Cold Injury in Extreme Sports

With the increasing interest in extreme sports, especially in colder environments, there is greater potential for cold related sports medicine problems. There are basically two types of cold injury: non-freezing cold injury and freezing cold injury. The most well known freezing injury is frostbite and the two most well known non-freezing cold problems are trench foot and chilblains. There are others that all exist on a continuum between the extreme with increasing amounts of seriousness and potential for fatal outcome at the worst extreme. All adventure and extreme athlete need to be aware of the risk and take the appropriate preventative measures and be aware when any of the problems develop as to what they should do about them.

At one extreme are the relatively minor chilblains. These are small patches of red, painful and itchy skin that typically appear on the toes when the skin is warmed up too quickly after it is cold. Chilblains are seasonal and never occur in the warmer climates. They are typically managed by keeping the foot warm and using chilblain creams to massage the area with to stimulate the circulation. They normally heal up relatively quickly unless they keep occurring, in which case they may become chronic.

At the other extreme there is frostbite where the tissues become frozen which is potentially fatal if not addressed immediately as a medical emergency. Often the best outcome is the amputation of a toe, so it is still serious.

Heel Pain in Child Athletes

Severs disease (or more appropriately called Calcaneal apophysitis) is a common injury to the growth plate at the back of the heel bone in children that play a lot of sport.

The growth plate at the back of the heel is located where the heel contacts the ground during walking and running. The Achilles tendon also inserts into that growth plate, so the pull from the Achilles tendon and the impact of that growth plate in the ground, it can be easy to see why in sports that Severs disease can be quite common. The pain is typically at the back, bottom and side of the heel bone, especially after sport. It can be particularly painful to squeezing of the heel bone.

An episode of PodChatLive had an in-depth discussion of calcaneal apophysitis/Severs Disease and is well worth listening to:

The management of Severs disease typically involved managing lifestyle and the loads. Physical activities and sports need to be reduced, but this can be very challenging in the child when the parents are not around. ICE, as cold therapy may be help to reduce the pain after sports activity of the pain is bad enough. A shock absorbing heel insert can often be helpful to protect the heel bone from stress and cushion it. This can also lesson the pull from the Achilles tendon on the growth plate.

Kevin Durant Ruptures his Achilles Tendon

On 10th June 2019, Golden State Warriors player, Kevin Durant ruptured his Achilles tendon in the 2nd quarter of game 5 of the NBA playoffs against the Toronto Raptors in Toronto. He underwent surgery for the rupture. There is controversy if an achilles tendon rupture should be treated surgically or not, as the outcomes of both are generally considered about the same.

There was also some controversy if he should have played or not as he was only recently getting over a calf strain that could have predisposed him to the Achilles rupture.

The Golden State Warriors went on to win the game 106 to 105 with the Raptors leading the series 3-2. The Raptors however went on to win game six and the series 4-2

For more, see this resource on achilles tendon ruptures.