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madisondancer27

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Reply with quote  #1 
The week of our recital last season DD was doing double over splits and her front heel slipped off the mat slamming into the ground and could barely dance at recital but pulled through and this was in May. After recital that week we went to our podiatrist and they took X-rays and said it was just a bone contusion or bruise and it would take a while to heal and come back if it wasn't feeling any better. So we went back beginning of July and he said to just not jump or run for the time being and do ultrasound treatments and come back before school starts if it's still bothering her. She is on her high school dance team and at a competitive studio so we have a lot of dance coming up and don't have time for this 😬 So it hadn't gotten better and we went back and Doc put DD on a steroid and we are going back in two weeks to see if it helps, as of now he said if it doesn't we can try a shot and if that doesn't work do a cast and non weight bearing for 4-6 and treat it as a fracture. Along with that he gave us the option to skip that shot and go straight to cast when coming back so we wouldn't miss out of State Solos in November and those Tryouts are beginning of Oct. what would you do? Would you go straight to cast and get it over with or risk not being able to Tryouts if the shot wasn't working? Thx so much we don't know what to decide
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Noel

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Reply with quote  #2 
In my opinion as a PT I would RUN to a second opinion. There's really nothing more for me to say here. I wish your daughter a speedy and complete recovery.
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madisondancer27

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Quote:
Originally Posted by Noel
In my opinion as a PT I would RUN to a second opinion. There's really nothing more for me to say here. I wish your daughter a speedy and complete recovery.

Could I ask what you would think should be done if you don't think this is the correct treatment, any opinion helps!!!
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emmymom

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Reply with quote  #4 
Skip the podiatrist and make an appointment with an orthopedist who specializes in foot and ankle care ASAP!

Wishing your DD the best!
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hsealover

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Reply with quote  #5 
I agree with the above posters! I would maybe even recommend a sports medicine doctor, you may be able to get in sooner. DD started experiencing foot problems in October 2016 and we went to sports medicine doctor after several failed attempts at the family doctor. Our sports med doctor was amazing and he was able to figure out what was wrong and how to treat it within minutes. His solution was fast and effective!
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PasDeChatMom

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Reply with quote  #6 
Ditto the other ladies suggestion to find an orthopedist that specializes in the foot/ankle. The orthopedist 'my daughter sees is part of the sports medicine department at a large children's hospital and he discussed cortisone shots as something that would be far down the list of things to try (knee issues not heels, but he explained his hesitance to use shots unless there were no other non-surgical options). Again that's just his opinion and of course all docs are different but I would definitely find an orthopedist and avoid a podiatrist. Good luck!
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Noel

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madisondancer27 it would be unprofessional for me to do that online, but what would be professional would be for me to encourage you to read up on stress fractures in the foot and what to expect when recovering from them, time frames, diagnostic studies done, expectations. Then look at your management to date.
Read up on things like Sever's disease (sometimes coincidences do happen).

Read up on the use of a bone scan vs. x ray for identification of microfractures.

Read up on incidence of missed fracture on x ray.

Read up on ultrasound treatment where growth plates are still active/ growing.

Read up about the success failure rate of injections (shot) and the many things that are injected and the risks and benefits. Find out precisely where they want to give the shot and why?

Read up about the retrocalcaneal bursa and what bursitis is.

Read up on what an MRI can tel you vs. an x ray.

Read up on weight bearing v. non weight bearing x rays for foot and ankle diagnoses.

All of these search terms should lead you to lots of good information, check that your sources are .org .edu or a trusted source.

Finally, trust your gut. Your gut told you to hit pause and start to question this process and post here. Your gut as a mom is almost always far better at the minimum of recognizing when the plan of care is not sufficient, and many times, in my experience, once the parent has a gut feeling about what is probably happening, they are often dead on if not awfully close.
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5678StarMom

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Reply with quote  #8 
Not sure how old your daughter is, but I would also be concerned with steroid use (was it an injection?) especially without a clear diagnosis. I was told by the doc treating my DD that steroid injections are terrible for athletes long term because they actually increase the chances of fracture by a ton in the future.
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madisondancer27

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DD is 16 and the steroid we used was a pill we took over 6 days not an injection. We have loved our podiatrist for awhile because DD has had 2 stress fractures in the top of her foot. He has done really good things after the other orthopedic we went to was very rude and told DD she should never dance again. In my area I'm not sure where to go to because we have an orthopedic business but they will send her to the woman we didn't care for. So I guess I'm stuck on where to go 😐
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5678StarMom

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Reply with quote  #10 
DD14 has had prior hip issues before so I can relate. She saw first her pediatrician, then a sports medicine doc, then an orthopedist. All at expensive co-pays and extra bills in the mail from overages on what the insurance wouldn't pay. None of them helped at all. Finally a chiropractor solved it for her over a few months with relating it back to her mild scoliosis and that her legs are very slightly 2 different lengths. Her relief and results have been amazing. She now has something going on with her foot and we are seeing a podiatrist who has treated dancers before and asked us very informed questions about her pointe work (how old were you when you started, about puberty, how many hours, etc) and so far the care has been great. I'm in the same boat about wondering what is the best "kind" of specialist to see and we are just hoping to have good results with this doctor from the beginning.

From watching friends of ours experiences with stress fractures and the like, I feel like the answer is just have to keep trying different doctors and opinions until there is a solution or relief to the problem.  

(This sort of thing is a hidden cost of high level dance that no one thinks of when they sign their kids up for class as toddlers!)
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Noel

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Reply with quote  #11 
Knowing there is a prior history of stress fracture is very significant. If I had a patient at just 16 with a known history of stress fracture in the same body region twice prior I would advocate strongly for an MRI to rule out a new stress fracture. Further, I would advise my hypothetical patient to consult with an endocrinologist and or gynecologist, whomever as a parent you felt more comfortable with, to do a full hormonal work up and to assess if bone mineral density is adequate. Bone deposits at this age and now is the time to establish bone health for the lifetime; the more densely deposited bone during this age when the body naturally loses density post menopause, the less likely the development of osteoporosis purely from a developmental lack. You cannot prevent genetic predisposition, but you certainly can be sure that a developing adolescent is getting enough mineral deposition at this age.
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dave9988

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Reply with quote  #12 
Quote:
Originally Posted by madisondancer27
DD is 16 and the steroid we used was a pill we took over 6 days not an injection. We have loved our podiatrist for awhile because DD has had 2 stress fractures in the top of her foot. He has done really good things after the other orthopedic we went to was very rude and told DD she should never dance again. In my area I'm not sure where to go to because we have an orthopedic business but they will send her to the woman we didn't care for. So I guess I'm stuck on where to go 😐


We have great doctors locally.  But we've also driving 6 hours to another city for a second opinion on dance pain.  As someone else pointed out, part of the hidden cost of dance.
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madisondancer27

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Reply with quote  #13 
Quote:
Originally Posted by Noel
Knowing there is a prior history of stress fracture is very significant. If I had a patient at just 16 with a known history of stress fracture in the same body region twice prior I would advocate strongly for an MRI to rule out a new stress fracture. Further, I would advise my hypothetical patient to consult with an endocrinologist and or gynecologist, whomever as a parent you felt more comfortable with, to do a full hormonal work up and to assess if bone mineral density is adequate. Bone deposits at this age and now is the time to establish bone health for the lifetime; the more densely deposited bone during this age when the body naturally loses density post menopause, the less likely the development of osteoporosis purely from a developmental lack. You cannot prevent genetic predisposition, but you certainly can be sure that a developing adolescent is getting enough mineral deposition at this age.
Thank you so much for all your help! I will keep y'all posted on how everything goes! If she does have a stress fracture do you happen to know how that would work since its her heel and you couldn't just be put in a boot
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Noel

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Reply with quote  #14 
I'm not trying to be difficult, but stress fractures are a lot like snowflakes, no two are alike and no two patients will recover the same. They can be frustrating and fickle and seem to take forever in one patient and another can be like new in 4 to 6 weeks without ever experiencing another. The bottom line is that as a PT I manage stress fracture patients with an eye on pain reporting in the same exact area. You must be explicitly clear about where the pain is and where the fracture is at the onset as you need to know if the pain from this stress fracture is improving, leveling or getting worse. You need to be extremely vigilant as to new pain because it could be a new stress fracture.

A patient with a diagnosed stress fracture who continues to have pain reported in the exact same spot as where the stress fracture was, regardless of diagnostic studies, particularly a developing adolescent, cannot return to full participation. Interventions from custom orthotics to unload the area to walking boots to full non weight bearing and a walker (crutches are a menace IMO) may be indicated and advice from a trusted physician is a must during this process. You must look at the diet, the BMI, the family medical history, and the overall bone health (perhaps with a BMD scan) when pain persists.

You are already several months into recovery, this is not a straight forward case in my opinion at all. You must have physician guidance you fully trust, and you must learn and advocate for yourself.
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Noel

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Reply with quote  #15 
While not dancing at full participation the dancer should be in the pool to keep up aerobic stamina. Floor barre to maintain strength and form, and cross training in safe manner to make return to dance less frustrating. There is so much non weight bearing activity you can do to strengthen the foot and ankle and to keep the whole body flexible during this time. It is a challenge but some dancers can return stronger and more agile and more flexible as all those hours not in class can be dedicated to fine tuning the body.
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ballerinamom13

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Reply with quote  #16 
Quote:
Originally Posted by emmymom
Skip the podiatrist and make an appointment with an orthopedist who specializes in foot and ankle care ASAP!

Wishing your DD the best!

THIS!!
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classydance

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Reply with quote  #17 
The precipitating event does not seem consistent with a stress fracture?  But I agree an orthopedist is probably the better person to treat it. And an MRI
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classydance

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Reply with quote  #18 
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madisondancer27

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Reply with quote  #19 
Update: We are getting an MRI on Wednesday because he either thinks it's a tear in her Plantar Fascia, a stress fracture, or still a bone bruise but he will be able to tell more with this! We will find out the next Wednesday at an appointment what's going and he said they will contact earlier if it's something serious. Please keep us in your thoughts and prayers 💕
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prancer

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Reply with quote  #20 
Good luck, madisondancer27.  I am glad you are getting a full assessment hope it brings good news.
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Billpayer2000

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Reply with quote  #21 
My advise as a nurse is for all families with active kids (sports or dance), should have Physical Medicine and Rehab doctor they trust.  Our PMR doc has saved us much grief and worry. 
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