0477, x = 9,60). O calçado esportivo teve relação com presença de unhas encravadas e perdas ungueais nas mulheres.CONCLUSÃO: Os homens apresentaram maior frequência de lesões musculares e as mulheres, de afecções cutâneas e ungueais.

Evaluation and treatment of injury and illness in the ultramarathon athlete

Participation in ultramarathon races and knowledge of these athletes continues to increase as the sport becomes more popular. Physicians and athletes need to better understand the impact of the unique aspects of ultramarathon races, such as race environment (temperature, humidity, and altitude), race distance, race stages, nutritional requirements and equipment, on athlete injuries and illness. Proper treatment of injuries and illnesses during an ultramarathon race is important for avoiding long-term medical issues. In this article, the evaluation and treatment of common musculoskeletal injuries and medical illnesses in ultramarathon runners are reviewed.

Common sports-related infections: a review on clinical pictures, management and time to return to sports

There is a relationship between exercise and changes in immunity. So athletes are prone to different medical problems such as injuries and infections. Infection is an important medical problem which could be a reason for athletes’ absence from training. The relationship between physical activity and immune system, characteristics of different types of infections in athletes with emphasis on special clinical presentations or complications, time to return to physical activity and training and strategies to prevent development and transmission of infections in athletes or physically active people are the main topics of this review.

Skin problems in the long-distance runner 2500 years after the Battle of Marathon

Long-distance running has evolved into a sport that continues to gain in popularity. Skin problems are common among long distance runners and may prompt athletes to seek medical attention. This paper reviews the skin problems of long distance runners and outlines treatments that we have found to be helpful.

Skin conditions in figure skaters, ice-hockey players and speed skaters: part I - mechanical dermatoses

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 reduce inflammation, but sometimes chemical or surgical matricectomies are required. Preventative measures of both onychocryptosis and skater's toe include cutting toenails straight across to allow for a more equal distribution of forces within the toe box. Finally, the prevention and treatment of lacerations, which constitute a potentially fatal type of mechanical injury, require special protective gear and acute surgical intervention with appropriate suturing. The subsequent companion review of skin conditions in ice skaters will discuss infectious, inflammatory and cold-induced dermatoses, with continued emphasis on clinical presentation, diagnosis, treatment and prevention.

Al Andalus Ultra Trail: an observation of medical interventions during a 219-km, 5-day ultramarathon stage race

OBJECTIVE

To record the injuries and health problems suffered by ultramarathon runners during a 219-km, 5-day stage race and to help race organizers plan medical provision for these events.

DESIGN

Observational study.

SETTING

Al Andalus Ultra Trail 2010, in southern Spain.

PARTICIPANTS

All 69 ultramarathon runners.

MAIN OUTCOME MEASURES

Total numbers and percentages of each clinical encounter with a health professional and their respective health problems.

RESULTS

Sixty-nine competitors started the race, and 39 runners were seen with a medical problem (56.5%). There were a total of 99 clinical encounters. The most common reasons for consulting were foot blisters (33.3%), followed by chafing (9.1%). Lower limb musculoskeletal injuries accounted for 22.2%, predominantly affecting the knee.

CONCLUSIONS

This is the first report of a multistage ultramarathon race where medical coverage was present throughout and has reported on musculoskeletal, dermatological, and other medical problems. When providing medical coverage for stage events, the medical team needs to promote practices that minimize injury and address both running-related injuries and non-running-related injuries, taking account of environmental conditions.

Risk factors for strap-related lesions in working donkeys at the World Heritage Site of Petra in Jordan

A risk analysis was undertaken in an attempt to improve improvised rump straps on donkeys carrying tourists at the World Heritage Site at Petra, Jordan. Tail-base lesions were identified in 63 of the 86 donkeys. Observations and questionnaires were used to collect data relating to the straps, donkey health and human attitudes. The worse lesions were associated with padded rather than unpadded straps, if tightly fitted. Padding could be a cause of, or a response to lesions, but results suggest that it did not effectively aid healing. Significantly worse lesions occurred with unclean than with clean straps and, contrary to many recommendations, cotton straps were associated with worse lesions than were synthetic straps. Since this was an exploratory study, findings should be considered to generate (not to test) hypotheses and any resulting interventions will require monitoring. Further possible risks are discussed, referring to medical and veterinary literature and applied expertise in working equines.

Skin friction blistering: computer model

BACKGROUND/PURPOSE

Friction blisters, a common injury in sports and military operations, can adversely effect or even halt performance. Given its frequency and hazardous nature, recent research efforts appear limited. Blistering can be treated as a delamination phenomenon; similar issues in materials science have been extensively investigated in theory and experiment. An obstacle in studying blistering is the difficulty of conducting experiment on humans and animals. Computer modeling thus becomes a preferred tool.

METHOD

This paper used a dynamic non-linear finite-element model with a blister-characterized structure and contact algorithm for outer materials and blister roof to investigate the effects on deformation and stress of an existing blister by changing the friction coefficient and elastic modulus of the material in contact with the blister.

RESULTS

Through the dynamics mode and harmonic frequency approach, we demonstrated that the loading frequency leads to dramatic changes of displacement and stress in spite of otherwise similar loading. Our simulations show that an increased friction coefficient does not necessarily result in an increase in either the stress on the hot spot or blister deformation; local maximum friction stress and Von Mises stress exist for some friction coefficients over the wide range examined here. In addition, the stiffness of contact material on blistering is also investigated, and no significant effects on deformation and Von Mises stress are found, again at the range used. The model and method provided here may be useful for evaluating loading environments and contact materials in reducing blistering incidents.

CONCLUSION

The coupling finite-element model can predict the effects of friction coefficient and contacting materials&apos stiffness on blister deformation and hot spot stress.

Contact dermatitis in athletes

Athletes face numerous hazards in their daily activities. An athlete's skin, in particular, endures repeated exposure to trauma, heat, moisture, and numerous allergens and chemicals. These factors combine with other unique and less well-defined genetically predisposing factors in the athlete's skin to cause both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). As with other cases of contact dermatitis, these eruptions in athletes present as a spectrum of acute to subacute to chronic dermatitis. Recognizing the unique environmental irritants and allergens encountered by athletes is paramount to facilitate appropriate therapy and prevention. This review comprehensively examines the literature on contact dermatitis in athletes. The different types of contact dermatitis have been classified under sport-specific subheadings. Furthermore, within each subheading, both ACD and ICD types are discussed.

Skin manifestations of running

As the United States comes increasingly closer to being the heaviest nation on earth, many people are turning to exercise, especially running, to lose weight. Most runners, whether novice or professional, will have a skin disorder that may prompt them to seek medical attention. Although case reports and sports reviews have discussed, in a cursory fashion, the nature of these skin lesions, to our knowledge there has never been an extensive review of the literature that specifically addresses the skin diseases of runners. In this article, we present the epidemiology, origin, clinical characteristics, treatment, and prevention of skin diseases inherent to runners.

An EFE Model on Skin-Sleeve Interactions During Arm Rotation

Skin and garment constitute a dynamic contact system for human body comfort and protection. Although dermatological injuries due to fabric actions during human body movement are common, there is still no general guidance or standard for measuring or evaluating skin/garment contact interactions, especially, during intense sports. A three-dimensional explicit finite element (EFE) model combined with Augmented Lagrange algorithm (ALA) is developed to simulate interactions between skin and fabric during rotation of the arm. Normalized effective shear stresses at the interface between skin and the sleeve during the arm rotation are provided to reflect the severity of the interactions. The effects due to changes in fabric properties, fabric-skin gap, and arm rotation rate are also illustrated. It has been demonstrated from our predictions that factors such as elastic modulus, friction coefficients, density of fabric, and the initial gap between skin and fabric influence significantly the shear stress and thus the discomfort and even injury potential to skin during intensive body movement such as sports and military. Thus this study for the first time confirms quantitatively that poorly chosen fabric with inappropriate garment design renders adverse actions on human skin.