Under the big toe are the two little sesamoid bones that are analogous to the patella or knee cap in how they function. For two tiny bones, a lot is expected of them as we do pivot of them when we play sport. They really do get subjected to a lot of load. Sesamoiditis is the condition that you get when there is an inflammation of the bone and surrounding tissues. The diagnosis is usually obvious with the pain located to the bone and the most common differential diagnosis is a fracture of the sesamoid bone. X-rays can be useful to rule this out but the sesamoid is often in two pieces normally. The most common treatment is to use padding or foot orthotics to off-load the area and sometimes cortisone to help the inflammation. At today’s clinic, we sent two off for surgery, which is the next option for chronic sesamoiditis.
It hard to deal with people with restless legs syndrome and we cannot really offer them much. I have been seeing a lot of older patients with it lately. While they come in for other reasons, they often comment that they have it. It is miserable problem as when they are in bed at night, the legs become retless and they have to keep moving them to relieve it. This affects sleep which in turn affects the quality of life. The research on what do to for this condition is not that good and the treatment is not clear. One thing I have noticed is that there are a lot of “cures” being marketed on the web. I hate snake oil as much as the next person, but sometimes when you have a condition like this that is so miserable, I almost feel like telling them to give this stuff a go. It is not going to do any harm.
My boyfriend just presented me with his case of pitted keratolysis! I recall one doc saying a few years ago to never treat family or friends! Pitted keratolyisis is a bacterial infection of a sweating foot that causes multiple small holes or ‘pits’ in the skin. Treatment is just with a short course of topical antibiotics and its prevented by good foot hygiene. That’s all.
I wonder if I will ever get sick of seeing plantar fasciitis? I seeing several cases a day. It is becoming the ‘bread and butter’ of the clinic I doing a preceptorship at. They all seem the same. Most of them are overweight and are standing a lot during the day at work. Obviously that puts a large strain on the plantar fascia leading to the overload. The all need a good pair of orthotics, some anti-inflams and lots of stretching and they should do fine. Some get a cortisone shot. One thing I have noticed about plantar fasciitis, is that there are a lot of magical and miracle cures on the web. There is snake oil everywhere! There is no secret recipe for plantar fasciitis! I found some good sensible information at Run Junkies site.
We had a couple of cases of posterior tibial tendon dysfunction (PTTD) today. Both older patients; both will be scheduled for surgery; both should have had more aggressive orthotic therapy sooner. PTTD is a very disabling condition if it is not caught early enough. It almost always progresses to the need for a surgical reconstruction if not caught early. Both these ladies are not the best surgical candidates, but with the surgery, their ability to ambulate will be severely impaired with other consequences on the health and well-being. That is going to impact in their quality of life.
Keeping up with all the running blogs and my studies is a challenge. One thing I see coming up a lot is the increasing emphasis on running form. There seems to be a number of different running forms and all have their very ardent supporters, but very little evidence behind them. We all know what happens when the passion outweighs the evidence! One of the more passionate are the Pose Runners. There is one study that does say that pose running is not as economical as other running forms. As far as studies go, it seems okay, but I got amazed at the extraordinary length that the Pose supporters go to dismiss this study. Most of their criticisms are off the mark and show a failure to understand the basics of research and the scientific method. At the same time they try to dismiss that study they blindly accept many other very flawed studies! This does not mean that there is anything wrong with Pose running or not, it just means that those who promote it like having it both ways. You can’t do that.
Been seeing a lot of patients with poor circulation and not diabetes. The reason I mention this is that if you have poor circulation and diabetes their seems to be a lot of resources thrown at the person when they have diabetes about what to do and what not to do to prevent problems from developing, There are regular check-ups put in place if you have the diabetes so the poor circulation is carefully monitored. This does not happen if you just have the poor circulation. There is the American Diabetes Association out there advocating for those with diabetes but there is no one out there advocating on behalf of those with poor circulation! There problems are no less severe and the consequences if something goes wrong is just as bad. Not sure what we can do about this though!