Monday, November 17, 2014

More Dancer Problems...

Dancers pretty much abuse their feet, with repetitive forces in unnatural poses, so it is no surprise that they end up with stress fractures in their feet. When we think about broken bones in the foot, most of us picture a broken toe or a large bone in the middle of the foot (the metatarsals). However, there are two tiny pea-like bones that can also be broken- the sesamoid bones. These little bones are embedded side by side within the tendon that is in the ball of your foot, just beneath the base of your big toe. They act like pulleys, allowing the tendon to slide more easily as you bend your foot, pushing off with running, jumping or walking. Stress fractures of the sesamoid bones show up as gradually increasing pain every time you put pressure on them, especially with the act of bending and pushing off. The pain tends to stay very localized, is relieved with rest, and the maximal tenderness to touch is underneath the base of your big toe.

How are these fractures diagnosed?
Sesamoid fractures, like all stress fractures, may not show up on x-rays till they have been present for a couple of weeks. A dark line is seen within the white "ball" that is the sesamoid bone. Occasionally the sesamoid bone will be completely broken into two parts, and these fractures may require surgical correction.

What is the treatment?
There is no quick fix for this problem, much to the dismay of dancers (and runners). The treatment is to stop bending the ball of your foot, most easily accomplished with a firm walking boot. How long? Typically a minimum of 3 weeks, but more often roughly 6 weeks. Upon return to activity, the key is to "start low and go slow"- do NOT jump back in to full workouts!

BOTTOM LINE: For deep, persistent, worsening pain under the ball of your foot, consider the possibility of a stress fracture of your sesamoids- head to your family doctor for an exam and possible X-ray.

Monday, November 10, 2014

Dancer Problems...

Have you ever had a plantar wart? These are the warts that show up as a painful bump underneath your foot. These unwelcome growths often show up at the site of "trauma", so dancers obviously most frequently develop them on their feet or toes. Warts are incredibly common, with a prevalence of up to 10% of Americans. In fact, the vast majority of us will develop at least one wart somewhere on our body during our lifetime.

Are warts dangerous? Not really. Warts do not turn in to cancer, and in fact, untreated, will eventually go away on their own. The problem is that "eventually" could be years. Since warts are rather unsightly, and obviously plantar warts can be painful (picture having a pebble under your foot as you walk), most people do not choose to do nothing and simply wait out the wart.

How can you get rid of a plantar wart?
There are many different remedies out there, most of which have some success- including the perennial favorite, duct tape. Over-the-counter fixes may work as well as treatments in your doctor's office. None are perfect. One relatively recent study from 2011 again demonstrated that home daily self-application of salicylic acid yielded the same results as a physician treating in the office once with cryotherapy (liquid nitrogen). EVerT: cryotherapy versus salicylic acid for the treatment of verrucae--a randomized controlled trial.

My personal favorite treatment for plantar warts is a non-prescription product called Curad Mediplast. This stick on product is a combination of higher dose salicylic acid (the active ingredient in most OTC liquid wart removers) and, well, tape. You simply cut a tiny piece large enough to just cover your wart, and stick it on your freshly washed, but thoroughly dry wart. Leave it on for 24 hours. Take it off, scrub your wart a bit with soapy water and a pumice stone or washcloth, then let dry for 10 minutes and place a new one on. Repeat this for ONE week. Then, do nothing for two weeks (you can continue to use the pumice stone if you want, but don't be tempted to start digging around with sharp objects. Repeat the week-long cycle again. Smaller plantar warts like the one pictured above may resolve after only one cycle, while larger ones may take three or more. Just remember- one week of treatment, then two weeks off. Is this 100% evidence-based practice? No, but it has been successful for my patients, and correlates with clinical studies using similar protocols.

BOTTOM LINE: Think you have a plantar wart? Head in to your family doctor to confirm the diagnosis and start on a treatment that will get you back to action as quickly as possible.