Port Dickson International Triathlon 19-20th July 2008

The Port Dickson International Triathlon is one of the major triathlon events held in Admiral Cove, Port Dickson yearly. This year I had the opportunity to be an unofficial observer as some of my patients were enrolled for the event! I wanted to compare it with the Manchester Commonwealth Games in 2002 where I was assigned to accompany the triathletes of the Malaysian team. The swim start has always been a scramble comparable with a stampede where a competitor needs to be fend off the flailing limbs of other triathletes. After surviving the 1.5km swim by the beach, the able bodied triathletes change to their cycling gear while getting onto their bicycles. The 40 km ride would often be interspersed with hills and valleys (and a beautiful scenery of Port-Dickson). By the time they return their bicycles and start running, they would be bathing in the morning sun for another 10km.

They had a full team of ambulances, Civil Defence forces, Police and paramedics to attend to emergencies. There were a few who sustained minor bruising and muscle cramps during the event.

I had these photos to tell about the event.

Shock Wave Treatment for Achillis tendon Calcific Tendinitis

A young male hockey player came with chronic pain in his Achilles tendon several months ago. His earlier Ultrasound scan showed calcification of his Achilles tendon adjacent to the insertion to the calcaneal bone. He was given extracorporeal shock wave therapy(ESWT) (2000 pulses) weekly and felt much better after the second treatment. He went on to play the Kuala Lumpur Hockey League without any symptoms after 8 weeks rehabilitation and has been symptom-free since then.

ESWT has been approved for plantar fasciitis and has been found to be useful in treating calcific tendinitis.

I took a few photos of the treatment session.





Related websites:
International Society for Musculoskeletal Shockwave Therapy
FDA New Device Approval
EMS Website
Principles of Shockwave Treatment

Foot Contusion and bruise from bike fall

A young lady in her 20s came in with a swollen and bruised right forefoot and toes from a fall off her bike. I sent her for an X-ray which did not show any signs of fracture. She was treated with RICE Treatment, topical Anti-Inflammatory gel and some Cox-2 Selective NSAIDS. The swelling and bruising should subside within 1 week but she will be reviewed in a week.

Hip-hop Dance and Fracture in the foot

An 11 yrs old girl came yesterday complaining of a swollen and painful left foot after hearing something snap in her foot while doing hip-hop barefoot. She had been training barefoot for 1 year but it did not cause any pain. Now, she could not walk or put pressure on the side of her foot or even tip-toe.

I examined her left foot and found that she had some bruising and swelling around outer part of her midfoot (lateral aspect adjacent to the base of 5th metatarsal). There was severe tenderness at the base of the the 5th metatarsal.

Her X-rays shown that her left foot had a non-displaced transverse fracture of the base of 5th metatarsal (Jones Fracture). She was treated non-surgically with non-weight bearing posterior slab crutches to allow the swelling to subsides. She would benefit from a daily dose of low frequency ultrasound (Exogen) to promote healing. Once the swelling subsides we may consider placing her foot in a functional walking brace but she would not be allowed to walk until after 6 weeks later.

Interesting links:
Diagram of metatarsal fractures