Ask Dr J – Issue 180 – SHOCKING!


I broke two toes a few months back and they have yet to heal. One is looking OK, but the other still has no mobility at the joint closest to the foot. Bending it is painful. Should I get it checked out or be more patient?

I am 31 years old and vegetarian. Not sure if this matters, but my bones seem reluctant to heal based on another break last year. I’ve been dosing with calcium and vitamin D as well as doubling the dark leafies.



One of my good friends, a dentist, sidled up to me at the gym. He was only wearing one shoe.

“Can you have a look at my toe?” he asked. “I don’t think it is broken but, gee, it hurts.”

He’d stubbed it on the side of a windsurfer. Being both observant and practical, he proceeded to straighten it and continued surfing for a few hours. Then it was off to the gym where he squeezed it into a shoe for several more hours

“It’s broken, George!”

“Nooooo! Really?” he asked, looking astonished. The following day he put his foot in the dental x-ray machine and delivered some postage-stamp films.

“Shattered” is probably a more accurate description of the condition. Were it not his little toe he probably would have needed surgery to screw it back together.

Toe fractures can be rather messy, and surgery is not out of the question. Smash one badly enough and you will end up with a fused joint. Or worse, it may just piss you off for the rest of your life. But, hey, it’s just your toe, right?

I would spend some bucks on an x-ray just to see what you are dealing with. If all is well, do as the Greeks did—roll over, bite your pillow and have that appendage manipulated. It’ll be worth it in the morning.

A vegetarian diet is fine if you manage it well. Simply deleting meat from your diet is a little remiss. A deficiency in protein, and its compatriots iron and zinc, will certainly slow fracture healing.

Collect a variety of vegetables. Make a rainbow installation in your shopping cart and you should be halfway there. Nuts and fish (one of the few “vegetables” to have bones) are great sources of minerals. That said, it’s a complex issue, and I’m not a nutritionist.

When Voodoo met Hypnotism there was more panting than a pervert at a nudist beach. Sparks flew, knees got grubby, and a bastard child called Marketing was born. Dudes are paid a lot of money to carefully word supplement labels. Unless you live in Lapland or the dark side of the moon, you are unlikely to need vitamin D supplements at your age for healthy bones. There is some hoopla that performance in athletes can be affected by vitamin-D insufficiency, but I would save your pill money and see a nutritionist instead. Supplements are superfluous for most vaguely healthy people, and if your issue was that straightforward they would have worked already.

If the flexibility is not improving and x-rays don’t show fractures that are not healing, manual therapy is a good idea. Delayed fracture healing will feel like grating bone ends when you bend your toe. After the grating will come vomiting and passing out.

Plain radiography remains the standard method to monitor fracture healing, but it documents delayed healing only late in the course. See your doctor if pain persists.



I’ve heard of people using shock therapy for finger injuries. Would you recommend this? If so, where can I get the equipment?

BRAD DALLEFELD | Bloomington, IL


Shock therapy?! “Where do I get the equipment?” Gold. First, though, add the Burn Unit to your list of emergency numbers.

Might I suggest that banging bulls’ horns together while bathing in a tub full of dead sardines and chanting Whitney Houston refrains would be more therapeutic? Call me out of touch, but the last time I heard of shock therapy outside of the green walls of an asylum was when medicos did not require insurance and guinea pigs weren’t nervous.

Does it strike anybody as odd that electricity could have so many therapeutic applications? Laser, ultrasound, vibrators, the list is endless. (In a rare combination of vision and blind stupidity, the vibrator was originally used by doctors in the late 1800s to alleviate female “hysteria”).

Suffice to say, electricity is not as versatile as you might think given the ubiquity of zappo medicine. Very few finger injuries cannot be placated with a little stretching, altered climbing habits and/or felicitous rest (among other home remedies, namely ice cream and fast cars).



I recently had a cortisone shot in the tendon of my middle finger to burst some type of cyst that formed after an injury. It feels much better now and I am climbing after a three-week rest, but I am curious if the tendon will return to full strength?



Cortisone is the cocaine of modern athletes, though much less fun (I wouldn’t know, I didn’t inhale).

Many sporty people seem to feel they need a regular shot and advertise it like a badge of honor. Cortisone is probably the most over prescribed drug in modern medicine outside of … all the others.

A metabolite of the catabolic steroid hormone cortisol, cortisone is involved in stress response. In the sporting domain, cortisone is predominantly used as a pain killer and anti-inflammatory (read: Band-Aid therapy). It is not so much the side effects that get my goat, but rather the complete lack of therapy that an injection entails. Cortisone is seldom a solution.

I think the majority of consultations follow this simple sequence:

Patient: I have blah-blah problem.

Doctor: There’s nothing I can do about that. But we could give you a cortisone shot if you like.

What the doctor does not say is that the inflammation is not the cause of your problem, it’s a symptom. CAN ANYONE HEAR ME?

For the most part, athletes are dealing with potential side effects from single doses rather than chronic use. Though side effects are typically minimal in the short term, cortisone does weaken tendons at the site of injection, and ruptures have been reported.

Though recurrence is disappointingly common, injecting cysts with cortisone can be helpful. In the instance that the cyst does not return, tendon strength should return within several months. Be very careful about excessively loading the tendon early on (at about three to four weeks). Not only will the cyst have weakened the tendon, the cortisone will be whipping up a catabolic hurricane: brief but furious.

Cortisone is a very common active ingredient in dermatitis medication. The irony that corticosteroids (of which cortisone is one) were voted “Allergen of the Year” by the American Contact Dermatitis Society is testament that not everybody agrees with its widespread use.