Malleolar bursitis in figure skaters - Indications for operative and nonoperative treatment

Figure skaters are unique athletes who must train for extended periods of time performing motions and routines that create excessive compressive and shear forces between their malleoli and boots. As a result, they are susceptible to the development of a painful adventitious malleolar bursitis. Most often these patients will relate a recent increase in their training schedule or the purchase of a new pair of skating boots. This condition usually responds favorably to nonoperative measures including stretching of the boot over the affected area and protective padding placed around the inflamed bursa. If the swelling is marked, then an aspiration, subsequent injection with cortisone, and a compressive wrap may be indicated. This treatment regimen will enable the majority of figure skaters to continue skating. If the symptoms continue or increase despite nonoperative measures, then cessation of skating for a brief period must be considered. If this is not a viable option for the skater, surgical excision of the bursa may be warranted. If septic bursitis occurs, immediate surgical debridement and intravenous antibiotics are indicated. A Staphyloccocus aureus organism is most often responsible and should be treated with appropriate antibiotics. These patients may return to skating when there is no sign of further infection, the soft tissues have fully healed, and there is no sign of residual inflammatory bursa, usually at 4 to 6 weeks after surgery.