Preventative Measures for Lower Extremity Skin Conditions in Paralympic and Adaptive Sports: An Epidemiological Overview

Author(s): Vera Wang, Andre Aabedi, Devendra K. Agrawal

Adaptive and Paralympic athletes face unique dermatologic challenges related to impaired sensation, prosthetic use, wheelchair friction, and comorbid conditions. Lower extremity skin infections are particularly concerning due to their impact on performance, participation, and overall health. To review the epidemiology, risk factors, clinical features, and evidence-based prevention strategies for lower extremity skin infections in adaptive and Paralympic athletes, and to identify current research gaps and future directions. A narrative epidemiological review was conducted using data from Paralympic Games surveillance systems, sports medicine registries, and dermatologic literature on skin infections in athletes with disabilities. Relevant studies addressing prevalence, pathophysiology, and preventive interventions were synthesized. Skin and soft tissue infections occur at a higher rate in adaptive sports athletes compared to the general population, with the highest rates in individuals with spinal cord injury and prosthetic use. Key risk factors include compromised skin barrier integrity, impaired circulation, hygiene challenges, and environmental exposure. Prevention requires a multifaceted approach emphasizing daily skin inspection, hygiene optimization, prosthetic fit adjustments, and facility disinfection. Multidisciplinary education of athletes, coaches, and clinicians is critical for early recognition and intervention. Despite the high burden, dermatologic outcomes remain underreported, and few studies evaluate targeted preventive measures. Lower extremity skin infections are a prevalent and preventable cause of morbidity in adaptive and Paralympic athletes. Tailored dermatologic care, standardized surveillance, and technological innovations—such as antimicrobial prosthetic liners and AIassisted tele-dermatology—offer promising avenues to reduce infection burden and promote inclusion in sport. Future research should prioritize longitudinal, multicenter studies to inform evidence-based prevention and management strategies.