Saturday, September 26, 2009

Broken Toes

St. Peter's Catholic Church is a tiny house of worship located at the 5 mile turn around where the Ironman Hawaii competitors head back to town and their journey on the Queen Ka'ahumanu Highway. If memory serves, there have been five different run courses since the race moved to the Big Island from Oahu in 1981.

True story. A local athlete participates in the regional 70.3 race, and seemingly coordinated in other aspects of life (yes, he can walk and chew gum at the same time) he has broken a toe twice at this race site before really getting his race going.

The first was his big toe having finished his warm up swim, wading back to the starting line, when he kicked a submerged rock...and Whammo - broken toe. Two years later, after exiting the 1.2 mile swim, running to the transition area on a long green miniature golf-like carpet, he tripped on a small fold in the carpet...and Whammo #2, a 4th toe broken on the other foot and the nail pulled 1/2 way off. And bleeding!. He finished both races!

Most broken toes are the result of trauma although I'd expect several of you to have suffered stress fractures of the same bones. We're covering the former today. Usually they occur secondary to an axial load such as a stubbed toe or some type of crush injury...such as dropping your bowling ball on it. Most will have significant pain at the time of injury although those with preexisting osteoporosis (thinning of the bones or loss of bone stock) may have less. Accompanied by less trauma. The injured usually are noted to have point tenderness at the site of the fracture although the skin is normally intact. The toe may be pointing a different direction...always a bad sign!

Although it's usually not an emergency, an early x-ray can be very helpful both in diagnosing the type and location of fracture, displacement if any, etc. A negative x-ray is no less useful. Also, in children, an x-ray can frequently reveal the presence or absence of a growth plate injury.

In fractures of toes 2-5, usually both the injury and treatment are less involved. Oftentimes, if the fracture is satisfactorily aligned and stable, simply taping the toe to it's next door neighbor, avoiding activities which might tend to displace the ends of the bones and occasionally a fracture shoe are all that's needed. However, a break in the bog toe is a horse of a different color given the importance of this structure in balance, directional control and weight bearing. If displaced or into the joint, the fracture needs to be reduced and the joint needs to be maintained. This can occasionally require a surgical procedure and prolonged post operative immobilization.

In short, if you think you may have broken a toe, and the pain doesn't subside in a reasonable time, why not let you local Urgent Care or health care provider take a gander and consider an x-ray.

Monday, September 21, 2009

Setting Goals - When 2nd is Better Than 1st

This is Sarah Reinertsen, the only female amputee finisher of the Hawaiian Ironman. Born with a limb deficiency known as PFFD, She had an above the knee amputation at a very early age and never really knew life without a prosthesis. Seen here from the back during the 2007 Kona Underpants Run (in a snappy home made skirt), her goal was the 2004 IMH. But, she fell short on the bike missing the cut off. Undaunted, she made some changes during the year returning in 2005. She bettered her bike split by two hours and finished the race easily with a big smile on her face. You talk about goal oriented!"

Another athlete I know is pretty competitive in his age group. In fact he can frequently win the age group at local races.

Joe Friel teaches that when you set your expectations for an upcoming race, you need to so carefully by picking an outcome that's dependent on your behavior alone. For example, a goal of winning the age group depends on the potential for a perfect race for you and the luck that nobody who can beat you shows up! Maybe, rather than an outcome of age group victory, the choice of a PR run split, or finally winning both T1 and T2 would be reasonable. A result that is both within your reach based on past performance and one that is almost totally under your control.

Our athlete has been thinking all summer that he would be getting another win at the upcoming tri (yawn - more hardware!) but what he didn't count on was that the race would be late in filling and that although he'd periodically review the list of entrants assuring himself that he was king cheese, at the last minute, someone from out of town registered who was way out of our boy's league.

Initially a little put out (and briefly considering, "Why even go if I can't win?") he eventually saw the race as an opportunity to really push it from the minute he got out of the water to the minute he exited T2 on the run. This change in attitude resulted in a terrific race, even though it was 2nd place by a wide margin. For 2009 he managed a faster swim, faster T1, faster bike, faster T2, and faster run than 2008. Overall, he cut his time for the sprint tri by SEVEN minutes over 2008.

And guess who had a huge grin getting that 2nd place trophy!

Monday, September 7, 2009

Plea For Carrying ID When You Ride

I've written before about the need to have some form of rapid ID on you when you're biking. Sadly, this article makes that point. ________

Bicyclist Killed By Car ID'd Posted 2009-08-27

Father Of JMU Frosh Was On Way To Surprise Son

By Pete DeLea and Jeremy Hunt

HARRISONBURG - Joseph V. Mirenda left Wintergreen on his bicycle Tuesday morning bound for Harrisonburg.

He was going to stop by and surprise his son, a freshman at James Madison University, but Mirenda didn't make it to the end of the 50-mile trek.

On Wednesday, police identified Mirenda, 49, of Virginia Beach, as the victim in Tuesday's fatal crash in Rockingham County.

Around 10:30 a.m. Tuesday, emergency personnel were dispatched to Port Republic Road, about a mile east of Cross Keys Road, where they found the cyclist lying in the ditch.

Mirenda was riding west on Port Republic Road when he was struck by a westbound 2000 Ford Taurus driven by Jessica Chandler, according to the Virginia State Police.

No charges were filed as of press time Wednesday, but investigators obtained a search warrant for the driver's cell phone records.

First Sgt. Bryan Hutcheson with the state police said investigators will be looking into whether Chandler, 22, of Port Republic, was talking on her cell phone or texting in the moments before the crash occurred.

"We don't want to leave any stones unturned," Hutcheson said.

Although the Daily-News Record has confirmed a search warrant was issued in the case, the document remains sealed by court order at the Rockingham County Circuit Court.

Meanwhile, investigators are still trying to piece together exactly how the crash happened.

They had spent Tuesday and most of Wednesday trying to determine the name of the cyclist, who had no identification on him.

State police caught a break in the investigation Wednesday afternoon when they received a call from the Wintergreen Police Department.

A Virginia Beach woman contacted the department and said she couldn't reach her husband, who was staying at the family's home in Wintergreen, Hutcheson explained.

The wife mentioned he may have gone on a bicycle ride.

Wintergreen officers recalled seeing a man riding a bicycle there Tuesday morning, and he matched the description of the then-unidentified cyclist killed in Tuesday's crash.

The state police and Wintergreen officers then confirmed the man's identity based on an inscription on a wedding band he was wearing.

It said "Frauke & Joe" with the date 9-24-88 on it.

Contact Pete DeLea at 574-6278 or [email protected]

When I put this up on one of the Tri web site forums, I received a number of clever answers where some people carry there drivers license, a business card, their cell phone, etc. One athlete has all his vitals written inside his helmet. But is seems that many simply have identifying data on a card in a plastic bag in a fanny pack, bike saddle tool kit, etc. Please make the effort. Do it today!

Sunday, September 6, 2009

The Meniscus - Torn Yours?

I don't need a whole lots of money, I don't need a big, fine car. I got everything that a man could want, I got more than I could ask for."
Grand Funk

In other words, my knees work just fine, thank you.

The meniscus is an important structure in your knee. Menisci, actually as we have two in each knee, an inside (medial) one and an outside (lateral) one. They are "C" shaped bits of fibrocartilage also known as semi-lunar cartilages which serve many functions. This is important as it wasn't that many years ago that surgeons felt the meniscus to have no purpose and excised them at will, especially in the pre-arthroscopy days. Some of you no doubt can remember that HS athletic injury by looking at the sizable scar on your knee from your open menisectomy (excision).

It's currently felt that the meniscus aids in the lubrication of the joint, stress transfer from femur to tibia, and that it contributes to the stability of the knee. Unless injured, the meniscus will provide a lifetime of service to it's owner with out complaint. That said, through injury, arthritis or just plain bad luck, any among us may suffer a "torn knee cartilage." As was true for both Tom Brady and Tiger Woods, the tear can accompany injury to one or more major ligaments. Usually bad news.

Frequently, the injured triathlete will have a physical exam, x-rays and/or an MRI with subsequent arthroscopy to remove or repair the damaged meniscus. (In highly selected cases, a meniscus transplant may be considered when more traditional methods have failed.) The arthroscopy is done in the sterile environment of the operating room under a variety of types of anesthesia - most of my patients watched theirs on the TV at bedside! The scope is introduced through two 1/4" punctures which rarely even need stitches at the end. Oftentimes the procedure is completed in under an hour, there are no crutches, and rehab exercises begin in the recovery room.

The surgeon who's seen the inside of your knee is likely in the best position to determine your return to sport, possible limitations, etc.

Take good care of your menisci, they should last a while!