title: Shoe rim and shoe buckle pseudotumor of the ankle in elite and professional figure skaters and snowboarders: MR imaging findings.
abstract: OBJECTIVE
  To review MR imaging of figure skaters and snowboarders presenting with painful soft-tissue swelling of the lateral supramalleolar region with a clinical provisional diagnosis of soft-tissue tumor.
  
  
  METHODS
  MR imaging was prospectively reviewed by two sub-specialized musculoskeletal radiologists. The findings were correlated with a second clinical review and examination of the shoe wear. The patients were four female athletes undergoing heavy training regimes, ranging in age between 16 and 25 years. Two patients were elite figure skaters, and two were professional snowboarders. Three patients had unilateral masses with pain, and one patient presented with bilateral clinical findings.
  
  
  RESULTS
  MR imaging showed subcutaneous, focal soft-tissue masses of the supramalleolar region in five ankles at the same level above the ankle joint. MR imaging prompted a second clinical review and correlation with the shoe wear. The MR imaging findings correlated to the level of the shoe rim or shoe buckle in all patients, confirming the suspected MR imaging diagnosis of an impingement syndrome. All four sportswomen were training excessively, ignoring safety advice regarding training duration, timing of breaks, and shoe wear rotation.
  
  
  CONCLUSIONS
  Ice skaters and snowboarders may present with persistent and disabling pain. On MR imaging, this corresponds to a focal soft-tissue abnormality, which may be due to subcutaneous fat impingement between the fibula and the shoe rim or shoe buckle.
authors.affiliation: Department of Diagnostic Radiology, University Hospital of Bern, Inselspital, 3010 Bern, Switzerland. suzanne.anderson@bluewin.ch, suzanne.anderson@insel.ch
authors.forename: S E
authors.initials: SE
authors.lastname: Anderson
authors.forename: M
authors.initials: M
authors.lastname: Weber
authors.forename: L S
authors.initials: LS
authors.lastname: Steinbach
authors.forename: F T
authors.initials: FT
authors.lastname: Ballmer
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D012090:Cumulative Trauma Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D012775:Shoes / Q000009:adverse effects*; D012861:Skating / Q000293:injuries*; D038161:Snow Sports / Q000293:injuries*; D012983:Soft Tissue Neoplasms / Q000209:etiology / Q000473:pathology* / Q000628:therapy