Do Your Feet Get “Tired” While Running?

I spend the majority of my day finding the flaw in people’s feet that explains why they are suffering from pain and deformity.  Usually it is this flaw that I can attribute to causing a problem with muscles, making them fatigue early.  The question always arises in the back of my mind, do people without the flaw in their foot also get muscle fatigue.  A recent study in the Journal of Podiatric Medicine answered this question.

 

The Effect of Moderate Running on Foot Posture Index and Plantar Pressure Distribution in Male Recreational Runners, took  30 men who run for exercise on a regular basis.  They examined the foot for flaws and excluded anyone who had a problem.  These men ran at 3.3 m/sec (7.3 mph) for 60 minutes.  The measurements reveal that all subjects suffered muscle fatigue leading to pronation while running.  This evil word “pronation” is the root of many problems in the foot.  The interesting part of this study is that even people who began the study with “very supinated” foot posture (that is the complete opposite of pronation) ended the run in a pronated foot posture.  This change altered the pressure on the ball of the foot and inside of the heel most.  This could explain pain in many people who run.

But what about runners who don’t have pain?  In a study of ultramarathon runners, Karagounis found the same changes in foot posture and pressure, but these changes resolved within 24 hours.  The take home message is that if your feet hurt when you run and the pain doesn’t go away in the first day after the run, you need help.  This could be as simple as adding support by orthoses or arch supports.  The risk of not getting help…stress fracture, plantar fasciitis, tendonitis.

 

References:

Escamilla-Martinez E, Martinez-Nova A, Gomez-Martin B, et al: The Effect of Moderate Running on Foot Posture Index and Plantar Pressure Distribution in Male Recreational Runners, JAPMA 103(2): 121-125, March/April 2013

Karagounis P, Prionas G, et al:  The Impact of the Spartathlon ultramarathon race on athlete’s plantar pressure patterns. Foot Ankle Spec 2: 173, 2009.

Toning Shoes: Justice is Served!? Don’t Fall Prey to False Advertising.

Last year I wrote about toning shoes.  Just to summarize:  it is not the shoe that tones your behind, it is what you do while wearing the shoes and what you eat that makes your butt smaller.  Do you really think the models they show wearing the shape up or similar shoes in their commercials eat potato chips or have a few beers in the evening after a long photo shoot?  I have worked out with professional models and I can tell you first hand that they are not relying on the shoe to make their bodies beautiful.  If you want to exercise to improve your body, I can help keep your foot from hurting.  That’s what I do!  Don’t let foot pain be an excuse and don’t rely on a shoe. 

The University of Wisconsin at Lacrosse Sports Medicine Department has shown that the claims made by Skechers about their Shape Up shoes are false.  Now it has cost Skechers $40,000,000 and the administration still refuses to admit their mistake or false claims.  The $40 million is a small slap on the wrist compared to the billions of dollars they have made on this one shoe model.  Read the link below and don’t become a victim of false advertising. 

Remember:  Shoes don’t fix feet, Podiatrists do!!

With beach season fast approaching, our schedule is filling up. Call Desert Foot Surgeons for your appointment today.

http://www.cbsnews.com/8301-504763_162-57436508-10391704/skechers-shape-ups-why-the-ftc-called-companys-studies-deceiving/

Foot Pain, Tendonitis, and Shin Splints: Announcing Another Resource Desert Foot Surgeons Has For You

“You can’t heal until the inflammation is gone!”

If you have heard me say this before than you also know that at Desert Foot Surgeons, I recommend using ice, stretching, and Biofreeze as methods to relieve inflammation.  There are pills I prescribe and shots I can give to relieve inflammation as well, but these can be scary to some people.  Let’s face it, there is a movement away from drugs because we are seeing that continued abuse of some of these medications affects your entire body.  Natural methods to relieve inflammation have been around since man first walked on two feet and anything that has stood the test of time that long has to have some merit.

One thing that makes Desert Foot Surgeons different is that I have always been athletic, working out nearly everyday of the week.  Because of this level of activity I get injured just like you.  I understand how hard it is to make inflammation go away with a busy work schedule, kids, and the various other demands on your life.  Still when you are in pain it means there is inflammation and you can’t heal until the inflammation is gone.  There are a ton of methods to relieve inflammation, and I have tried all of them.  Therapeutic massage, yoga, acupuncture, various relaxation methods (if you know me, you know I’m no good at these), you name it I have probably tried it.  I am always looking for massage therapists and yoga studios to recommend for my patients.

What makes me most excited about the new office location on 44th street and Camelback in Phoenix is the friendships I have made in such a short time with other business owners in the area.  I’m happy to tell you about a business I think will be a huge asset to patients at Desert Foot Surgeons.  I have found you a business that contains all of the things I recommend quite often.  Massage, yoga, spa services.

Spa Lamar is located at 5155 N. Scottsdale Road (480.945.7066).  Services at Spa Lamar include the usual spa services such as hair styling, manicures, and pedicures, plus services that I’ve never been able to find under one roof.  Heidi Lamar has been developing her spa for years and with recent expansions has been able to include a yoga studio and massage therapists in her spa among the pool and hot tub, steam room, and dry sauna.  The first Wednesday night of the month, if you bring a friend, you can enjoy live music and snacks to help with that relaxation that I find so difficult.  What’s best is with the pricey resort spas in the same area, Spa Lamar is truly priced for the locals.  You will not get this level of service at a comparable price anywhere in the area.

When you’re in pain don’t forget:  You Can’t Heal Until The Inflammation is Gone!

Toning Shoes – Important Myths About Buying Toning Shoes

I love when patients come to me with advertisements, especially about shoes.  The latest trend is “toning shoes”.  I’m sure you’ve seen adds with Joe Montana or beautiful models in exercise clothes walking with these thick-soled shoes that are supposed to tone you calves, thighs, and buttocks.

I’m drawn to these advertisements as much as you, but I have a responsibility to my patients when it comes to shoes so I dug a little deeper into the toning shoe topic.

At Desert Foot Surgeons, we want our patients to be well informed so below is a link to an article about these shoes.  If you have thought about purchasing a “toning shoe”, please read this article.

http://www.acefitness.org/getfit/studies/toningshoes072010.pdf

Dr. Geller

Marathon Recovery – After PF Changs Phoenix Marathon

Paul trained for his first marathon.  He was smart about it going first to his doctor for a physical then having his feet and shoes checked in my office.  His training program included strength training, flexibility, and running.  Paul said the race was hard on his body, but he was happy to have finished.  About 3 weeks later I saw Paul again.  This time he was a wreck.  He was in pain from his low back to his toes.  Paul hadn’t been sleeping well and was just not as happy as he expected to be after completing his first marathon.

I asked about his recovery from the race.  I heard about the celebration that night soaking in a hot tub with friends drinking and eating whatever was there.  His wife had scheduled him for a massage the day after the race.  Paul said it hurt more than it felt good and had no lasting effect.  Stretching was impossible because of the pain and stiffness.  The tight muscles made it nearly impossible to run the few times he had tried.  When I asked if he was following any schedule or program he reminded me of his pre-race training program, but had nothing to follow for recovery.  Do you know what Paul did wrong?

What you do immediately after the race is as important as what you did to get there.  You know that running 26 miles is serious business, that’s why you were so careful in your training program.  After the race you will be exhausted mentally and physically.  Your recovery plan has to be set before you race so you won’t have to think about it.  Your muscles have worked hard for 26 miles and all nutrients in your body have been used.  When your body works hard for a long time you get inflammation.  Treat your body right and this will go away quickly so you’ll be running again in no time.  Ignore the inflammation and you’ll suffer.  I’m sure you’ve heard stories about people who ran a marathon and were never able to run again.  If you ask them about their post-race recovery I bet you’ll get a blank stare.

As soon as you finish the race:

You’re exhausted and legs feel weak, but this is the time you need to keep walking.  Don’t stop and get a chair massage, don’t chat at the booths.  Get your packet, medal, snack pack, and drink water as you walk around.  Make a mental note of what hurts.  I don’t mean big areas like your entire leg.  I mean specific areas like your calf muscle, front of your thigh, back of the thigh, front of your leg, arch, heel, toe.  Pay attention to any pains so that you can address these after a thorough cool down.

Your kidneys have been fighting to balance your hydration and electrolytes.  All the waist products coming from all that muscle action of running 26 miles is filtered by your kidneys.  They have worked overtime and need to recover.  Anti-inflammatory medications stress your kidney more.  This is not the time to take anti-inflammatory medications like Ibuprofen or Naproxen.  Refuel by drinking water, electrolyte drinks are OK, but water has to continue even if you’re drinking electrolytes.  Eat like you did while you were training.  Protein helps repair muscles and carbohydrates help with fuel. 

I don’t know how to describe it, but there’s an excited feeling in your legs, some people tell me a throbbing, others say it’s like their legs are just revved up.  Don’t stretch until that feeling in your legs goes away.  You can ice the sore spots and gently stretch.  When you get home take a cool bath.  Use a foam roller or gently massage sore muscles.  If possible schedule a massage in the evening, at least 4 hours after the race.

Things to avoid:

  1. Sitting for more than 10-20 minutes
  2. Soaking in warm water or hot tub
  3. Sauna
  4. Anti-inflammatory medications

The first week:

Inflammation can last 24-72 hours.  You will have to pay close attention to your body. If you treat the inflammation right you’ll be running again after a few days.  Ignore the inflammation and it can become a repeating cycle that is difficult to break even with my treatment.  Have more massages, practice yoga, swim or bike.  Don’t be aggressive, your goal is to stay loose.

If you have no aches and pains by day 3 you can begin gentle-paced, low mileage runs.  Do not exceed the mileage you did the week before the marathon.  Begin every three days with light resistance training on off days.  Any aches and pains need to be addressed.  Don’t wait to see me for any pains that remain.  The sooner these are addressed the easier they are to treat.

The 2nd week and forward:

If you’ve made it this far without needing me you’re doing well.  Gradually increase run frequency and distance back to your training levels as tolerated.  You might find that you are more easily fatigued, but that is normal for the first month.  Anything more than that and you should seek medical attention.  Don’t forget to have your running shoes checked.  During this return to training period you will need to have new shoes.  At Desert Foot Surgeons we offer video gait analysis to see what the naked eye cannot.  Come have your gait analyzed in or out of shoes.

Congratulations, you did it!!

A note from Dr. Geller

I know what you’re thinking;  Hey doc, you don’t say much about what you do during this recovery.  That’s because recovering from a marathon is all about you.  I’m very happy and proud that you were able to complete a marathon especially if I could help in the beginning.  I hope you don’t need me for this, but if you do, I’ll be there.
You did great!
Sincerely,
Dr. Geller

Marathon Recovery: Plan Your Recovery Before You Finish The Race

Paul trained for his first marathon.  He was smart about it going first to his doctor for a physical then having his feet and shoes checked in my office.  His training program included strength training, flexibility, and running.  Paul said the race was hard on his body, but he was happy to have finished.  About 3 weeks later I saw Paul again.  This time he was a wreck.  He was in pain from his low back to his toes.  Paul hadn’t been sleeping well and was just not as happy as he expected to be after completing his first marathon.

I asked about his recovery from the race.  I heard about the celebration that night soaking in a hot tub with friends drinking and eating whatever was there.  His wife had scheduled him for a massage the day after the race.  Paul said it hurt more than it felt good and had no lasting effect.  Stretching was impossible because of the pain and stiffness.  The tight muscles made it nearly impossible to run the few times he had tried.  When I asked if he was following any schedule or program he reminded me of his pre-race training program, but had nothing to follow for recovery.  Do you know what Paul did wrong?

What you do immediately after the race is as important as what you did to get there.  You know that running 26 miles is serious business, that’s why you were so careful in your training program.  After the race you will be exhausted mentally and physically.  Your recovery plan has to be set before you race so you won’t have to think about it.  Your muscles have worked hard for 26 miles and all nutrients in your body have been used.  When your body works hard for a long time you get inflammation.  Treat your body right and this will go away quickly so you’ll be running again in no time.  Ignore the inflammation and you’ll suffer.  I’m sure you’ve heard stories about people who ran a marathon and were never able to run again.  If you ask them about their post-race recovery I bet you’ll get a blank stare.

 

As soon as you finish the race:

You’re exhausted and legs feel weak, but this is the time you need to keep walking.  Don’t stop and get a chair massage, don’t chat at the booths.  Get your packet, medal, snack pack, and drink water as you walk around.  Make a mental note of what hurts.  I don’t mean big areas like your entire leg.  I mean specific areas like your calf muscle, front of your thigh, back of the thigh, front of your leg, arch, heel, toe.  Pay attention to any pains so that you can address these after a thorough cool down.

Your kidneys have been fighting to balance your hydration and electrolytes.  All the waist products coming from all that muscle action of running 26 miles is filtered by your kidneys.  They have worked overtime and need to recover.  Anti-inflammatory medications stress your kidney more.  This is not the time to take anti-inflammatory medications like Ibuprofen or Naproxen.  Refuel by drinking water, electrolyte drinks are OK, but water has to continue even if you’re drinking electrolytes.  Eat like you did while you were training.  Protein helps repair muscles and carbohydrates help with fuel.

I don’t know how to describe it, but there’s an excited feeling in your legs, some people tell me a throbbing, others say it’s like their legs are just revved up.  Don’t stretch until that feeling in your legs goes away.  You can ice the sore spots and gently stretch.  When you get home take a cool bath.  Use a foam roller or gently massage sore muscles.  If possible schedule a massage in the evening, at least 4 hours after the race.

Things to avoid:

  1. Sitting for more than 10-20 minutes
  2. Soaking in warm water or hot tub
  3. Sauna
  4. Anti-inflammatory medications

The first week:

Inflammation can last 24-72 hours.  You will have to pay close attention to your body. If you treat the inflammation right you’ll be running again after a few days.  Ignore the inflammation and it can become a repeating cycle that is difficult to break even with my treatment.  Have more massages, practice yoga, swim or bike.  Don’t be aggressive, your goal is to stay loose.

If you have no aches and pains by day 3 you can begin gentle-paced, low mileage runs.  Do not exceed the mileage you did the week before the marathon.  Begin every three days with light resistance training on off days.  Any aches and pains need to be addressed.  Don’t wait to see me for any pains that remain.  The sooner these are addressed the easier they are to treat.

The 2nd week and forward:

If you’ve made it this far without needing me you’re doing well.  Gradually increase run frequency and distance back to your training levels as tolerated.  You might find that you are more easily fatigued, but that is normal for the first month.  Anything more than that and you should seek medical attention.  Don’t forget to have your running shoes checked.  During this return to training period you will need to have new shoes.  At Desert Foot Surgeons we offer video gait analysis to see what the naked eye cannot.  Come have your gait analyzed in or out of shoes.

Congratulations, you did it!!

A note from Dr. GellerI know what you’re thinking;  Hey doc, you don’t say much about what you do during this recovery.  That’s because recovering from a marathon is all about you.  I’m very happy and proud that you were able to complete a marathon especially if I could help in the beginning.  I hope you don’t need me for this, but if you do, I’ll be there.
You did great!
Sincerely,
Dr. Geller

Injuries While Training: Running a Marathon

Grab a pair of sneakers and go.  That’s all it takes to run, right?  Maybe that’s why more people than ever are running marathons.  Running a marathon is an admirable goal, but the philosophy of just grabbing a pair of shoes and running may be why I’m seeing more running injuries than ever before.  Training for marathons has turned into big business.  You can join a club, buy a magazine, or purchase a plan online.  My problem with these training schedules is a lack of individual attention.  Remember my saying, “feet are like snowflakes, no two are the same”.  Some people have feet that can run 26 miles, but does that mean your feet can?  Well there’s two mind sets:  1. you’ll never know until you try, or 2. I’ll follow a training program.  But what’s missing?  Neither approach is designed with you in mind, so when you get hurt you end up needing me.

Recently three people came to see me for the most common running injuries.  Even though these people had different pain, were different ages, lived in different cities, and had different lifestyles, they all had similar stories about training for a marathon.  All three had not run for exercise consistently in more than 5 years.  A friend had convinced each one to train for the marathon.  Not one of the 3 had a training program made specifically for them, but all were using a group training schedule from either a magazine, the internet, or joining a training group.

The first patient complained of heel pain that was worse with the first steps out of bed then again in the evenings especially after running.  I diagnosed this patient with plantar fasciitis and relieved her pain by teaching her how to stretch and ice, gave her foot orthotics to support her sudden increase in activity, and plantar fascia night splint for the morning pain and stiffness.  Plantar fasciitis is a common overuse injury.  The muscles in your arch stretch beyond their limits when you walk or run.  A sudden increase in activity, change in shoes, or an injury is usually related to the start of pain, but very few people realize this until I point it out.  In this case the patient had a new activity, running.  She also had new shoes that she bought for this training.  Had I seen her before she started training I could have watched her walk on slow motion video and analyzed how her foot might be effected by running.  Stretching could have been started before training began and help individualizing her training program could have been arranged.  Her heel pain and time away from training could have been avoided, but she will be able to run the marathon.

The second patient came to me with the complaint of pain and swelling in the top of his foot.  He was training for a marathon and noticed the pain increasing gradually as his distance increased.  Pain was present all day long, worse in shoes, and swelling increased the more he walked.  Running had stopped because of the pain.  X-rays showed a stress fracture of his 2nd metatarsal.  This is the bone behind your second toe and is commonly the bone involved in stress fractures of the foot.  Stress fractures are broken bones that happen gradually when you have a sudden increase in activity.  The sudden increased pressure on the bone causes inflammation that weakens the bone, but you’re still not aware of it so you keep on training.  When the weak area of the bone breaks you get the big ouch.  Treating the fracture early is easiest.  A removable cast and anti-inflammatory pills relieve the pressure and inflammation allowing the fracture to heal.  Once you heal the real treatment begins.  There is a reason the fractured bone has more pressure than the others and it’s my job to find out.  Detailed exam of your foot structure including video gait analysis will be done so that custom foot orthoses can be made.  This will correct the pressure problems in your foot and prevent further fractures.  Unfortunately in this case the patient came to me once his bone had broken.  His goal of completing a marathon will have to be postponed until later in the year.

The third patient wasn’t far along in her marathon training when she developed pain in her lower legs.  This pain was very bad when running and improved with rest.  She wanted to run the marathon so bad that she trained until until her leg started to swell.  By the time I saw her my major concern was a stress fracture of her tibia, the main bone in the lower leg.  The beginning of her story was more like shin splints, but I had to make sure so a few tests were done to prove this was not a stress fracture and she improved with treatment for shin splints.  Medial tibial stress syndrome is the newer term used in sports medicine for shin splints.  The cause is always related to pronation, see my article “Are You a Pronator”.  Most foot problems can be related to pronation, but medial tibial stress syndrome occurs in the leg.  To make a long story short, it’s the rotation of your lower leg when you run that causes this pain.  Custom foot orthoses are the only way to make this go away and stay away.  I had to modify this patient’s training program and get her help to strengthen her thigh muscles, but she will be running in the marathon.

Running is good for you!  No one will argue that point, but getting started is the hard part.  Buying a running shoe from a specialty store is a good idea, but now a lot of stores are using pressure mapping to tell you how your foot works.  First of all, you cannot tell how the foot works by standing still on a pressure plate.  At Desert Foot Surgeons I use video gait analysis to see exactly how your foot works while you run or walk barefoot and in shoes.  Second the study of foot motion is called biomechanics.  This takes years of study to master and is only provided in podiatry schools.  I have many friends in the running shoe business and have learned a lot about shoes from them.  Likewise I have taught my friends a lot about biomechanics.  I won’t pretend to know more about shoes than these professional salespeople and all of my friends will not pretend to know more about the function of the foot than I do.

Come see me before you start running.  I can help you with more than just shoes and orthotics.  I can get you personalized training or even physical therapy.  If you have shoes already video gait analysis will show if they are working for you.  Preventing injuries is much easier than treating injuries.  Running is good for you, just do it smart!

Arterial Ulceration

Of adults over 40 years of age in the United States, about 4.5% have peripheral arterial disease (PAD). This is a lack of circulation to your legs and feet.  Healing an ulceration where there is a lack of circulation is very challenging for you and your doctor.  The most important part of healing these open sores is bringing blood into the foot.  Dr. Geller works with vascular surgeons, interventional cardiologists and radiologists who can help with this part of your care.  The actual care of the open wound is determined by Dr. Geller.  This will involve something to keep pressure off the sore and medication applied to the wound.  At Desert Foot Surgeons you will find a physician with the expertise and experience needed to develop a program that best suits your needs.

Those of you who have healed an arterial ulceration have suffered a great deal of pain and possibly even undergone surgical correction of the poor artery circulation.  If this is not enough reason to quit smoking I don’t know what is. Part of your recovery will be walking for exercise to increase circulation even if you had surgery. Since most arterial ulcerations are on the feet you will need protection of the scar by shoes and possibly inserts. Your heels may need to be protected while lying in bed. Moisturizing dry skin using specific foot creams is also recommended to help prevent new or recurrent ulcerations.

Dr. Stephen Geller, AZ Podiatrist