Hockey Doc

The Hockey Doc: Skate bite

By Dr. Rob LaPrade
http://drrobertlaprademd.com

Question: I have been skating in new skates I just received for Christmas. I have been having more and more pain and swelling over the front part of my ankle every time I skate. What should I do for this?

Answer: The problem that you are describing is something which is commonly called “skate bite” or “lace bite.” Skate bite almost always occurs due to a new pair of skates being worn for the first few times.

 

Skate bite almost always occurs early in the hockey season in players with new skates or inflexible old skates or in the middle of the season for players who receive a new pair of skates for Christmas.

Skate bite is caused by too much pressure from a stiff skate tongue which has not been broken in well, or in old skates which have old and inflexible skate tongues. In both of these situations, the inflexible skate tongue puts extra pressure over the anterior or front part of the ankle. When the skate is laced up tight, the tongue part of the skate presses against the front part of the ankle and the tendons under this.

The tendons over the front part of the ankle are very important to move your ankle in an upward position (dorsiflexion). Repeated motion of these tendons against a tight skate tongue during activities can cause inflammation of the main tendon, which results in tendonitis (swelling of the tendon) which can be quite painful and debilitating for on-ice activities.

The treatment for skate bite is to decrease the effect of the “too tight” skate tongue pressing against the front part of the ankle. Either you or your athletic trainer can fashion a soft piece of foam rubber to be placed outside of your hockey sock that takes some of the pressure off and decreases the irritation of the tendon for on-ice activities. In addition, working on the skate tongue by bending it back and forth frequently (while doing homework) to increase its pliability and suppleness would help to decrease the stiffness and would help to decrease pressure on the tendon.

Since skate bite appears to be due to inflammation of the tendon sheath, the use of over-the-counter anti-inflammatory medications can be useful to decrease some of the irritation present. However, these medicines do not treat the underlying problem of the too rigid skate tongue and should not be used as the only way to treat this problem.

Over time, the skate tongue will break in and the irritation of the tendon will decrease. Sometimes, cutting a channel out of the felt in the skate tongue will allow players get back to activities faster (but this is not recommended if you have the time to work on the pliability and suppleness of the skate tongue).


Hockey players with new skates who anticipate full on-ice skating activities immediately in these skates can’t help but decrease their chance of getting skate bite by working on the flexibility of the skate tongue prior to on-ice activities. If you find that the skate tongue seems to be excessively rigid, placing a well contoured piece of foam rubber between the top part of the ankle and the skate tongue may help decrease the chance of this problem developing.

Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado.  He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it to This email address is being protected from spambots. You need JavaScript enabled to view it..