Running Podiatrists' First Aid Kit

Heel Pain Can Be a Calcaneal Stress Fracture!

2012-01-11T17:26:00.001-08:00

Not all heel pain is plantar fasciitis, you may have a calcaneal stress fracture!

Got Heel Pain? Give me a call!

How to Train for a Marathon or Race

2012-01-11T14:31:00.000-08:00

Dr. Peter Wishnie, an active runner, is also a podiatrist in Hillsborough and Piscataway, NJ. Dr. Wishnie just completed his first half marathon injury-free and in this video he describes how you can too. In order to have a successful race you need to make sure you have the right equipment, such as shoes and orthotics, but you also need a trained body!

Running Shoes 101: Things you need to know before you purchase your shoes.

2011-10-19T07:49:00.000-07:00

Things to consider:

1) Size of your foot: Let’s begin with your foot. Don’t assume that you know the size of your foot.
Have the running shoe store person (RSSP) measure you preferably towards the end of the day, when your feet are the largest from standing on them all day. Your toes should NOT reach the end of the shoes. You should be able to place your thumb at the end of your longest toe and the shoe should end there. If the shoe is any shorter, you will end up with blisters, hammertoes and black toenails. (More about those things in future blogs). When I say RSSP, I do not mean the sales person. I mean go to a certified running store that is owned by someone who runs and can fit you properly.

2) What is the shape of your foot? : Don’t guess about this. You probably will be wrong. Ask the RSSP or a qualified podiatrist or pedorthist to explain to you the shape of your foot in both the weight bearing and non- weight bearing positions. One of the most important things you have to keep in mind….The shape of the shoe MUST fit the shape of your foot. This is not negotiable!!!!

3) $$$: Money is important, but as a runner, you have chosen a relatively inexpensive sport. The only main expense is your shoes, unless you want to be a fashionista. Bad, inexpensive shoes can cost you more money in the long run, especially if you get injured. However, that being said, a good running shoe does not have to cost you and arm and a leg. The average cost of a good running shoe will be in the $90-$125 price range. There are a myriad of brands, styles and prices to choose from. Don’t be “lured in” by a name brand that someone else has told you about. This is only the beginning of your “shoe trek” and you want to keep all of your options open.

4) Be open minded. You should be more concerned with comfort and proper fit over style and color. This is a sport for you to maintain or a healthy life style. Worry about being fashion conscious at a later time.

5) Wear a comfortable, cushioned pair of socks. A sock with a poly/cotton blend is the best for everyday wear. Sweat wicking blends like Coolmaxx or Dry-weave are best for running. If you have a chronic fungal infection or itchy feet, you may like socks impregnated with silver or copper to decrease the fungus and bacteria collecting in between your toes.Leave the “thin nylon socks” for your dress shoes.

6) Lacing of the shoes: Not all of the holes in the shoes need to have the laces going thru them. Running shoes are made to be adaptable for the subtle and vast differences found in the human foot. Experience will dictate which holes to use and how snug to tie them.

7) Removable insole. This is not a negotiable item. If the insole is glued in, the shoes are usually of an inferior quality, regardless of the name brand or even the price you paid. Removable insoles will also allow you to easily insert your functional orthotics.

8) The modern day running shoe should feel great from your first few steps. However, this does not mean you buy a new pair of shoes right before race day. You should train with your new shoes for 3 weeks prior to your race, but start with your short runs and then build up your mileage.
I think this is enough information to get you started on the right foot in your search for the greatest and most comfortable running shoe.

Be open minded and if you take away only one idea from this blog that would be: The shape of your shoe MUST fit the shape of your foot! “

Does Your Calf Hurt When You Walk Or Run?

2011-10-05T08:17:00.000-07:00

Do you have an unusual amount of pain or discomfort in your calf or heel with any type of movement? Are you a runner or did you just start a new activity or job requiring a lot of time on your feet? If so, you may complain of a pulling pain when you walk or run and even while going UP stairs or a steep incline. The pain may also radiate up towards your knee and thighs. Some people may experience leg cramps with daily activities but also in the middle of the night.

These are the symptoms and activities consistent of someone who has a condition fcalled Achilles tendonitis. The “itis” means inflammation. So this in an inflammation of the Achilles tendon, which is the strongest tendon in your body. A tendon is a strong substance of fibers connecting your muscles to the bone and crosses a joint to allow for range of motion. Those with flatfeet develop a condition called equinus or an inability to fully flex your toes towards your nose. This equinus in flatfeet is due to the malalignment of the foot and the Achilles compensates for this by contracting or tightening up.

There are two main types of Achilles tendonitis – insertional and non-insertional. The Achilles tendon connects the two calf muscles (Gastrocnemius and Soleus muscles) to the heel bone (calcaneus). You have insertional tendonitis if the pain is directly on the bone in the back of the heel but if the area of non-insertional Achilles tendonitis.

This can also be associated with “heel spurs”. The body responds to the pulling of the tendon on the bone by creating new bone called a spur in the back of the heel. You may develop a bump in the back of your heel and shoes rubbing against it may aggravate this condition. This is why a lot of people with insertional Achilles tendonitis wear open-backed shoes or clogs so it doesn’t rub the bump. Podiatrists call the bump a “pump bump” or Haglund’s deformity. Those with non-insertional Achilles tendonitis may have a painful lump or large swollen mass in the tendon itself not involving the bone.

If left untreated, those with Achilles tendonitis can develop scarring, thickening and degeneration of the tendon called “tendonosis.” This is the chronic condition of tendonitis. This leaves one suffering from tendonosis prone to partial tears of the tendon and even acute ruptures of the tendon both requiring surgical repair for optimal treatment success.

So, if you have any of these symptoms do not treat it yourself. Simple stretching exercises will not alleviate your condition. In order to alleviate your condition, see your local foot and ankle specialist, whom is also a podiatric surgeon, to prevent this tendonitis from becoming a bigger problem requiring invasive treatment and months of recovery from the surgery. In addition to rest, ice, elevation, and compression, your doctor may prescribe an anti-inflammatory medication. Temporary heel lifts are also usually prescribed to offload the tendon to avoid the pull of the Achilles. Physical therapy is another treatment that is a necessity as it provides a formal program of rehabilitation and soft tissue mobilization. Once out of the heel lifts, custom orthotics are needed to maintain the new, lengthened, stretched out position of the tendon. Custom orthotics, not the over-the-counter kind, are a pair of devices always for both feet that you put in your shoes for functional restoration of normal foot and ankle mechanics and to stop excessive motion in your foot mostly from pronation or supination for those with high arches. The orthotics will correct the underlying cause of the tendon tightness. This can also help alleviate pain in other joints such as the knees, hips and even the back.

If you are feeling better but you still have persistent pain with all of the above conservative treatments, your doctor may order an MRI to further evaluate the integrity of the tendon to make sure there are no tears of the tendon. If your pain persists and no tear or rupture is present, then there are other non-invasive and minimally invasive procedures that can be done such as extra-corporeal shock wave therapy, laser treatment, radiofrequency ablation and cryotherapy.

So there are plenty of options available for pain-relief. They KEY is to catch this early and seek professional treatment as the longer you wait and the more active you are despite your pain, the more treatment it will take to get you better.

Top 5 Running Injuries

2011-06-06T07:40:00.000-07:00

Dr. Peter Wishnie of Family Foot & Ankle Specialists in Piscataway and Hillsborough, NJ discusses the top 5 running injuries amongst runners at the annual Hillsborough Hop 5K. Unfortunately, plantar fasciitis (heel pain) made the list.

National Running Day

2011-06-01T09:07:00.000-07:00

Today, June 1st, is National Running Day. Here in New Jersey, it is a beautiful day to run. I ran my six miles. Why do I run? I run for me. Running clears my head and makes me feel good. After a good run I am more motivated and creative and definitely in a better mood.

Besides the mental benefits, running keeps my heart strong, gets rid of excess fat and can make you a lean, mean, fighting machine. Today is a wonderful day to get a group of people together to run. Running with others will make the run easier and is also an excellent way to increase the bond of friendship with the people you like.

If you are not a runner and would like to start, remember to go slow initially. Maybe start with a fast pace walk and then run a little. Always warm up your muscles and stretch and make sure you stretch afterward your run. There are excellent books on running. I recommend a book titled, “If Your Running Feet Could Talk,” by Dr. Marybeth Crane. Go to: http://www.faant.com/reports/.cfm and get a copy.
Now, how about you? Why do you run? Let me know. Happy running.

Buried Alive and STILL on his Feet!

2010-11-07T18:54:00.000-08:00

Five hours, 40 minutes, and 51 seconds is how long it takes to run a marathon after training underground. Edison Pena was one of the 33 men who survived trapped underground in a mine for 69 days. He was known as “the runner,” because he filled the days underground by running through the mine tunnels and signing Elvis. Not even a dark hole of abyss stopped him from keeping his running spirit. What have you done lately?

It is all too easy to start making excuses to not hit the pavement, go to the gym, or attend your weekly yoga class. Are any of our excuses any good? The Chilean miner had only work boots, mining clothes, a bummed knee and dark tunnels and he found a way. What’s the secret to keeping up with the running spirit?
2 hours, 8 minutes and 14 seconds is how long it takes to win the New York Marathon. Gebre Gebremariam won the marathon while a former marathon champion Haile Gebrselassie announced retirement leaving the race after only 16 miles with an injury. Running professionals, these men make a living by concurring world records and finishing in times unfathomable by the hobby runner. Does it have to be your source of income to stay dedicated?

The first couple weeks of training are strenuous, mortifying, painful and agonizing, yet so many make it through with one goal in mind: finishing the 26 mile, 385 yard race. Nearly 45,000 runners had that common goal in New York City this year. Whether your goal is a marathon or a mile on the treadmill, it takes self motivation and determination to get to the end of your race. No one will do it for you and only you can get yourself there.

The Chilean miner stated he did this to motivate others. Hopefully he motivated you. The only way we can keep ourselves healthy and decrease the growing rates of obesity and diabetes is to become more heath conscious and active. There is a solid link between obesity and diabetes, heart disease and a number of other illnesses. Going to the gym or hitting the pavement is more than a hobby, it is a life saving activity. Every day I see patients who let go of their running hobbies because they got too busy. Not only did they lose an enjoyable hobby, but they also lost their health and are now trying 10 times harder to reverse the consequences of an inactive lifestyle. Let Pena, Gebremariam and Gebrselassie’s running accomplishments be your motivation to get up, get out, and run!

Common Running Pains & Injuries

2010-06-29T20:24:00.000-07:00

Aches and Pains of Running

Even with the best preparation, aches and pains are an inevitable result of a new jogging regimen. If the pain subsides with slow easy exercise, you may continue, but if it gets worse, stop the activity and rest. If it persists, see your podiatrist.

The most common pain associated with jogging is known as runner’s knee, a catch-all for jogging-related knee pain. One of the most common causes of runner’s knee is excessive pronation, or rolling in and down, of the foot. This syndrome is now often called the patello-femoral pain syndrome.

Orthoses (arch supports — shoe inserts) prescribed by your podiatrist are the best way to alleviate the problem. Occasionally, rubber pads in the arch of the shoe will help.

Shin splints, which painfully appear at the front and inside of the leg, are caused by running on hard surfaces, overstriding, muscle imbalance, or overuse. Treatment includes changing running technique or insertion of an orthotic device in the shoe.

Common Running Injuries

Plantar fasciitis (arch pain) — Arch pain is often caused by frequent stress on the plantar aspect, or bottom of the foot. When the plantar fascia, a supportive, fibrous band of tissue running from the heel to the ball of the foot, becomes injured, pain on the bottom of the foot results. Forefoot and rearfoot instability, with excessive pronation, may result in plantar fasciitis. Overtraining may contribute. Shoes with good midfoot stability may help prevent plantar fasciitis. If pain persists visit your sports podiatrist.

Heel spurs — Heel spur syndrome, related to plantar fasciitis, occurs after calcium deposits build up on the underside of the heel bone. Heel spurs form gradually over many months. Both plantar fasciitis and heel spurs can be avoided by a proper warm-up that includes stretching the band of tissue on the bottom of the foot. The soft tissue injury is usually the cause of the pain and not the spur itself.

Sesamoiditis — Sometimes referred to as the ball bearings of the foot, the sesamoids are a set of accessory bones found beneath the large first metatarsal bone. Incredible forces are exerted on the sesamoid bones during aerobics, and inflammation and fractures can occur. Proper shoe selection and custom orthotic devices can be useful in treating sesamoiditis.

Shin splints — Aside from ankle sprains, shin splints are perhaps the most common injury to the lower body, as the muscles attached to the shin bone bring the foot up and down. The pain is usually an inflammation of the shin muscle and tendon due to stress factors. Treat shin pain with cold compresses immediately after the workout to reduce inflammation. Proper stretching before the workout should prevent the onset of shin splints. Strengthening of muscles also helps reduce shin splints.

Achilles tendon and calf pain — The frequent rising on the toes of an aerobics routine often creates pain and tightness in the large muscles in the back of the legs, which can create pain and tightness in the calf and inflammation of the achilles tendon. Again, stretching the calf muscles gently and gradually before and after the workout will ordinarily help alleviate the pain and stiffness.

Stress fractures — Stress fractures often occur from overtraining. Make sure you gradually increase your running distance and intensity and have an adequate dietary intake of calcium.

Before beginning an exercise regimen, proper stretching is essential. If muscles are properly warmed up, the strain on muscles, tendons, and joints is reduced.

The foot is an engineering marvel consisting of 26 bones, 33 joints, 112 ligaments, and a network of tendons, nerves, and blood vessels all working together to establish the graceful synergy involved in running. Running requires balance, support and propulsion which all depend on the foot. Therefore, it is important to make sure your feet and shoes are in good working order before undertaking a serious running regimen.

A good start for someone just starting a training regimen is to examine your feet for anything that may seem irregular to you, such as lumps and bumps, skin irritations or discoloration. A podiatrist can perform a thorough evaluation and recommend any treatment if necessary along with shoe buying recommendations. Of course if you have any underlying medical conditions or have not been seen by a doctor in less than a year, a thorough check up is recommended before starting any training program.

TightRope Procedure

2010-06-17T10:51:00.000-07:00

Stop bunion pain today! New advancements in bunion surgery...
Dr. Vargas Performs New Tightrope Procedure for Bunions!!
Revolutionary procedure for bunions using a device called a tightrope. There is no doubt that this procedure represents a huge advancement in bunion surgery.

Traditionally, the bunion procedures I perform involve a bone cut to reposition the bone which is held together with a pin or a screw. Following the surgery, patients walk around in a cast boot for 4-6 weeks to allow for bone healing. With the new tightrope procedure patients experience a faster recovery, less pain and fewer complications. Patients are out of the cast boot and into regular shoes as soon as 3 weeks postoperatively.

While the tightrope procedure is not indicated in every type of bunion deformity, it can be performed in the vast majority. It represents a revolutionary change in bunion surgery and will allow more people to undergo bunion correction due to a faster recovery, less pain and fewer complications. This means fewer days missed at work or less down time with the kids – 2 of the main reasons many people avoid bunion correction.

Nail Fungus 101

2010-06-17T07:50:00.000-07:00

Nail Fungus 101:

How to Successfully Treat Onychomycosis

If you have ugly, thick, yellow, brittle nails, chances are you have nail fungus or Onychomycosis. You have probably tried several different products both medical and home made to get rid of this problem with little or no success. If so, you are not alone. Approximately 35 million Americans suffer from nail fungus, or Onychomycosis, and there are almost as many remedies to cure it. The problem is, there are only a handful of treatment options that have been proven successful in the treatment of this stubborn condition.

First, a little background on nail fungus or Onychomycosis. It is caused by fungal organisms that occur naturally in the environment much like the bacteria that cause colds. When it enters the body, it circulates in the blood and infects the nail matrix, which is where the nail originates. It then settles on the nail bed where it thrives and makes it way up into the nail causing the unsightly appearance that everyone associates with nail fungus. It grows mainly on the nails of the feet since it thrives in dark, damp, warm environments like the one found inside of shoes. Nail fungus can appear as a white, flaky plaque on the surface of the nail or it can make the nail thick, brittle and yellow. Occasionally the deformation of the nail can cause infection and pain, making nail fungus a serious medical condition, not just cosmetic. There are only 3 treatments that are used by podiatrists regularly that have been proven reasonably effective: topical and oral medications and laser treatment.

Topical medications, usually recommended for mild to moderate cases, come in the form of creams or polishes. They usually combine a traditional anti fungal with some type of nail softener to allow for penetration of the nail down to the nail bed, which is where the fungus lives. In addition, some products combine this with proven “natural” ingredients, such as tea tree oil and grape seed extract among others.

Oral antifungals are also used but are somewhat controversial because of the misconception that they cause liver damage. While rare, there have been instances where liver enzymes have become elevated in patients taking oral antifungals. However, this condition is easily reversed by stopping the medication. Therefore, it is necessary to do blood work before, during and after treatment to make sure liver function is not adversely affected and that it is prescribed to patients with normal liver function. Usual treatment course is one pill daily for 12 weeks and it is indicated in moderate to severe cases.

Finally, laser treatment is relatively new, and in my opinion, the best way to go. One 30 minute treatment is usually enough to kill the fungus no matter the degree of infection. Treatments are done in the office without anesthesia and rarely need to be repeated. For good measure, I also recommend applying a good topical antifungal polish 3-4 times per week as added insurance and to prevent recurrence.

As with any medical condition, if you suspect you have nail fungus, it is best to treat it as early as possible to have the best chance for a complete cure.

New Tightrope Procedure for Bunions

2010-06-09T09:25:00.000-07:00

Dr. Vargas Performs New Tightrope Procedure for Bunions!!

This past week I, Dr. Marco A Vargas of Foot & Ankle Associates, performed a revolutionary procedure for bunions using a device called a tightrope. While the procedure has been around for several months now, I felt that there were enough positive outcomes reported in the podiatry literature to feel comfortable enough to perform the procedure on my own patients. What makes the procedure revolutionary is that patients’ recovery time is half of what it is with traditional bunion surgery and there is significantly less postoperative pain due to no bone cut and less swelling. There is also a significantly reduced risk of postoperative complications due to the fact that there is no bone cut. There is no doubt that this procedure represents a huge advancement in bunion surgery.

Traditionally, the bunion procedures I perform involve a bone cut to reposition the bone which is held together with a pin or a screw. Following the surgery, patients walk around in a cast boot for 4-6 weeks to allow for bone healing. At this time they are able to return to regular shoes; however, postoperative swelling due to the bone cut, fixation and immobilization may limit their shoe gear choices for several weeks more. Although pain is mild to moderate for the first few days, it is usually well controlled with pain medication and physical therapy.
With the new tightrope procedure patients experience a faster recovery, less pain and fewer complications. Patients are out of the cast boot and into regular shoes as soon as 3 weeks postoperative. Because there is no bone cut made to reposition the bone, there is less swelling which means less pain and more choices of shoe gear sooner. Finally, should there be any complications due to the tightrope procedure, it is easy to remove making the procedure completely reversible so that there is no permanent alteration or deformity of the foot structure.
While the tightrope procedure is not indicated in every type of bunion deformity, it can be performed in the vast majority. It represents a revolutionary change in bunion surgery and will allow more people to undergo bunion correction due to a faster recovery, less pain and fewer complications. This means fewer days missed at work or less down time with the kids – 2 of the main reasons many people avoid bunion correction.

Forget The Pain, Running Injuries Can Be Depressing!!

2010-05-03T07:03:00.000-07:00

Earlier this year I treated a patient who ran the Houston Marathon and jumped right into training for the upcoming triathlon season the following week, against my advice, while nursing a painful case of posterior tibial tendon tendonitits. Unfortunately this approach eventually sidelined him and forced him to scrap the entire triathlon season in order to undergo surgery and recover from his injury. This eventually led to a major case of depression which far outlasted his recovery from injury and almost kept him out indefinitely.

By nature, athletes have an extremely high tolerance for pain and at times tend to view their injuries as a normal part of their training regimen often to the point of ignoring serious symptoms. Posterior tibial tendonitis is a common injury in runners usually resulting from chronic overpronation and overuse caused by the repetitive force and trauma asociated with overtraining. Symptoms usually begin as soreness along the inside of the ankle and/or arch when pushing off and can eventually lead to weakness and severe pain. Left untreated, it can progress to a tear which usually requires lengthy immobilization or surgical intervention causing a major delay in any training regimen. However, if the injury is caught early and treated aggressively, it can be done without any interruption or possibly a slight, brief alteration in the training schedule while avoiding a lengthy delay which can spoil any runner's plans.

In this particular case, my patient underwent approximately 8 weeks of physical therapy, anti inflammatories and forced rest. During this time he became discouraged, angry and unmotivated, even though I recommended cross training to maintain at least some level of fitness so that his return to running would not be so traumatic. He resisted the entire time and even admitted to feeling "worthless" at one point. Once he was pain free, he was still afraid to resume running for fear he would reinjure his foot and it would sideine him again.

About 3 months after stopping running completely to rehabilitate from his injury, he began cycling, swimming and using the elliptical machine gradually. More recently, he resumed running starting at a much reduced distance than where he left off, and he is starting to regain confidence and a sense of self worth.

He now realizes what caused his depression and I have no doubt that he will return stronger than ever. More importantly, I think the lesson he learned and one that all athletes should learn, particularly runners, is not to ignore any injury. No matter how small or insignificant you may think the injury is, it can become significant if it is not addressed early and aggressively. The resulting depression from the mental trauma of having something so meaningful and enjoyable taken away can lead to an even more prolonged layoff from which you may never fully recover, long after the injury has healed.

Running is my Prozac!

2010-03-24T11:13:00.000-07:00

I read a quote today that really outlines how I feel about running's goal in my life so I figured I would share:

"The secret shared by women runners: running is not just physical exercise but a spiritual, mental, and emotional journey. " Taken from Runner's Gazette

Running has always been my stress relief, my Prozac, and my outlet. A time that is all mine with an audience of God and nature.....and a few peeps from time to time. I hate the treadmill because I don't get my daily dose of nature, critters, and fresh air. Thank God it's spring!

Run Happy!

Five Items Every Runner Should Have On Their Holiday Wish List

2009-11-25T10:25:00.000-08:00

The holiday season is here yet again. With only a few weeks left before all the holiday madness begins it is time to start thinking about what to put on your holiday wish list for this year. If you are a runner or maybe just someone who will want to run off the extra holiday pounds below are 5 items that everyone will want to have on their list this year.

1) A new pair of running shoes - Let’s face it, running shoes tend to be one of those things many people push off replacing. Whether you are busy preparing for the holidays or if you are just really partial to one pair of running shoes, a new pair of shoes can really help to keep your feet and body injury free. Although experts vary on how often to replace a pair of shoes, a good standard to go by is to replace your shoes every 350 miles or six months, whichever comes sooner.

2) Moisture Wicking Socks - The best pair of shoes in the world won’t be nearly as beneficial without a good pair of moisture wicking socks. Although it may seem extreme to have to pay $5 for a pair of specialty socks when you can get a 5 pack of cotton socks for the same price, socks are one thing you don't want to skimp on. They help keep your feet and toes stay dry in order to prevent blisters from forming.

3) Nike Fit - I really have to hand it to Nike because the Nike Fit is an extremely helpful tool for runners of all skill levels. This device allows you to track your runs, pace, and states of each workout through a chip in your shoe that can later be downloaded on to your computer to monitor your runs. If Nike isn’t the right shoe for you, there are adapters you can purchase to use the technology with other brands of shoes.

4) Running Utility Belt - If you have ever run a long distance race then you have probably seen those people with the belts around their waist that have little pouches to held various items. This is a great item for people who are long distance runners. The belt is ideal to hold little bottles of water, gel food packs or even your keys or cell phone.

5) Road ID - Although this last item may seem a bit much it is one of those things that it is better to be safe than sorry. A Road ID is an identification bracelet that runners and cyclists wear in case of an emergency so they can be identified. Accidents happen every day between athletes and automobiles, Road ID is a simple way to protect yourself in case anything were to ever happen to you while you are out on a run.

With the holidays being right around the corner don't forget to add these 5 items to your wish list this year so that you can have the gear you need to run off all those extra holiday calories.
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Playing Sports Does Not Have to Mean Getting Hurt!

2009-11-19T08:00:00.000-08:00

Sports Injuries of the Foot and Ankle

Sports injuries of the foot and ankle generally fall into one of two categories: (1) Acute/Traumatic Injuries which occur due to a sudden force, or impact, on the foot or ankle, and (2) Overuse Injuries which result from overuse, lack of proper rest, lack of proper warm-ups, or poor conditioning.

But playing sports does not have to mean getting hurt. Warming up adequately, training effectively, using proper equipment for your sport, and recognizing and addressing the early warning signs of injury can reduce your risk of aches and pains.

The following is a list of some of the most common sports-related injuries of the foot and ankle:

Baseball—blisters, ankle sprains, muscle strains, stress fractures

Basketball—ankle sprains, Achilles tendonitis

Bicycling—Achilles tendonitis, plantar fasciitis, blisters

Dance—ankle sprains, dancer's fracture, sesamoiditis, plantar fasciitis, metatarsalgia, Achilles tendonitis, trigger toe

Football—shin splints, ankle sprains, Achilles tendonitis, turf toe, blisters

Golf—plantar fasciitis, stress fractures, blisters

Running—ankle sprains, Achilles tendonitis, blisters, plantar fasciitis, IT band syndrome, patellofemoral pain syndrome, piriformis syndrome, shin splints, stress fractures, muscle cramps

Skiing/Snowboarding—frostbite, muscle strains, ankle sprains

Soccer—ankle sprains, Achilles tendonitis, IT band syndrome, muscle cramps, blisters, patellofemoral pain syndrome, plantar fasciitis, shin splints, stress fractures

Tennis—Achilles tendonitis, ankle sprains, IT band syndrome, Achilles tendon rupture, stress fractures

Volleyball—Achilles tendonitis, Achilles tendon rupture, ankle sprains

While it is impossible to prevent every injury, research suggests that injury rates could be reduced by 25% if athletes took appropriate preventative action, including the following: be in proper physical condition to play a sport, play by the rules of the sport, wear appropriate protective gear, rest, warm-up, and avoid playing when in pain or when tired.

Just a few extra words about running:

Running is one of the easiest ways for athletes to get injured. Running injuries are common and often affect the ankles and feet. The impact and stress of running is sometimes hard on the muscles and joints, especially if the early warning signs of an injury are ignored. The best way to avoid running injuries is to prevent them using tips such as these:
· Stretch, stretch, stretch!
· Wear Proper Footwear
· Replace Shoes as Needed
· Warm Up Properly
· Cross Train
· Avoid Overtraining
· Follow the Ten Percent Rule

A podiatrist can recommend the proper running shoe for your foot type. If you're not sure which shoe is right for you, consult your podiatrist.

The Nike Free Running Shoe

2009-11-11T20:46:00.000-08:00

Nike has developed a line of shoes called the Nike Free that has become very popular among long distance runners, track and field athletes, and football and basketball players. Nike Free is unique because it has a special design incorporating new technology that simulates barefoot running mechanics while still wearing shoes. The goals that barefoot running technique strives to reach, and that Nike Free has adapted, is attempting to strengthen the intrinsic muscles of the foot and leg thus preventing long term injuries.

Although Nike Free has become popular among runners there are some important things to take into consideration when deciding to buy these shoes or not.

1) Versions - If you do a little research on the Nike Free you will come to find out that there are actually many different versions of this shoe. The Nike Free can be ordered on a scale of 10.0 to 3.0 with 10.0 being the most supportive shoe and the 3.0 being the least supportive and most similar to barefoot running.

2) Ease into the Shoes - If you have never done any barefoot running, or ran in any minimalist shoes that strive to achieve the same goal as Nike Free shoes, then it is important to ease your way into these shoes. It is recommended to start off running a mile in these shoes and then gradually increasing your distance based on your body’s response to the shoes.

3) They aren't for everyone - Although Nike is continuously trying to find ways to make small changes and adding versions to the Nike Free to allow the largest population of runners to use them, these shoes still aren't for everyone. If you don't run consistently, need extra-cushioned running shoes, or are prone to ankle sprains, I would not recommend these shoes to you. The Nike Free is really built for routine runners with no other major foot problems. Furthermore, barefoot-style running requires significant changes in running mechanics to be successful. If you run in these shoes just as you would in a structured running shoe, you will put yourself at risk for becoming injured.

Nike Free technology has really changed the face of running shoes, opening a whole new vision into what running shoes could do for your feet and body. Although these shoes are becoming increasingly more popular in the running community, these shoes simply aren't for everybody. Be sure to visit with your sports podiatrist who can help recommend the right shoe for you.

Should You Change The Way You Run For Greater Speed?

2009-11-09T16:17:00.000-08:00

In one study quoted all over the internet, it was found that long-distance runners were faster if they used forefoot or midfoot strike patterns. People were encouraged to speed up their running by changing the pattern of running. Newer studies have made these findings less clear...

According to Joseph Hamill, PhD, a professor of kinesiology at the University of Massachusetts at Amherts, which found some mild differences to the running patterns. They even found that midfoot running took slightly more energy than rearfoot running. But even more importantly was the findings that midfoot or forefoot runners should not change their running patterns to rearfoot running, as it would not be as efficient. It was recommended instead that you continue the natural pattern. Let me explain:

- If you are a rearfoot runner or a midfoot or forefoot runner, you will get more benefit from adjusting your running efficiency by correction of your stride length and arm motion.
- Correct shoegear to allow highest quality of running pattern will also increase efficiency.
- I would agree with the findings of the study that it is "better to just do what's normal for you."

Run smart and run fast. Just remember that you can do it the way your foot functions without learning a new way to run.

How To Run Smart...Even In the Cold

2009-10-30T12:50:00.000-07:00

It is only October, but the snow has already fallen a couple times (luckily it hasn't stuck around) and reminds me of the special risks that come with winter running. In a state like Utah, we often need to consider running in snow or ice conditions. I just wanted to make a quick note about the options available:

1. Treadmill Running
Although I dislike this type or running, because part of the joy of running for me includes running in nature, a very snowy or icy day is not worth the risk. I will often run on a treadmill to limit slips or falls that may cause injury that will interfere more with my running. This can also be an option for rainy days or days with significant wind. I don't do this often, but it allows training to continue.

2. Indoor Tracks
A good option on a bad day may be indoor running on a track. Many exercise facilities will include a track. This provides an opportunity to do speed work, like sprinting fixed distances. If I am scheduled to run a distance, not speed work, I would rather run on a treadmill than run around a track 1000 times. (Note: Indoor tracks are typically smaller than the tracks utilized at High Schools or Colleges).

3. Specialized Equipment

By utilizing the correct equipment to stay warm to the trunk without increasing bulk and to add traction to the shoes, running can be done even outside in the winter. Some possible traction options include:

•STABILicers SPORT

•Kahtoola MICROspikes

•Yaktrax Pro

Other important considerations include staying hydrated as the cold can be just as problematic as the warmth.

I invite you to continue to run and enjoy the running that can come with running smart.

How Weather Conditions Affect Running Performance

2009-10-20T09:00:00.000-07:00

If you are an outdoor runner you certainly have noticed that the weather can dictate how well you feel during your run. You may be surprised to learn that your performance during a run or race is directly related to the weather. The "perfect running temperature" has been scientifically debated to be somewhere around 50-54 degrees!! Most people begin to slow after 55 degrees and can really "hit the wall" if the temperature rises above 65 degrees while racing.

For people who live in chronically warmer states, such as we are in Houston, TX, it is essential to try and get your runs done in the early in the morning or later at night in order to avoid the heat of the day. However if you are stuck running in the hot weather, there are a couple of things to keep in mind. First, the hotter it is the more your body must work to cool you down by producing sweat. Sweating takes up energy, causing you to tire more quickly and lose fluids and electrolytes more rapidly, making it essential to replenish your fluid levels during and after runs. Increased heat also causes your feet to become moister in your shoes which can cause blisters. Make sure that on hot days you are wearing extra moisture-wicking socks to prevent your feet from blistering.

Besides the temperature, another weather factor that can impact your performance is rain. How rain impacts performance really depends on the amount of rain. If there is a light drizzle coming down on you while you run then the cooling effect of the moisture on your body can actually help enhance your performance. If the precipitation is more extreme, leading to conditions where you are getting totally drenched, then your performance is going to be hindered for a couple of reasons. First, your performance suffers during heavy rain because, whether consciously or not, you run more cautiously in order to prevent slipping on the wet surface that you are running on. Also, heavy rain can get your clothing so wet that you can develop blisters very quickly which can become painful. Some of the most common places to develop blisters from rain are on your feet, between your thighs, and around a woman's sports bra.

Although Mother Nature is not so kind as to provide 53 degrees cloudy running weather every day, there are some ways to make sure your run goes as smoothly as possible for the conditions that you face while running. The easiest way to make sure that the temperature does not negatively impact your performance is to plan ahead and anticipate any obstacles that the weather may provide.

Dancing With the Stars: Another Foot Injury?

2009-10-14T10:00:00.000-07:00

What doe this have to do with running? A lot, if the training before a race or before a dance performance is not done properly.

Donny Osmond is the latest in a series of injuries from the reality show "Dancing with the Stars." He was dancing this week with a broken toe. A fractured toe can be quite painful, depending on the location, angle, and severity of the break in the bone(s). I speak from personal experience on this injury. I fractured one of my toes while I was a surgical resident and had no choice but to work, walk on it, wear closed toe shoes, and stand on it for prolonged periods of time. However, I did not continue to run or dance or engage in other sports for the weeks that was required for it to heal.

But...there seems to be a trend on this show with injuries and the stars continuing to dance and perform while injured. We saw this in the past few weeks with Tom DeLay who continued to dance on stress fractures in both feet until it got to the point where he had to quit the show...eventually. Other previous foot & ankle injuries included Misty-May Treanor with a ruptured Achilles tendon, Lance Bass with a toe fracture, and Kristi Yamaguchi with an ankle injury.

This is similar to what us physicians see with "weekend athletes" or runners to try to do too much, too soon. Proper sports training is just that--training. If an athlete is a beginner, such as these celebrities, with respect to a particular sport, then a gradual and incremental training process in necessary to prevent injury. If this does not occur, injury is more than likely to happen. So it is not surprising to me and many of my colleagues that these stars are getting injured at such a high rate. Perhaps the medical professionals associated with the show could point this out to the show executives and try to do something about it...or perhaps we will continue to see another series of injuries in upcoming episodes.

What do you think? Feel free to comment below on this possibly controversial subject. In my professional, medical opinion, it is quite obvious what will occur if changes are not made in the show's training schedule.

Stress Fractures in Runners

2009-10-07T09:46:00.000-07:00

A stress fracture is a small incomplete crack in a bone that is due to repeated stress in an area in the body. 95% of stress fractures develop in the lower extremity and account for 10% of all running injuries. Stress fractures are a common injury in runners because of the repeated motion that runners go through over thousands of steps. Stress fractures commonly occur in runners when they have too many miles on their shoes, change the surface they run on, or change the intensity level of their workout.

The symptoms of a stress fracture are tenderness over a localized area, pain when you put weight on the affected limb, and slight swelling around the area. Runners who are most prone to getting stress fractures are women with amenorrhea (loss of menses) because of the role estrogen plays in strengthening bones, thinner athletes, and people who are not getting the proper nutrients to replenish their bones.

It is important as a runner to make sure that you are getting the proper nutrients to keep your bones strong in order to avoid developing stress fractures. It is recommended that you get 1000 mg of Calcium per day and 200 IU of Vitamin D per day, as well as maintaining a Body Mass Index (BMI) of at least 18.5 or higher and a body fat level of at least 14%. All of these factors will help insure that your bones have the right nutrients to sustain themselves even through daily running stresses.

If you think that you may have a stress fracture then the first thing to do is to decrease the amount of exercise you are doing. It is also important to go see your doctor or podiatrist so they can take an x-ray of the site. X-rays are not always able to detect a stress fracture and a bone scan may be required. Although stress fractures can be frustrating to an athlete who is in training, it is important to listen to your doctor’s instructions to modify your workout routine or you may create a more severe injury that may require surgery and more time away from your sport.

Are Your Legs Different Lengths?

2009-09-25T15:05:00.000-07:00

From early in the development process, the body's two halves develop independently. As they develop, usually they will be very similar and almost identical. But since they are independent, each individual has eyes that are different sizes, nostrils that are different sizes and ears that are different sizes. This difference can also be seen in different size feet and legs. In many individuals this may be without problems, but in a runner this matters.

Which foot is larger?
- When fitting shoes, ensure that you know which foot is larger and fit that foot especially. A shoe that is too small (even for one foot) will predispose a runner to more injuries from loss of toenails, to ingrown toenails, to blisters and even stress fractures. Check your feet and fit both feet to the shoes, especially the larger foot.

Which leg is longer?
- If the leg length difference is only minor, you will often not notice any difference and can continue to run without difficulty.
- If one leg is longer, it is important to understand this and modify your training as necessary. Do you need a heel lift to even the legs and reduce the pronation force on the shorter leg? Do you need to switch sides of the road you run on so the longer leg is on the down side of the road? Is the pain you currently have when running due to the leg length difference.

Although these differences are normal, injury and pain can be the result of not recognizing even the smallest foot or leg length differences.

For additional information on leg length differences, visit Dr Gibson's blog at www.UtahRunDoc.Blogspot.com or his website at www.UtahFootDoc.com.

How do I begin to train for my first marathon?

2009-09-21T11:45:00.000-07:00

This is a question that comes often in our office, so here are a few things to keep in mind:

Running a marathon requires both physical and mental strength, focus, commitment, and time. If you do take this step and make the commitment, you will find that completing a marathon could be one of the most satisfying experiences of your life.

Getting Started:
*Training to run a marathon will test your physical limits and stretch the boundaries of your endurance. Before you hit the pavement and before you purchase equipment, you must first formulate a plan and educate yourself on all aspects of marathon training. It is similar to planning a trip. Once you find out where you want to go you have to figure out how to get there. Give yourself at least 6 months of training to get there.
*Set a date. Find out when the next marathon in your area will be by checking a marathon calendar or a marathon guide.
*Start running regularly. It will be extremely helpful to have your body used to running when you start a 16-week training program.
*If you haven't exercised in some time, allow yourself more time to train and try an 8-week conditioning program. Listen to your body. Your body might adjust quickly, or it might take a little longer to be ready for the marathon training program.

Invest in the proper running equipment:
*Running shoes are the most important purchase you will make on your quest to successfully train and participate in a marathon. You will be putting more miles on them per week than all of your other shoes combined. The right shoes will alleviate stress in your legs and back. Before you visit a running shoe store, check with your podiatrist to see what it is that YOU need in a running shoe. Is it stability, cushion, motion control, or would you be best off with a light weight trainer? Your podiatrist can help you with this by evaluating your foot type and your gait pattern.
*Having the right running clothes isn't as important as having the right shoes. However, you must know what type of clothes to avoid and what clothes can aid you while you train.

Preventing Injury:
*Once you begin your training program, injury prevention will be of utmost importance! Stretching, warm-ups, proper training, and nutrition will all come into play during your training in order to prevent running injuries.
*If you do experience pain in your feet or ankles while running, it is very important to visit your podiatrist right away to diagnose the problem and get proper treatment. Don't make the mistake that many people do when they think "it will go away eventually."

The Stink in Your Feet!

2009-08-08T09:11:00.000-07:00

Are you embarrassed about the stank that comes from your feet. Do your husband’s feet stink? What about your children’s feet, especially your young athlete? Stinky feet have been plaguing man kind since the stone age! Thus, you can only imagine all of the home remedies. I once heard of one that consisted of soaking your feet in 7-up then barbecue sauce and then finishing off with a blow dryer. Sounds ridiculous to me but some people swear by it! So, what is it that instigates that odor and how do you really get rid of that smell?

The number one reason for stinky feet is perspiration. Your foot has many sweat glands on the bottom of the foot. Some people have more than others. It is just like the rest of your body. Some people just sweat more than others. It is estimated that there is over a quarter of a million sweat glands in your feet. So when your body heats up it releases heat via sweat from sweat glands.

Warm wet areas are a haven for bacteria. The bacteria live, reproduce and feed off of the foot, shoes and socks. The bacteria produce chemicals that cause an odor. Thus stinky feet are actually caused by bacteria!

To treat stinky feet we have to tackle the root of the problem: the sweat. The first line of defense is to wash your feet at least twice a day! Changing your socks to a dry pair in the middle of the day will also cut down on the bacteria because they need a warm, moist place to grow. It is also recommended to wear sandals often in the warmer months to allow your feet to breath. When choosing what shoes to wear, try to stay away from black shoes. Chose shoes that are lighter colors and that has a lot of mesh compared to all leather. It is also strongly recommended to never wear the same pair of shoes two days in a row. This allows the shoes to dry and eliminate some of the stinky bacteria. Sometimes, these precautions are not enough or are impossible because of work or lifestyle restrictions. So then what?

There are products that can help dry the foot and decrease the sweat. These products must be recommended and monitored by a podiatric physician. There are different products for adults and children and thus you should never use products you receive for your husband on your children. Other products that a doctor can provide you with is anti-fungal and/or anti-bacteria powders. It is common for people with sweaty feet to acquire athlete’s foot and toenail fungus. What starts out as stinky feet can quickly turn into ugly feet!

There is a negative stigma with stinky feet. No one wants to have them, no one wants to marry them, and no one wants to give birth to them, but sometimes stinky is just the way they come. Well, it is not as doom and gloom as it sounds. There are a number of simple treatments and other more advance treatments that decreases the stinky stigma and the chances of athlete’s foot and toenail fungus. I don’t know about you, but I think talking to your podiatrist about your or your family’s unfortunate smelling problem is worth a shot!

Training for a Half Marathon

2009-07-27T08:33:00.000-07:00

Half marathons are a very popular length race to run. For those runners who are well trained, hard-core athletes the half marathon has its appeal because it can help train them for a full marathon. Many training schedules include a half marathon as one of its long runs in order to help get an athlete in prime condition for a marathon. In fact some marathons will even take half marathon times for qualification for a starting corral.

For other runners who are maybe just getting into running, very young or very old, or people who don't have as much time to train, a half marathon has an appeal for an entirely different reason. For the beginners a half marathon is seen as a reachable goal. Many new runners may be overwhelmed by how far a marathon is, but the option of running a half marathon seems to be a much more feasible, yet still respectable goal. For those people who fall into the category of being very young or very old, a half marathon is a popular option to prevent them from getting injured by attempting to run a full marathon.

Whether you are the well trained athlete, the beginner, or on either end of the age spectrum there are some things about training for and racing a half marathon that apply to all runners. First, always pick a training schedule that is right for your experience level. There are many free training programs out there that range from beginner to expert. It is important to use these schedules in order to know that you are not over working your body too quickly and making sure you get the right amount of rest that your body requires to replenish its essential chemicals. Second, it is important to always stretch before and after each run to help prevent injuries from occurring. Third, remember that the more that you run the more you must eat and drink to compensate for the extra calories and sweat you’re burning. Lastly, make sure you have a good pair of running shoes that give you the right stability and support you need to sustain the number of miles you will run throughout your training and race.

Half marathons are a great length because they allow people of all running abilities to participate. As long as the runner follows a training schedule, stretches, and takes care of their feet they will have a healthy and successful race.

Sports Injuries

2009-07-23T15:37:00.000-07:00

Warning Signs You Don't Want to Ignore:

Joint Pain:
Joint pain, particularly in the joints of the knee, ankle, and foot, should never be ignored. Because of the anatomy of these joints, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a physician's diagnosis.

Tenderness at a Specific Point:
If you can elicit pain at a specific point in a bone, muscle or joint, by pressing your finger into it, you may have a significant injury. If the same spot on the other side of the body does not produce the same pain, you should probably see a physician.

Swelling:
Nearly all sports injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may just feel as though something is swollen even though it look normal. Swelling usual goes hand-in-hand with pain, redness and heat. Swelling within a joint often causes pain, stiffness, and may produce a clicking sound as the tendons snap over one another after having been pushed into a new position from the swelling.

Reduced Range of Motion:
If swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion -- the limb will only go so far in each direction. Again, compare one side of the body with the other to identify major differences; if there are any, you likely have an injury that needs attention.

Comparative Weakness:
Comparing one side to the other for weakness is often hard to do, but can be helpful when assessing an injury. One way to tell is to lift the same weight with the right and left side and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another tip-off to an injury that requires attention.

Numbness and Tingling:
Never ignore numbness or tingling. Such sensations are often related to nerve compression, and these warning signs may indicate serious injury that should always be seen by a physician.

Walking for Cancer: How to Save Your Feet!

2009-07-05T05:34:00.000-07:00

Throughout the summer and into the fall, many hit the city streets to walk for breast cancer, arthritis, and many other devastating medical conditions. If you have ever participated in a Breast Cancer walk, you know the emotional drive behind finishing the race for yourself, and loved ones. Nothing stands in the way of a herd of women and men in pink. Well, maybe foot pain. Many of these walks are 20+ miles a day and for most of us, we don’t normally put that kind of millage on our feet. Even if you are an avid runner, walking applies different kinds of forces on your feet compared to running so don’t be surprised if you have some aching feet. Is there anything to prevent the blisters, aches, and pains during and after the walk? Here are some helpful hints to prepare you for your walks against cancer!
Train, train, and more training!
You may think that walking doesn’t take too much training, but it does! Just as marathon runners prepare for the big race, walkers should train for their big walk. Some walks are 50+ miles long. When was the last time you put that kind of mileage on your body? The best way to prevent injury is to build up your body’s endurance and appropriate muscle support. Walk daily and slowly increase the distance daily and weekly.

Don’t Forget Your Shoes!
Most walkers wear the wrong size shoes which can cause blisters, loss of toenails, and aches and pains. Proper fit is one of the most important factors in finding the correct shoes for your walking adventure. Make sure you try both shoes on and walk around in them before you buy them. While standing (not sitting) you should have about a fingers width between your big toe and the end of the shoe. Make sure the shoe is wide enough. You should be able to freely wiggle your toes inside the shoe. Buy your shoes several months before the walk and train in them. Never wear brand new shoes on a long distance walk.

Grease Up!
Most walkers get painful blister! Luckily, there are ways to prevent these fluid filled monsters! Vaseline or products such as Body glide decrease the friction of your skin with your shoe and sock. Applying such products to “high risk” areas of your feet will decrease the chances of a blister. Apply the product regularly along your walk or when you feel a blister coming on. If you have a blister, seek help at a medical tent. They can pop the blister and provide padding to relieve the pain.

Don’t Ignore the Pain!
There is so much emotion and drive in these walks that people stop listening to what their body is telling them. If you are experiencing pain, there are medical professional at every pit stop to help you. Something as silly as a blister can be cared for and you won’t have to stop walking, but some pains may be serious. Drinking lots of fluids and paying attention to how often you urinate is very important. Dehydration is the most common complication on these walks! If you want to finish the walk it is best to address your aches and pains on the way so you don’t end up with a more serious problem!

Enjoy Yourself
No matter what you are walking for or who you are walking for, remember to embrace the experience. You are making a statement for you community and the ill across the nation. The walks are long and hard, but stay positive and focused on the real meaning and purpose of this community gathering. WALK ON!!!

Marathon Training: The Week Before Race Day

2009-06-25T09:44:00.000-07:00

Running a marathon is no easy feat. It takes months of preparation and dedication. After this long preparatory process it is important to take the final steps the week before the race to make sure you are maximally prepared to take on your marathon. Here is a day by day schedule of what you should be doing to prepare the week before the marathon.

Monday - Rest day. Do not run today since you probably have done a 4 mile run the day before, but make sure you still stretch out well and stay hydrated.

Tuesday - Run 3 miles today. Make sure you stretch before and after your run and drink plenty of fluids throughout the day.

Wednesday - Run 4 miles today. Stretch out well today and stay hydrated. Plan out how much time you are going to need to get to the race and decide if you are going to drive or take public transportation. You do not want to be stressed out about these details the morning of the race.

Thursday - Rest Day. Do not run today but make sure you still stretch out your muscles to prevent them from getting too stiff. Don't forget to hydrate well today.

Friday - Rest Day. Do not run today. Check the weather to see what to expect on race day. Make sure you have the proper shoes, socks, and outfit for the weather. Don’t forget to stretch!

Saturday - Run 2 miles today. Make sure you take it easy on this run. The whole point of this run is to get your muscles moving the day before the race. Stretch out well before and after the run to make sure that you will not be stiff for the big race tomorrow. Have a hearty dinner filled with high protein and carbohydrates such as spaghetti and meatballs.

Sunday (Race Day) - Make sure you eat before the race. Don't eat anything that you normally wouldn't before a race. Some good choices are oatmeal, a bagel and cream cheese, or a cereal with fiber and whole grains.

The week before a marathon is the time that you make sure that you are hydrated for your race and have eaten the proper foods so that you have enough fuel to run 26.2 miles. Be sure you have tapered and stretched enough that muscles are rested and ready to run. If you follow these simple steps the week before the marathon you will complete your marathon training and ensure a successful race.

Walking Safely for a Cure

2009-06-10T08:58:00.000-07:00

There are many walking fundraiser events these days that truly tests a person’s endurance. The Houston area hosts several of these events every year. One of the most popular examples is the two and three day breast cancer walks in which you can walk the distance of almost two marathons. The way most of these events work is you walk all day, sleep in a tent overnight, and then get up the next morning to keep walking. While causes like breast cancer really strike a cord with people there are a couple of things that people must keep into consideration when taking on a challenge like this so that they can prevent getting hurt.

1. Listen to your body, not your mind:
Many times when people are walking or running for a cause they get very emotionally involved in their drive to finish the race. It is important to listen to your body. If it hurts, stop!! Just because you don't finish a race or event does not mean you are letting someone down or that you don't care about the cause.

2. Just because you are a runner doesn't mean you are a walker:
There are many runners out there who attempt to do one of these long walks and find themselves more sore then after they run…this is natural. Walking uses different muscles than running, so it is like your body is starting a new exercise routine that it is not used to.

3. Don't be afraid to stop for aid:
At all of these events there are always medical and podiatry tents to care for race-day injuries. One of the most common injuries seen when walking long distances is blisters. If you stop at a podiatry tent, there are many trained medical volunteers who are there to help drain your blisters and bandage you up so that the rest of your race will be more comfortable. It also prevents further trauma that can cause infection.

Walking for a cure is one of the most emotionally gratifying things you can do. Just make sure that if you attempt a walk with a distance longer than you’re used to that you know what to expect. Listening to your body and stopping for help if you need it, even if you are an experienced runner, should not be a blow to your athletic psyche.

Exercise Doesn't Boost Metabolism?

2009-05-26T07:49:00.001-07:00

There goes my theory that I can eat whatever I want and just run more! I even have a t-shirt that says, "Do I eat to run or run to eat?" A new study just published refutes the theory that exercise boosts your metabolism and makes you into a fat burning machine. Too bad....guess I'll have to work on that diet if I slow down. Don't get me wrong, they didn't say you don't burn more calories or feel better with exercise. What they cited is that you don't necessarily burn more fat. Perhaps this is why I know more than a few people that train for an Ironman and still have a beer gut! To read the entire article, click on the link below....time for the old calorie counter...ugh! Does this mean no more bagel and a beer after a long run?

"Exercise not likely to rev up your metabolism
Studies bust myth that working out gives you a fat-burning boost"

"The biggest thing standing between you and your next PR is injuries"....Be proactive, not reactive! click here to purchase Dr Crane's new book on running injuries!

Here Comes Summer...Runners Beware

2009-05-20T11:42:00.000-07:00

As the Houston summer quickly approaches, so do those long summer days with the scorching hot sun and humid conditions. If you are a runner this means that you are going to have to prepare yourself to bear the heat if you want to keep up the pace during the summer months. One of the most important aspects of running, no matter what time of year it is, is staying hydrated. I can still remember my high school cross country coach telling the team that training doesn’t end when you leave practice but continues with everything you put in your body because this will affect your run tomorrow and the next day. He would say that you can tell if you are drinking enough water if you are urinating clear. Back in those years I thought this was a silly analogy to be teaching high school students but thinking back on it now it was actually a very clever way to tell if I was truly drinking enough fluids to keep up with the toll I was taking on my body with each run.

There are many other ways to make sure you stay fully hydrated during hot and humid runs. Many runners choose to wear camelbacks, because they are relatively lightweight and don’t require you to stop if you want a sip of water. There are also many fuel belts on the market that allow runner to wear a belt that holds containers for water or juices.

It is important to consider that sometimes water is not the best choice in hot circumstances because you are not merely losing water when you run but also essential electrolytes. Alternatives such as Gatorade, Vitamin Water, and PowerAid are great products that help to keep you hydrated and replenish your electrolytes.

When you run in the heat you also sweat more. Make sure you wear socks that are made out of a material that can wick the increased perspiration away from your feet. If you wear cheap cotton socks you will have a greater risk of developing blisters.

However you choose to help quench your thirst and dodge the heat while running in the summer months always keep in mind that you must be especially in tuned with your body during this time. Don’t push yourself to hard. If you start feeling heat cramps, dizziness, or lightheadedness coming on stop immediately and seek shade and water.

Join National Running Day on June 3, 2009

2009-05-16T09:30:00.000-07:00

Running is one of the most popular means of exercise around. The reason is, it's easy and accessible! We have our feet, there's road outside our door...all you need to do is step outside. National Running Day is a national initiative whereby many of the major organizations within the running industry are joining forces in an unprecedented unified effort to nationally and locally promote running.

There will be cities around the country hosting organized runs for all ages and levels. Houston, TX is definitely a participant and the Chevron Houston Marathon is a sponsor. If you do not live in or near a participating city, that's no problem! Just go outside and run!

Don't run alone either!! Run with your husband or wife, boyfriend or girlfriend, fraternity or sorority. Run with your kids or run with your parents. Run with your dog (dog's love to run with you.) Run around your block, go to a park and run, or run on a high school track. It doesn't matter where...it doesn't matter with who...just get out and go!

For more information, visit http://www.runningday.org

Running Uphill Correctly

2009-05-12T08:05:00.000-07:00

I was talking on Sunday with a runner who is training for the Wasatch Back Relay and has been running without difficulty for months. Recently she has been runnning hills and is trying a new hill running technique taught at the local Rec Center and has started having leg pain (shin splints). To help others avoid overuse injury while running hills, I will give my recommendations for hill running:

1. Run hills utilizing the same energy as on flat ground. Instead of "attacking" hills, I recommend running at the same energy expenditure, meaning slightly slower with shorter steps. This will allow you to reach the top of a hill without being short of breath and permit you to return to your pre-hill speed (often passing many runners that overexerted on the hill).

2. Use proper running technique. As you run, arms should swing at your side toward the front and back. Never allow arms to swing across the body as this reduces efficiency of running and interferes with proper swing of the legs. Legs should move straight forward (not to the side, not crossing).

3. Arm swing should be shorter and lower. By less aggressive arm swing, you are keeping the legs closer to the ground allowing better propulsion up the hill.

4. Break hills into reachable mental goals. A majority of hill running is mental (as is most running) and setting short goals helps keep you moving up the hill. I break hills into little sections and countdown the sections as I complete a long or difficult hill.

Uphill running can be a great addition to any running program, and can provide you with an edge when racing. Run smart and keep running...

What Should Be In Your Training Bag? Newbie Running Tips

2009-05-08T18:35:00.000-07:00

This is an excerpt from Dr Crane's book "If Your Running Feet Could Talk!"

The greatest thing about running is the low "getting started" cost, but here are a few things that are essential if you want to progress to distance running and competing or just want to avoid injuries. Your training bag is your best friend, so what should it include?

1. Road ID. I made this first because it is so important and often forgotten. You need some type of ID on your body for the one time you pass out, get hit by a bus, or just fall off the curb and hit your head. If you think it doesn't happen, read the papers. One year at the half-marathon in Dallas, several runners got hit by a car on their way back to their cars. Some kind of ID will help the EMTs find your family. I recommend the kind that is attached to your running shoes so you never forget it. Make sure the phone number is current! I've never needed mine in 30 years of running, but it only takes once.

2. Two pairs of running shoes. I always recommend you have two pairs of shoes that you rotate unless you are running less than 15 miles per week. The midsole material often takes almost 24 hours to rebound and frankly the shoes take time to dry out. Wet shoes equal fungus infections. Buy two pairs of either the same and mark A and B or buy a stiffer shoe for your longer runs and a lighter shoe for your short stuff and speed workouts.

3. Shorts

4. Shirt or Tank. Preferably a moisture wicking technical shirt.

5. Socks. There is a whole chapter on socks, but remember cotton is not your friend! Buy several pairs of synthetic moisture wicking socks so when you lose them in the dryer or your kid steal them because they are comfortable (yes. My daughter loves my running socks) you still have some to run in.

6. Sports Bra (woman only)

7. Hat. Mesh or visor, whatever your preference. Hats keep your head warm in the winter and cool in the summer.

8. Water bottle and carrier. Get the kind with a pocket to carry your cell phone and a little money as well as your gels.

9. Nutrition. This can be Power Bars, gels, new jelly bites, electrolyte replacement, or really whatever your heart desires. There will be a day when you skipped breakfast or lunch and need some fuel before you run. You should also carry some type of nutrition when running over an hour.

10. Body Glide. Everyone chafes sometime no matter how thin you are!

11. Sun screen. Melanoma kills 35 year old runners...enough said.

12. Sunglasses. Too much sun causes macular degeneration!

13. Heart Rate Monitor and watch

14. I pod or MP3 player. This is for the days your peeps blow you off or leaves you in the dust. It happens.

15. Towel. To dry off or to protect your car seat from your sweaty body. Your family will thank you.

16. Tights or sweats and gloves for those unexpected cold days

17. Extra set of clothing (for the days you forgot to clean out your bag and the clothes are dirty, it happens - our lives are full)

18. Plastic Bag for the stinky stuff

19. Toilet Paper or tissues for the sniffles and the port-a-john that's out of tissue

20. Money. Have about $20 or so in your water bottle carrier just in case you're having a rough run and need to take a cab home or just want an ice cream cone!

Put all this in a nice bag in the trunk of your car. Carry it every day. That way you are always ready to go and have eliminated one excuse entirely!

Dr Crane's New Book Now Available!

2009-05-04T15:47:00.000-07:00

Dr Crane's new book : If Your Running Feet Could Talk now available on Amazon.com

Click on the title for more information.

Dr Crane has written a prescription for surviving and avoiding injuries on the run. This book provides practical advice and resources to the running community to keep you running healthy and strong. It is meant for the novice and intermediate runner who needs solid advice on getting started, training programs, aches and pains, and recovery. Persistence and determination is the key to surviving then ultimately avoiding most running injuries. This book couples years of blood, sweat and tears on the pavement with sound medical advice for all runners.

Please enjoy and send your comments for the next version :)

Run Happy!

Paula Radcliffe Looking To Medal in Marathon after Bunion Surgery

2009-04-29T11:00:00.000-07:00

British marathoner Paula Radcliffe lately has been plagued by injuries. In fact, she had to pull out from this weekend's London marathon after breaking a toe. She since has had bunion surgery and is hoping the realigned foot mechanics will end her long stream of injuries. After running the marathon for the Beijing Olympics just four months after breaking a leg, she is focused on her 2012 goal of medaling in the London Olympics, her home city.

A bunion is an enlargement of the great toe joint. It, however, is not from a growth of bone, but rather a shifting of the first metatarsal bone due to unstable mechanics. The forces causes the great toe to shift towards the second to and the metatarsal bone to shift out of alignment. Bunion surgery, when necessary, realigns the relationship of the bones, but does not alter the underlying mechanics that caused the bunion in the first place. If left uncontrolled, the bunion can return over time and can even require a second surgery.

The best way to balance the lower extremity is with the use of a custom orthotic. An orthotic redistributes the mechanical pressures, permitting the feet to function as a more stable unit. This allows for more a more efficient gait in walking and running. It also helps to moderate the deforming forces that caused the bunion in the first place.

In 2012, Paula Radcliffe will be 38 years old. It is not unheard of for a woman of 38 to win Olympic gold in the maraton. Constantina Dita of Romania won the Beijing marathon this past summer at the same age. Lets just hope that Paula is able to rehabilitate and resume her training, injury free, while taking all the necessary precautions to allow her body to function at peak performance.

Don't forget your stretches before you run!!!

2009-04-23T11:20:00.000-07:00

As podiatrists, we treat all types of foot and ankle injuries, but we also want to PREVENT foot and ankle injuries...so we encourage our patients (and friends and family) to always remember to do their stretching before running and exercising.

We practice what we preach!!! Although we all have different styles of exercising and running, we all do our stretches first. Feel free to ask us questions about your stretches and techniques. We're here to help you!

Here are some simple stretches that you can try:

HEEL CORD STRETCHES #1 (Gastrocnemius Wall Stretch)

1. Lean against a wall with one knee locked and the other bent. You will feel a pull in your calf muscles.

2. Hold the stretch for 15 seconds & alternate the locking and bent knees.

3. Relax for 15 seconds & do 10 REPS.

4. Repeat this exercise 2-3 times a day.

HEEL CORD STRETCHES #2 (Soleus Wall Stretch)

1. Position is silimar to Gastrocnemius stretch but with both legs bent and the buttocks dropped. Make sure you are facing straight and not turned out.

2. Gently lean into the wall and keep your heels on the floor while bending both knees, putting a little more weight on the back leg.

3. Continue until you feel stretching in your lower calf.

4. Hold the stretch for 30 seconds.

5. Repeat 2-3 times on each side.

HEEL CORD STRETCHES #3 (Gastrocnemius Stair Stretch)

1. Stand with the ball of the foot on the edge of a stair and heels off of the step.

2. Rise as high as possible on the toes and then lower yourself slowly as far as you can without rolling the foot inward or outward until you feel a stretch in the calf.

3. Hold this position for 1-2 seconds.

4. Repeat 10-20 times.

PLANTAR FASCIAL STRETCHES

1. Raise toes toward you while bending your ankle as high as you can.

2. Hold this position for 15 seconds.

3. Alternate doing this with the opposite foot 10 times.

4. Perform this exercise 2- 3 times a day.

HAMSTRING STRETCHES

1. Lie with your back flat to the floor with your eyes focused upward.

2. Grasp the back of the thigh with both hands and, with the leg bent, pull the thigh until it is perpendicular to the floor.

3. Slowly straighten the knee.

4. Repeat the exercise with the other leg.

Don't Let Shin Splints Get You Down!

2009-04-22T13:06:00.000-07:00

As the northern cities clear the last snowfall, spring is on everyone’s mind. Warm weather and outdoor activities are around the corner. Though we are all eager to play catch or hit the running trails, we need to make sure we do not get injured in the process. Outdoor sports often mean uneven terrain. This can lead to a disaster if you do not take time to warm up and train for the demands of outdoor sports.

One of the most common complaints of spring athletes is shin splints. We have all had them and they are just strait up uncomfortable! Your leg muscles are over working and you may develop small tears or inflammation in the muscles or tendons. The injury is minor and can be relieved by rest and icing but the injury can be very painful and will interrupt your training schedule. Through the pain is caused by inflammation of the muscles and tendons in your lower leg, it may actually be the result of a foot problem!

Poor shock absorption can lead to increased stress on the muscles of your lower leg. Imagine when you are jumping and running how much force is being applied to your leg. We wear shoes to help absorb this shock and decrease the stress on our feet and legs. After time, your shoes will eventually lose its shock absorption quality. So if you are planning on wearing your 2 year old sneakers to the track today, you may need to stop at the local shoe store first.
Certain foot types are also poor shock absorbers. Our feet and legs are naturally constructed to absorb the stresses of walking, running and jumping, but not everyone’s foot is created equal. A high arched foot is a poor shock absorber and shoes with additional support should be worn if you have this foot type. You can also get the needed support by wearing custom made orthotics from your local podiatric physician.

Flat feet can also lead to painful shin splints. Flat feet are often caused by excessive pronation. This means that your foot and ankle roll inward at a greater degree than normal. Since your foot and leg function as a unit, when your foot over-pronates your leg will twist. This twisting puts stress on your leg muscles that will lead to inflammation and shin splits when exercising.
Don’t let these common foot problems and painful shin splints keep you off the field or track this season. Podiatric physicians are highly trained to accommodate your footgear and to provide custom support devices or orthotics to help manage your foot type. If you commonly have shin splints, your podiatric physician may also recommend physical therapy to strengthen your leg muscles and to prevent further injury. If you are currently suffering from shin splints remember to rest and ice your leg to allow your muscles and tendons to repair and recoup from the injury.

Are Your Feet Overstressed?

2009-04-21T15:49:00.000-07:00

A stress fracture is a tiny crack in the bone caused by overuse. Most stress fractures occur on your metatarsal bones in your foot but they can occur in any part of the body. Stress fractures develop over a long period of time and are often initially unnoticed. Your bones naturally break down bone and rebuild bone on a continual basis. If too much force in repeatedly applied to the bone, then the breaking down of bone will exceeds the rebuilding of bone. The bone is insufficiently repairing itself. This is called bone fatigue. Over time the bone becomes weaker and eventually cracks. The fracture is very small and is often unapparent on x-rays.

Physical activity is always encouraged, but working out too hard too fast puts your body at risk for injury. When starting to work out or changing your workout routine, make sure you give your body time to adjust to the new stresses. It takes time for your muscles and bones gain the strength necessary to absorb the impact of running, jumping, and jarring. When your muscles fatigue, they no longer distribute the forces along the entire bone and the bone has to carry an increase of load. This will lead to fractures. Sometimes even changing the surface you run on can lead to injuries. If you are used to running on the grass or a softer surface, changing to cement or concrete surfaces will force your body to absorb more of the impact. You may not notice the bone fatigue initially but over time, you may develop a small crack in the bone or stress fracture.
Stress fracture pain is usually experienced with increased activity. Therefore, one may notice the pain to get worse the more they work out. The pain also occurs earlier in the workout as the fracture progresses. Initially the pain will subside with rest, but as the fracture increases in size the pain will become more constant. The pain may also be elicited by palpating the area over the fracture. Sometime a doctor may use a tuning fork to elicit the pain. The fork causes vibrations in your bone, and if a fracture is present it will cause pain. If no fracture is present, the tuning fork will not cause pain. Your podiatric physician will also take x-rays to rule out any other complications. The stress fracture will often be unapparent on a x-ray because the crack is so small. Therefore, the physician may need to order an MRI or bone scan to further assess the injury.

The best treatment for a stress fracture is rest. Chen Lu, a professional figure skater, missed the Olympics due to a stress fracture, Scott Neidemayer missed his Hockey All Star Game, and Yao Ming had to sit out a large portion of the season to nurse his stress fracture. Whether you are a professional athlete or have sport hobbies, you need to rest if you have a stress fracture. The only way to fully recover and prevent the injury is to slow down and allow your body to heal. Changing your workout to less impact sports and slowly increasing your body’s demands is highly recommended. Athletic shoes lose their shock absorptive properties and should be replaced at least every 6 months. NSAIDS can be taken to reduce the pain but should not be taken for long periods of time. If you are experience any foot pain that is continually getting worse, you should see a podiatric physician to assess the injury.

My 4 Keys To Marathon Recovery

2009-04-20T17:00:00.001-07:00

After my recent marathon, I had near complete resolution of my muscle pain and weakness after just 48 hours. Since many runners are seaking keys to quicker recovery, I felt it was benefitial to list my current recovery regimen.

1. Cool Down
As recommended in research, I walk for at least 10-15 minutes without sitting or stretching to ensure the muscles have time to cool down with a light stretch from regular motion. If the cool down is done effectively, it will alleviate some of the after marathon recovery.

2. Refuel
Since exercise related pain is due to lactic acid or protein (muscle) breakdown, refueling is a key.
In a study by the University of Illinois on rats in 1999, quicker recovery was found from refuelling quickly after exercise with Leucine (an amino acid) containing products. Leucine is found in protein products such as meats and dairy products, as well as in protein bars and some sports drinks. So how do I refuel after a race? After any run, and especially after this marathon, I drank a large glass of milk withing 30 minutes of completing the exercise. Fluids are also imperative as are some other carbohydrates to help further maintain blood glucose and reduce lightheadedness from low blood glucose. When I don't want to eat within 30 minutes after an exercise, I eat anyway, especially the large cup of milk and/or a yogurt to get the Leucine benefits. (For addition information on this research, visit my original post.)

3. Fluids, Fluids, Fluids...
Part of refueling is getting the necessary fluids to replenish the body. I have a tendancy to start sweating when I think about exercise. I therefore must replace a large amount of fluid after any form of exercise. This replacement is both for refueling and for providing the reservoir for flushing out waste products from the body and especially the muscles. It requires more fluid to carry all these waste products out of the muscles into the kidneys for excretion. Try to drink 6-8 ounces of water every 2-3 hours during the initial recovery period.

4. Hot or Cold?
Although everything I have read recommends ice baths or ice massage after a strenuous exercise, and often they recommend avoiding the heat after exercise. I will say now that I aggressively treat my muscle soreness after an exercise (even after the marathon) with soaking in a warm bath or hot tub. Let me explain the science behind my actions. (Note that for me this works really well and decreases my muscle soreness significantly within the first 24 hours and reduces it nearly completely by 48 hours.)

The body reacts to hot and cold by dilation or contracture of blood vessels. Cold (ice) will reduce(vessel contracture) the blood flow into the area or cause the body to pull the blood from the area. Heat will increase (vessel dilation) the blood flow to the area and allow increased blood flow through the area. Since muscle pain is often due to lactic acid in the muscles or other waste products of "anaerobic" muscle metabolism (contracture), heat will allow blood flow through the muscles that can remove these waste products. Heat is only recommended by me during the first 12-24 hours. Ice can be utilized at anytime, but is rarely necessary if I undergo my usual exercise recovery regimen.

These four steps or keys find me nearly painfree 48 hours following a strenuous 26.2 miles. I plan to continue to train and run marathons and will evaluate the benefits of this regimen after any strenuous exercise. The proof will be in my recovery.

For additional information on my running: http://www.utahrundoc.blogspot.com/

Are Runners More Susceptible to Upper Respiratory Infections?

2009-04-14T01:05:00.000-07:00

I’m just getting over a spring sinus infection. Again! I’ve always considered myself a middle-of-the road, moderate intensity runner. I run two marathons a year and dabble in triathlon in the spring and summer. Nothing crazy. Yet, every spring I seem to be susceptible to the dreaded runny nose syndromes. I’ve always chalked the whole thing up to Texas allergens, but is that it? Or does my running make me more susceptible to the common cold? Interesting question posed to me by an ENT colleague. She pointed out that many marathoners experience significant increase in upper respiratory infections in the post-race months.

Let’s look at the research. A recent survey of 30 different studies of runners and decreased immune function that may lead to increased upper respiratory infections revealed little agreement from the experts. Yes, they all agree that moderate activity may enhance immune function, but they describe this as brisk walking for 30 to 45 minutes a day. What runner does that little activity? Most studies also agreed that high-intensity exercise temporarily impairs the immune competence. Hence the increased incidence of upper respiratory infections in marathon runner and especially ultra-marathon runners.

Athletes, when compared with their couch potato colleagues, experience higher rate of upper respiratory infections especially in the few weeks after intense training and races. In non-athletes, increasing physical activity is associated with a decreased risk of upper respiratory infections.

This so-called open window of altered immunity is temporary, lasting from three to 72 hours after an intense, prolonged event. Nevertheless, it presents an ideal opportunity to viruses and other invading pathogens, especially those that enter the body through the respiratory system.

Sounds bad, so what can we do to increase our immunity and avoid the runny-nose syndromes?

Several vitamins and minerals, including vitamins A, E, and C, and the minerals zinc and iron, are essential for normal immune function. Vitamins C and E, in particular, are also powerful antioxidants. It has long been known that long-distance running and other endurance events can increase the levels of free radicals—molecules that oxidize and cause damage to cells, including immune cells. The body produces its own antioxidants to counter free radicals and oxidative stress.

Many runners, operating under the theory that more of a good thing is better, take vitamin and mineral supplements. And while moderate amounts may very well be beneficial for the active individual, there is little evidence to support taking megadoses, with the possible exception of vitamin C. Some studies found that taking vitamin C (about 600 milligrams/day) for three weeks before an ultramarathon reduced postrace cold symptoms. Other researchers have found that vitamin C supplementation made no difference. Sounds like a multivitamin with extra vitamin C can’t hurt, but may not be our savior!

Should you run when you’re sick?

If you have a cold, most doctors recommend waiting a day or so after your cold symptoms disappear to resume intensive exercise. Mild to moderate exercise (such as walking) when you have a cold is fine. If your illness is more serious—fever, fatigue, muscle aches—you should wait two to four weeks before resuming your training regimen. Like any of us do that!

Just as intense, extended physical stress can depress certain immune responses, so too can chronic psychological stress and inadequate sleep. So during periods of intense training and before long races, the take-home message is this: keep other life stresses to a minimum if possible. Get enough sleep, avoid rapid weight loss, and eat a healthy diet. Sounds like a no-brainer!

Bottom line: marathon runners are more susceptible to upper respiratory infections. Getting more sleep, decreasing your overall stress and taking a multivitamin with extra vitamin C may help.

Treadmill Running...Just Slow Down!!

2009-04-11T15:36:00.000-07:00

I was reviewing the post about Madonna falling off of her treadmill and started thinking of the multitude of injuries I see due to the perceived safety of a treadmill. True, the surface of a treadmill does absorb shock, but there is a major natural pitfall with using a treadmill.

When you run - for real, with real forward progression - you are in control. As you tire, what happens? You slow down, of course! Not so on a treadmill. We typically set a speed and stick with it the whole way, for better or for worse. Some can maintain that steady pace, but most can not. As we tire, we'll naturally shift the upper body forward and the running gait will be more unnatural. What will happen? The anterior muscle group of the lower extremity (the front of the leg) will be overworked, as will the Achilles tendon. Then comes the pain...shin splints most commonly along with Achilles pain.

So what do you do to stop it? Well, just slow down! Not by a lot...every so often, maybe after the first third of the run or walk, lower the speed by 0.2 mph. This will allow for the natural fatigue of your baby.

If you wait too long and start to feel some discomfort, drop the speed even more, by as much as 0.5 mph to even a full mph. Then, depending how you feel, slowly increase your speed. If the pain persists, be sure to visit your podiatrist sooner than later.

A treadmill is not meant to be a passive experience. Be sure to listen to your body and make appropriate adjustments along the way.

Newton Running Shoes

2009-04-10T11:51:00.000-07:00

I just got a pair of Newton running shoes....yes, I did. I'm very curious if they will help me in the transition from bike to run in triathlon. The more biomechanics research I read, the more I believe that for some runners they may be helpful. I'm not saying I completely support their use just yet, but I'll keep you posted! The research is quite good and anecdotal evidence from all my triathlon peeps is good!
Here is a video that outlines the basis of Newton shoes.

I'll update periodically so you know how the trial is going!

Run Happy! And don't be afraid to try new things!

Top 3 Preparations For A Run

2009-04-03T07:56:00.001-07:00

As you prepare to run any distance, how you prepare is important. Of all the preparations you make, there are 3 top preparations that should be undergone.

1. Physical Preparation --> In preparing physically, this should include getting adequate sleep at night (6-8 hours recommended), eating regular, quality, well balanced meals, and working up to the distance you plan to run. If you have never run, part of physical preparation is starting to run with enough time to train for your first 5K (3.1 miles), 10K (6.2 miles) or marathon or half-marathon. Physical preparation is a constant process and not a destination.

2. Mental Preparation --> I talk to people on a regular basis that say they could never run 2 miles. They are correct. Not because their body can't be trained to do it, but because they have already given up. One of the keys to running (again any distance) is self belief. In your physical preparation, have you done adequate running to believe you can complete the distance? Belief is what helps you push a tired leg forward, continue through an aching muscle, climb a hill that doesn't seem to end and finish even when you body says it is tired.

3. Correct Equipment --> With all the physical and mental preparation, injury can occur in a run if poor equipment (or even worn out equipment)is used. Things to consider are the shoe, and what clothes will be worn for the run.

With shoes, mileage over 300 - 400 miles will wearout a shoe. A new shoe, however, should also not be worn in a race without a breakin period. A quality running store with staff that understands running can be utilized to get a good shoe.

Clothing choice is more variable. What will the weather be like? How will you limit rubbing that can cause soreness throughout a run? What will you do to limit sunburn or other discomfort during the run? Will you wear a hat? Whatever the clothing choices may be, it is important to train with these clothes, even utilizing them on longer runs to ensure that you are able to enjoy the race without interruptions from the clothing you wore (or didn't wear).

It is important to prepare correctly to avoid even minor injuries during a run. You deserve to continue running without interruptions and preparation is the key.

Toenail Troubles Slowing Your Runs?

2009-04-02T04:28:00.001-07:00

Toes can be a runner's weakest link. For some, it's the knees, for others, the back. And for many, the toes, or at least one of them, can be the problem that tortures an otherwise trouble-free runner. Any runner can get into toe trouble with the right (or wrong) conditions. From blisters, corns, and calluses to stress fractures and ingrowns, those cute little toes can become a big headache.

Toenails alone can be the source of a long list of troubles. Chief among the potential problems is the ingrown toenail--with or without infection. Other, not too pretty problems, are nail thickening due to fungal infections, black toenails due to repeated trauma, and of course other irritations, inflammations and infections. Here are just a few common causes of troubled toenails.

Ingrown Nails

You may be familiar with the warning, "Don't cut the nails too short." Trimming too short can cause the leading edge of the nail to grow forward and cause pressure on the soft tissue at the toe tip. Although this can happen, by far the more common cause of ingrown toenail, and the pain that goes with it, is the curvature of the nail into the tissue on both the medial (inner) and the lateral (next to the other toes) sides of the nail. You can get the picture by looking head-on at your thumbnail. From this vantage point, it looks as if the nail were clipped onto the top of the thumb. Toenails follow a similar curve.

If there is excessive pressure on the nail against the soft tissue from the forefoot of the shoe, problems can develop. Pressure on the side of the nail, where the toe touches the shoe, can push the soft tissue against the incurved edge of the nail. Then the toe gets inflamed, enlarges, and more pressure is felt on the toe. With enough pressure, the nail edge will break the skin surface allowing bacterial or fungal contamination into the toe, causing infection and even more swelling and pain. The warm sweaty environment of a running shoe makes an ideal site for proliferation of infection. Infection can spread around the rest of the nail, further increasing pressure and pain.

Using local antibiotics like bacitracin and antifungal creams may help, but it's hard to reverse an ingrown, infected nail without an office surgical procedure using local anesthesia. See your podiatrist! Never try to cut the nail "to relieve pressure" yourself. This is a recipe for disaster. It will heal faster and better with a smaller chance of recurrence if you see a podiatrist for treatment. Ingrown toenails do not lend themselves well to bathroom surgery.

Runner's Nail

Long distance runners and ballerinas both may be known for their athletic prowess and war-worn, beat up feet. Thickened toenails are so common among long distance runners, the condition has been dubbed, "Runner's Nail." The thickening and changes in color are caused by repetitive pressure of the shoe on the nail. The resulting thickening makes the nail even more vulnerable to additional problems since it is raised closer to the top of the shoe. These can be treated with a urea compound to soften the nail.

Fungal Toenails

A fungus (like the one that causes athlete's foot) can infect the nail and also cause thickening and discoloration of the toenail. This problem is distinguished from the Runner's Nail by infection. The fungus invades the nail when there is an injury or trauma, which may be so subtle you don't even know it is there. Once infected, a fungal nail is very difficult to treat. New laser therapy works, but prevention is a much better bet. If you notice changes in your toenails, see a podiatrist for diagnosis and treatment.

Black Toenails

Although you can get a black toenail from a sudden, painful trauma that causes bleeding under the nail, for runners it is more likely a chronic, repetitive trauma to the nail caused by short shoes, running downhill, or wearing loose shoes. This repeated micro-trauma causes only a light amount of bleeding and minimal pressure buildup, so little or no pain is felt. In many cases, you only realize this is happening when you notice your toe is discolored. But don't ignore it. The nail can gradually become thicker, and more problems develop.
Eliminate the cause of the irritation, and a new nail will gradually form. It takes six to nine months for a new nail to form, so be patient. If the nail thickens, you can file it down. If there is pressure and pain under the toenail, see a doctor. Drainage from a blackened nail can be a sign of melanoma and should not be ignored.

Why did that toe decide to torture you?

Trauma, either acute or chronic can contribute to all of these toenail troubles. Trauma--like stubbing a toe--can cause changes in the growth pattern of the nail and eventually it can cause thickening, discoloration, or infection. More often, excess pressure and repetitive trauma is caused by the mechanics of the foot inside the shoe.

Trauma can come from shoes that are too small or shoes that don't grab the midfoot firmly. If the shoe is too small, every step causes the toes to press against the front of the shoe. Tight shoes restrict blood supply to the toes, increasing the risk of infection. If the shoe doesn't grip the midfoot adequately, each time the shoe hits the ground and stops abruptly due to friction, the foot will slide forward unless it is firmly held in place inside the shoe. Momentum forces the foot forward inside the shoe until the toes collide with the front portion of the shoe.
It is important to prevent this sliding or pistoning of the foot inside the shoe. If the shoe comes up high enough on the front of the foot, it can help prevent the foot from sliding forward by holding it at the ankle. Most running shoes, however, don't come up high enough to be effective. In most cases, the lacing across the midfoot has to do the job. You can also glue extra tongue padding in the shoe for a tighter grip on the foot. The extra padding allows the laces to be tighter without pain. Both the padding and tight lacing stop the foot from sliding forward in the shoe.

The best way to prevent most of these problems is to get the right fit. Find a running shoe store where the employees are professionals who understand runners' needs and the differences in the shoes the sophisticated industry is producing. Shop late in the day or after a good run to allow for the natural swelling of the foot. Don't rely on street shoe size or assume that the size is the same from one shoe to the next. Try on both shoes, lace them firmly, and run. A good running shoe store will let you run up and down the block. Get a promise that you can return the shoes after several days of wear inside at home. Don't ever expect running shoes to "break in." They need to fit well from day one.

As you can see, toenail troubles are often from self inflicted trauma or trauma from shoes. If your toenail are looking funny or painful, see your podiatrist for answers to your toenail troubles.

It's Just a Step To The Left...

2009-03-28T22:38:00.001-07:00

No, this isn't doing the "Time Warp!" I'm more interested in my runners who come in complaining about foot, ankle, shin, knee, or hip pain ON ONE SIDE. Here in Houston, TX we have major drainage issues, so all of our streets are banked.

So when runners come into my office, they have done online searches and have a million reasons why they are hurting. They have bought all sorts of supports and liniments to make them feel better...but they don't seem to work. They come in complaining of their IT band hurting, or some shin splint pain on one side and expect me to run a whole barrage of tests to tell them in a high-tech way why they hurt and how to solve it. Then, after I listen to them, I ask the most important question:

What surface are you running on?

Invariably I'll hear an answer that they're running on the side of the road, or another similar uneven surface. I watch as they brace to hear a lecture on how "asphalt is a terrible surface" or "never run on concrete." Instead I ask my next question:

Where on the road do you run?

This is a loaded question...I know pretty well that they're not running in the middle of the road (if they were, there would be bigger problems than limb pain). They're, of course, running harmlessly on the side of the road. A-ha!!

When someone runs on the side of a banked surface, like the local Houston roads, they are essentially creating a leg length difference. This will cause the two feet to function very differently. One limb is going to compensate by attempting to lengthen and the other is going to shorten. A significant imbalance will result and can cause a variety of pains. My great wisdom for these runners?

Take a step to the left...

That's all? That's what they came in for? Well...yes. Sometimes a simple change makes a huge difference. By running on a more even surface, it allows for a more stable and even base and doesn't overwhelm the mechanics. My advice is to not take time off. Nurse the injury with ice and some anti-inflammatory medication, and be more aware of where they're running. I ask them to call me in a week to tell me how they're doing.

The results are amazing! A small adjustment like this causes the lower extremity to even up and makes a huge impact on the biomechanics. The pain gradually improves with essentially no time away from training!

Run Smart And Avoid Shin Splints

2009-03-24T08:47:00.000-07:00

Commonly runners are sidelined or limited by the presentation of leg pain during and often after runs. The pain is usually located at the sides of the "shin" bone and can be debilitating, even limiting the ability to walk. Over the years, this has been a problem that I sometimes have encountered in my running. Since I love running (and don't like not running), I have researched over the years some ways to limit the presentation of shin splints while training for a race, or in my case a marathon. I will discuss some ways that we can "run smart" and limit the injuries that have been commonly classified as shin splints.

Although I will not discuss the full causes of shin splints, or what a shin splint is here, additional information can be found at another blog: Utah Running Doctor. For this blog, however, here is the findings I have:

1. Use Correct Shoes --> Running shoes should be used for running, not cross trainers or walking shoes. A quality running shoe will assist in the running motion by limiting over pronation (excessive flattening of the foot) or over supination (increased arch height - rolling out). In choosing a shoe, price is not the most important, but cheap priced shoes are usually cheap shoes. Get a quality shoe, designed for the exercise you are doing (running shoe for running or walking, basketball shoe for basketball, etc.).

2. Train Smart --> As you run or train, Run Smart!

If you are running on a track, understand that always running the same direction on the track will work muscles differently than switching directions. One of the possible causes for shin splints is working muscles at different rates, therefore switching directions regularly will work all muscle of the legs equally and reduce the chances for shin splints.

If you are running on a road, most roads in most locations throughout the country are canted (or tilted to improve water runoff). Therefore, running against traffic always will cause supination of the left foot and pronation of the right foot. With supination, you will work the lateral (outside) muscles of the leg more than the medial (inside) muscles of the leg. Pronation does the opposite. By switching sides periodically, you will again work all muscles equally and prevent the presentation of shin splint symptoms.

Lastly, in running smart, the speed of training should be carefully controlled. Start slow and progress slowly to the amount of running you desire. Give the leg muscles time to get strengthened before forcing them into harder regimen. The speed of progress will require understanding of how much running you have done and where you should start. Cross training (elliptical or bike) can also help even the muscle strength as you progress.

In all these aspects of running smart, it should be understood that shin splints are caused by overusing a muscle group and creating an injury. By adjusting the training to reduce this overuse, you will have a more enjoyable run.

3) Evaluation for possible "gait" abnormalities.

“Gait” abnormalities are best described as running or walking abnormalities. Do you have a leg length problem? Do you over pronate or over supinate? Do you have imbalance issues, back problems, knee problems, or other reasons to overwork a muscle group that may cause your shin spints?

By being evaluated for your running, your “gait” abnormalities can be evaluated and often adjusted to help you return to running without the pain. Once you start to run and love it, everything should be done to keep you running.

Running Book Review

2009-03-24T05:44:00.000-07:00

I just finished reading Bart Yasso's book, "My Life on the Run". It's a quick read with many of the interesting adventures that Bart has been involved in. Bart was at the National Marathon the past weekend signing the book and just talking to us runners. Great guy, very laid back and just enjoys talking running. He has lead an interesting life and he shares if beautifully. Grab a copy sometime and enjoy his adventures.

Running Stores Know Runners

2009-03-21T20:33:00.000-07:00

I had an opportunity to sit down with the store manager and shoe manager of Luke's Locker, a specialty running store here in Houston. The partnership between a good running store and their clients is a vital one. They're the ones that stay on top of the new shoe styles, monitor changes and "upgrades" and can best identify when a shoe is not appropriate for a particular runner.

Staying on top of changes in running shoes is tough. Most shoe companies will "upgrade" a shoe as often as twice a year. Why the quotes? Well an upgrade may end up being an entirely redesigned shoe with a new last but with the same name. While it may have been the right shoe for you at one time, it no longer may fit right once it was updated.

Most podiatrists are unable to keep up with the constantly changing variety of shoes. Since I see lots of runners, triathletes, and other athletes, I do my best to stay abreast of changes, but I often refer to the experts. A specialty running store has knowledgeable managers who educate their salespeople as to the appropriate shoes for foot types. Some even bring in podiatrists and other experts into their stores to run workshop for their sales staff and even for their customers.

A properly fitting shoe is vital to foot health in general, but especially if you're involved in an exercise program. Proper shoes can not solve all foot problems (otherwise I'd be out of business) but they're an important step to providing the environment that will be most helpful in healing many foot issues.

Barefoot Runners are Crazy!

2009-03-15T07:58:00.000-07:00

The zealots are out...I made a comment on another blog's discussion of barefoot marathon running and now I'm being attacked!

Here was my comment:
Just a quick comment on barefoot running. Not for the average Joe! It takes years of building up the skin and musculature of your foot to be able to run barefoot and not have significant injuries. There is a huge barefoot community around the globe with amny runners who will never go back to shoes. There are many many more that have tried it and gotten significant injuries. A better way to gain the "benefits" of barefoot running and not sustain greater risk for injury would be to try a "barefoot like" shoe such as Newtons. Also, you can investigate "Chi Running" style. Bottom line: barefoot running is not a good idea for your average American. If this is something you would like to try, start with a barefoot technology shoe before you subject your tootsie to the bare pavement. This has been a debate for many years. I actually discussed this in the Wall Street Journal back in 2006! http://www.barefootrunner.org/news/06wsj/06wsj.htm The debate goes on and on and on....because there is no good answer....every runner needs to decide for themselves whether it is worth the risks.

The discussion is now closed.....but to see the whole shebang....go to http://tanglewoodfootspecialists.blogspot.com/

Carbo Loading For the Marathon

2009-02-10T11:35:00.000-08:00

Is carbo loading all about eating more pasta?

Is there a magic formula?

If you are an endurance athlete who is fearful of hitting the wall,listen up: proper fueling before a marathon, triathlon, century bike ride, or other competitive endurance events can make the difference between agony and ecstasy!

If you plan to compete for longer than 90 minutes, you want to maximize the amount of glycogen stored in your muscles, because poorly fueled muscles are associated with needless fatigue. The more glycogen, the more endurance (potentially).

Read the entire article by Nancy Clark a leader in sports nutrition.
http://www.goldsnutrition.com/0209carbo.html

Got Heel Pain?

2009-01-18T08:27:00.000-08:00

Heel Pain Slowing Your Runs?

Why is it that so many runners still suffer from heel pain on a regular basis? Shoe technology has advanced remarkably in the last 20 years, but it seems like the incidence of chronic plantar fasciitis has not subsided at all! Why is this?

Unfortunately the most common cause of plantar fasciitis or arch strain in runners is not shoes; but too much, too soon, too fast syndrome. This is very typical of the American personality. The “I want it all right now!” syndrome.

Let’s look a little closer. I also see many patients wearing gorgeous $100+ running shoes that are totally inappropriate for their feet. These are bought because of color, style, advertisements, or simply the fact that their friends really liked them. When will we get away from picking running shoes for looks or peer pressure? Are we all still in high school?

That may sound harsh, but let’s think about the last pair of shoes you bought. Did you go to the running store with a preconceived notion about what you wanted? Probably. Did you try on different styles? Brands? Anything you had never heard of? If most of us are honest, if we tried something new it was because of some article we read or ad we saw in a magazine.

Off the commercial running shoe soapbox, let’s get back to talking about heel pain. So you have arch and heel pain? You get up in the morning and it feels like someone stabbed you in the heel like you have a “stone bruise” in the heel fat pad? It’s been getting worse every day, especially the morning after a run? Sounds like plantar fasciitis. At this point it probably doesn’t hurt while you are running. It warms up quickly in the morning but as soon as you sit down or get in your car to drive, it tightens up, and when you get back up the pain starts again. Sound familiar?

It is important to have you foot evaluated by a podiatrist to make sure it is really just plantar fasciitis. Other things can mimic the symptoms of plantar fasciitis; a calcaneal stress fracture, tarsal tunnel syndrome (entrapped nerve), bone tumor, and even lumbar radiculopathy (a pinched nerve in your back). An x-ray and physical exam can rule out most other problems and confirm the diagnosis of plantar fasciitis.

What should you do now? Start simple.
Step one: Look at your running shoes. Are they worn out? Are they the right kind? Are you trying to run in tennis shoes or cross-trainers? When in doubt, consult the shoe guy at the local running store, a pedorthist or your podiatrist. If they fit but just need a little help, add an arch support.
Step two: Ice is a wonderful thing for heel pain. 15 minutes to the area at least twice a day.
Step three: lots of stretching! Stretch the arch of your foot and the Achilles tendon (heel cord).
Step four: take your running down a notch. Slow down, take walk breaks, and stay off of uneven surfaces or hills. If you feel any sharp pains or tearing, stop immediately! A plantar fascial tear will take you off the trails for at least 2 months.

If these simple things don’t help, its now time to see a sports medicine podiatrist. They will evaluate your heel and your biomechanics. Advanced treatments with rest, night splints, anti-inflammatories, injection therapy, physical therapy, and custom foot orthotics may be necessary to curb your plantar fascial pain. Conservative treatment is around 85% effective and surgery is rarely needed except in recalcitrant cases. The longer you wait to seek professional help, the more likely you will need advanced therapy or surgery to control your heel pain.

Don’t let heel pain sideline your running! Get started on the road to recovery today!

Cramps Slowing Down Your Run?

2008-12-17T19:59:00.000-08:00

Tim just completed the White Rock Marathon in Dallas this weekend. Weather was warm and extremely windy, but he was feeling good and managing to keep his pace through the half way mark. The race was going perfect and pacing was exactly as planned all the way until about mile 18. As he passed the 18 mile marker, he started feeling small cramps in his calves. He tried to slow down a bit to make them go away, but by mile 19 they hit so hard if felt like a ball bearing digging into his calf muscle and the pain literally brought him to the ground in the middle of an intersection. (Much to the traffic cop’s surprise) He had to stop, stretch and hobble along until they stopped. He had to walk for awhile, until they went away and then slowly started to run the last few miles. The cramps did not disappear and he had to stop again and stretch once or twice every mile. So much for his time goal!!

Question is, why do cramps happen and how can you prevent them? They have never occurred during his extensive training, so why in the middle of a race?

Muscle cramping usually occurs due to a depletion of ‘The Big 4′: sodium, potassium, magnesium, and calcium. Also, if an athlete is dehydrated, even slightly, going into a race, muscle cramps can be common (no matter how spot-on race day hydration is). Cramping can occur due to the depletion of one or a combination of these four minerals. One area that I would first examine is your everyday fueling. I realize that conventional thinking says that if an athlete cramps up during a race, then it must have been something nutritionally that went awry during the race. This may be the case, but actually the answer usually lies in one’s everyday nutrition and hydration.

The first thing I would suggest is to monitor your hydration levels before and after training (especially long training days). This can easily be done with a body fat scale that also measures body water percentage. Take this reading each night before bed for 7 days straight so you can determine an average body water percentage; then, after training sessions, re-measure your water percentage. You will probably notice a reduction in your water percentage, as this is normal. Your goal now is to refuel and rehydrate in order to get this water percentage back to its ‘normal’ level. Another easy way to monitor your hydration level is to pay close attention to your urine color. The goal is to keep your urine color in a range from clear to a very light yellow. If one’s urine color is a darker yellow, this can be a sign of dehydration (be aware, that if you take a multiple vitamin, the B-vitamins will turn your urine color yellow, and this is normal; not a sign of dehydration). Following a long training run or race…get your urine clear and keep it clear throughout the day, as this will ensure proper hydration.

In regards to the Big 4, try to consume a fluid replacement drink that contains all four of these minerals, and be sure to consume this fluid replacement drink during training and racing. Also, be sure to use your “sodium capsule” of choice during training, and not just on race day (you may already be doing this). If you find yourself avoiding sodium in your daily nutrition, try to lightly salt your foods with sea salt. Also, drinking vegetable juice is a great source of sodium and potassium (be sure to check with your physician that there are no blood pressure issues that would contraindicate the use of additional sodium).

So, in summary, my advice to Tim would make everyday hydration and fueling your focus as this will get you to the start line in a state of optimal hydration. This should help avert any nasty cramps in your next race!