David Goyette 💙

@DrJN_SportsMed Sorry to hear this James. Hope your rehab is smooth.

Felt i had to post & update here I could only handle 6 days of savage radicular leg pain - mostly at night And foot drop (this bothered me less tbh) God knows how pts deal with this for weeks / months (should they have to deal with it?) I’m incredibly lucky that I have a support group around me - friends & clinicians - and ease of access to timely care - enormous thank you to Mr David Cummings at the Cleveland Clinic Some suggested to me to ‘wait it out’ - maybe i’m not strong enough, but there was no way i could hold out - it was killing me physically & emotionally Discectomy at 4pm yesterday - massive sequestered fragment stuck in canal & recess squishing L4 & L5 roots (so a bit of quad involved took as well as tib anterior) I’m now pain free, slept in any position i cared to and foot drop already improving) - at home now doing Zooms & boring people on SoMe again Lessons - In some radicular presentations early surgery is the right decision How big a disservice / how much harm are we doing to NHS patients with delayed access to ortho services - when the ‘ship has sailed’? Radicular pain can be just as much extension related as flexion (the latter relieving for me) The only analgesia that gave me decent relief was old school diclofenac Neural flossing ain’t going to cut it - and really f*+king hurts MRIs are not evil

@DrJN_SportsMed Mueller Weiss

Consent ✅ Footballer, 20s Worsening anterior ankle & mid foot pain with recent increase in training volume & new surface No trauma Push off, change of direction, forceful laces strike Dislikes passive plantar flexion, mid foot pronation / supination, hop & jump Tender through lateral aspect of talonavicular joint What does the weight bearing lateral xray & ultrasound suggest? MRI awaited

@nas_vascular Great work. 👏🏻👏🏻

It's out! Our paper describing the 46% reduction in lower limb amputations. It's taken 6 years of hard work from so many people to make this happen. Thank you to everyone involved. The work is now being scaled up! diabetesonthenet.com/diabetic-foot-…

@DrJN_SportsMed Other than the weakness

@DrJN_SportsMed Any neuro findings clinically?

Consent✅ 1 year progressive severe (painless) L calf atrophy & weakness Medial bulk affected > lateral - see pic Affecting football performance Rolling over in bed onto R side - sudden 'spasms' in leg leg US - diffuse fatty atrophy of medial gastroc & soleus (vs R) EMG / NCS - severe L5 & S1 subacute chronic radiculopathy MRI - no herniated disc - but 5cm filum terminale lipoma (high signal on T1 seq, low on STIR). Also very low lying conus medullaris & tethered cord suggestive of spinal dysraphism (spina bifida occulta) Neurosurgical referral

@SophieBPodiatry @HSciences Congratulations.

@MRheumy Then Happy Birthday Harry. Too big to be pushed around a 10k these days.

@MRheumy gelukkige verjaarsdag Harry.

1, 2 and 5 year survival after a diabetic foot ulcer is 80%, 69% and 29% diabeticfootonline.com/2016/12/19/1-3…

@T_L_WilliamsPhD Toni, is it ok to share the survey more widely?

@DrJN_SportsMed Am I the only one bothered by the two bags the wrong way round?

John Wick’s crisp draw

@MRheumy @londonfoot @DrJN_SportsMed Let me know when you're back. Look forward to it.

@MRheumy @londonfoot No personal experience of PRP, have never read any convincing evidence but would defer to @DrJN_SportsMed. Appreciate the inherent difficulties but the metabolic/BMI would be top of my list to address.

@MRheumy @londonfoot Assuming the tear is the driver of pain? Mid substance lesion? . Exhaust Load management and progressive rehab. There are some surgical options. I'd be reluctant Initially.

@DrcamWareham Congratulations Cam.

Very pleased to have been invited to join Guernica 37 Barristers Chambers in London. G37 is a leading International Law practice which covers international human rights, international crime in The Hague and now International Dispute Resolution.

@MRheumy @FirstContactH Mike. What mix did you inject?

@Flawless_Physio Useful exercise for abd Hal and certainly worth trying. But, the pathology with a bunion is medial deviation of the 1st metatarsal relative to the second, unlikely to “fix”

@BunionSlayer What’s your plan? Thoughts on addressing the flat foot?

@SurgeonFRCPodS Surely one for a poll? Fay-lanx singular Fa-langes plural

Phalanx Is it FA-LANKS or FAY-LANX Settle this #MedTwitter #orthotwitter #Orthopedics #podiatry #podiatricsurgery

@BunionSlayer How many products do I need to use to get a place at a conference funded?