On the beaches of Southern California, the odd-looking knobs that can be seen protruding just below the kneecaps and on the top of the feet of suntanned surfboarders are generally recognized as a status symbol, the mark of a practiced wave rider. The medical significance of the strange lumps is a knottier problem, and West Coast doctors are now seeing more and more evidence of such surf board trauma.
Flexed Feet. The Pacific off Southern California is relatively cold, averaging about 60°F. even in summer. A surfer may get uncomfortably chilled if he rides his board out toward the breakers in the traditional Polynesian fashion—lying prone while paddling with arms deep in the water. To a man, California surfers have adopted the kneeling position with feet flexed back, all their weight resting on the top of the shin just below the knee, the middle of the top of the foot and the top of one or more toes. After a week or two of paddling out and riding in, a surfer often develops tender knobs at these pressure points. Hawaiian surfers who still paddle out prone develop no knobs.
The first case of surfer’s knobs seen by Dr. Sheldon Swift at the Permanente Medical Group in Panorama City made a deep impression; the British-born dermatologist had never seen anything like them around the muddy Mersey, where he went to medical school. Dr. Swift reported in the A.M.A. Journal that the knobs were benign tumors, made up mainly of an overgrowth of the horny layer of the skin. They were not to be confused with the socially less acceptable housemaid’s knee, which is a bursitis. Dr. Swift saw no reason for surgical removal of the knobs. He noted that they usually went away after the first few weeks of the fall semester, when undergraduate surfers are landbound.
$15 a Specimen. Dr. Edwin A. Taylor of La Jolla diagnoses the knobs differently. He noted that in the early stages the knobs were movable and had a little bounce, so he expected them to be filled with fluid that could be drawn off to hasten recovery. When he cut into the knobs, though, he found cords of pearly white material, and he was afraid that he might have hit a misplaced tendon or nerve. Eventually, he decided that the white strands were an overgrowth of connective tissue, the deeper, fibrous layer between skin and bone. This might be more serious than an overgrowth of the horny layer, but it too will subside if the surfer stays off his board for four to six months.
Dr. Taylor has seen no sign that surfer’s knobs predispose to cancer or other serious disease, and there is one case that he has studied closely and anxiously for six years—that of his own 19-year-old son. With Dr. Walter R. Nickel he has been collecting specimens of knobby tissue for microscopic study by offering surfers $15 for a blob.
Though doctors generally see no cause for alarm about serious permanent damage from surfer’s knobs, California draft boards are becoming deeply concerned. The typical knob on the top of the foot makes it impossible for a surfer to wear high-cut G.I. shoes. The beachniks are beating the draft.
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