Dr. Peter Wishnie explains the benefits of stretching in this video. Incorporating a stretching routine into your life will make you a healthier person, better athlete, and all around make you feel better. In order to prevent injuries, especially running injuries, it is essential to perform stretching exercises.
Wednesday, March 21, 2012
Monday, January 30, 2012
Runners Knee Could Be Caused By Your Feet
Do your knees hurt while you're running?? You may not have thought, but it could be caused by your feet! Dr. Wishnie, podiatrist and active runner, explains what causes runner's knee and how you can treat and prevent it.
Wednesday, January 11, 2012
Heel Pain Can Be a Calcaneal Stress Fracture!
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
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!
Wednesday, October 19, 2011
Running Shoes 101: Things you need to know before you purchase your shoes.
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! “
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! “
Wednesday, October 5, 2011
Does Your Calf Hurt When You Walk Or Run?
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.
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.
Monday, June 6, 2011
Top 5 Running Injuries
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.
Wednesday, June 1, 2011
National Running Day
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.
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.
Sunday, November 7, 2010
Buried Alive and STILL on his Feet!
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!
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!
Tuesday, June 29, 2010
Common Running Pains & Injuries
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.
Thursday, June 17, 2010
TightRope Procedure
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.
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
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.
Wednesday, June 9, 2010
New Tightrope Procedure for Bunions
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.
Monday, May 3, 2010
Forget The Pain, Running Injuries Can Be Depressing!!
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.
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.
Wednesday, March 24, 2010
Running is my Prozac!
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!
"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!
Wednesday, November 25, 2009
Five Items Every Runner Should Have On Their Holiday Wish List
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.
,
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.
,
Thursday, November 19, 2009
Playing Sports Does Not Have to Mean Getting Hurt!
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.
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.
Wednesday, November 11, 2009
The Nike Free Running Shoe
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.
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.
Monday, November 9, 2009
Should You Change The Way You Run For Greater Speed?
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.
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.
Friday, October 30, 2009
How To Run Smart...Even In the Cold
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).
•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.
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:
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.
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