Why do my feet itch so much? Why does it seem to happen more in the summer time even though I'm not wearing closed in shoes? Why does it itch more some days but not others? All good questions! Let's talk a little about itchy feet.

 

Many people have itchy feet from simply dry skin. Their skin is drier in the summer because they are either going barefoot or wearing sandals all of the time. They also don't habitually put moisturizer on like they do in the winter time. They also may be predisposed to dry skin from underlying medical problems like diabetes, poor circulation or hypothyroidism. Luckily dry skin has a simple fix. Exfoliate your feet with a combination of a cream or lotion that contains urea or lactic acid coupled with a gentle buffer or sand paper. If you do this a few times a week, it should alleviate all the itching of alligator feet.

 

But you don't think you simply have dry skin? Perhaps you have a fungal infection. Chronic itchy feet from an underlying tinea pedis (also known as athlete's foot fungus) is extremely common. It is more common in the summer due to increasingly sweaty feet. Fungus loves sweaty feet! Take a look at the skin on the bottom of your feet and in between your toes. Do you have a wet whitish peeling look to the skin in between your toes? This is called maceration. It happens when you toes are wet a lot or have been submerged in water for a long time; but it is also a hallmark of interdigital tinea pedis or fungus in between your toes. Check out the bottom of your feet. Does the skin have little red bumps or scaling skin in the pattern on very small circles? This is also indicative of fungus. The great thing about athlete's foot fungus is that it is easily treated with a topical medication and then decontaminating your shoes. Keep your feet clean and dry and make sure you change your socks if you sweat a lot.

 

So you don't think its dry skin and really don't have the hallmark signs of fungus? Another common problem is contact dermatitis. You may have contact dermatitis if you have a red, scaly, itchy rash and it is in the pattern of your new sandals or perhaps socks. You can also get contact dermatitis from a new cream or tanning lotion. Any kind of topical allergen can cause a skin reaction. I've even seen dermatitis from an ankle bracelet! Contact dermatitis is usually a new problem and a little detective work will help you find the culprit! Topical treatment with a steroid cream coupled with removing the allergen usually rapidly relieves the itchy rash. Rarely an oral steroid is needed to calm down the itching and alleviate the rash.

 

Other causes of itchy feet can be any kind of skin problem like eczema or psoriasis. Most people will see a telltale skin rash prior to the itching and are familiar with the symptoms they have in other area of their skin. Treatments vary depending on the underlying skin problem.

 

So these are the top reasons for itchy feet: chronic dry skin, tinea pedis, or a dermatitis or skin disorder. Itchy feet driving you nuts? If your detective work falls short, and your itching persists; it is time to visit your podiatrist. Skin scrapings or a biopsy can often help find the culprit and eliminate the annoying itch!

 

How long does it take to recover from a marathon? How long does it take to recover from an Ironman triathlon? How much racing is bad for my body? These are all good questions posed in my office on a regular basis. The problem is that the answer is always, "It depends". Everyone recovers at a different rate. Age, experience and current fitness level are large variables in the equation. I know a marathon runner in town who ran 100 marathons in a less than 10 years; and of course, we have all heard of Dane Rauschenberg who ran 52 marathons in one year for charity and then wrote a book about it! The flip side is that I know runners who can only do one marathon a year without getting hurt and most triathletes only train for one Ironman a year.

 

So what is the magic formula? How much is too much? I think the first thing to think about is what is your goal? If you are just talking about finishing the marathons and not really having a time crunch, then feel free to do up to six a year but realize that having more than two quality runs in a year is very difficult. The Ironman distance should not be attempted more than 2 or 3 times a year regardless of time goals! Now, for those of us who are addicted to the watch, "racing" a marathon is something that should not be done more than twice a year. "Racing" an Ironman triathlon should only be attempted one a year.

 

Why is this true? Well, simple math. It takes a minimum of 4 months to train effectively for a marathon and 6 months for an Ironman. Then you need at least one day for every mile you ran and three to five days for every hour your triathlon took. That means a month of recovery before you start to train again after a marathon and at least 6 weeks after a 12 hour Ironman. Last time I checked, there were only 12 months in a year; hence, the common recommendation of racing no more than 2 quality marathons or one quality Ironman triathlon a year.

 

Why do some people recover faster? Age. My feeling is that youth is wasted on the young. I remember being able to run a marathon and get up and go to work the next day. Now I have to take at least one day off and often take two! Experience does help. Your body has been there before, so it knows it will live. Veterans often have a post-race routine down that helps them recover. (Often this includes the anesthesia known as beer!) If your fitness level is high and your nutritional status is good, you will recover faster.

 

What can you do to hasten recovery? Walk a cool down after the race. Do not sit down immediately even though your legs are begging you to! Take a 15 to 20 minute walk and stretch gently. An ice bath is best, but very few people I know are that tough. A cool bath followed by stretching before you go to bed is helpful. A large amount of carbohydrates and water also helps. Hence the beer phenomenon! A massage a few days after the race will help you recover. More than anything, do not start training again until you are fully recovered. Many injuries occur due to too much, too soon, too fast and too fatigued syndrome!

 

So how much is too much? Again, the answer is always, "It depends." Listen to your body. Really listen and stop being stubborn or stupid! If you start training and you are exhausted, you are doing too much. If you are spending too much time in my office and less on your bike, you are doing too much. The answer is really simple stupid. Listen to your body and it will tell you how much is too much.

 

Bottom line: Let your body fully recover from your races and quality times will be recorded. Race only one to two marathons or one Ironman triathlon a year. As for other distances, keep in mind that you need one day for every mile of a running race and at least 3 days for every hour you raced in triathlon. Anything shorter, you better take off your watch and go for the finish instead of the time and prepare yourself to spend some quality time with your local sports medicine physician!

 

Run Happy! And Recover Well!

 

 

Texas Man triathlon series is this weekend in Denton, Texas. The girls at FAANT (Foot & Ankle Associates of North Texas) have decided to try to suck in one of our coworkers and do the Half-Ironman distance relay. Janet and I are still tired from the New Orleans 70.3 so we thought a relay would be fun and it would get Lori to drink the K00l-aid of triathlon! I get to swim (why does everyone hate the swim?), Janet is going to smash the bike (I heard there were a few little hills, ha ha) and our newest triathlete, Lori, is going to motor the run! A good time I’m sure will be had by all. I’m happy because the swim should be wet suit legal! I float better that way. The forecast is bleak and includes possible thunderstorms, so pray for good weather at 7am on Sunday! We will update you after the race!

 

Here’s a shout out to everyone else racing this weekend. Be safe and have fun!

 

Run Happy!!

2. It is a great pain reliever.

3. It makes the end of a race much more enjoyable.

4. It can precipitate post-race amnesia making you want to do another one.

5. It tastes much better than Gatorade.

6. I think I even read a study that showed beer helps flush out all that lactic acid!

7. It promotes social activity after a race when you feel like you just got run over by a truck

8. It’s a great carbohydrate replacement recovery drink.

9. It makes the ride home so much more comfortable……….and the next morning if you don’t have to go to work 

 

All right, all funny aside, how about the ice versus heat question?

 

Ice versus heat? This is a common question a lot of athletes, coming into my Grapevine, Texas office, ask. Most understand that ice immediately after injury is very important. The questions usually revolve around when to use heat.  There are some basic guidelines that every athlete can use to reduce confusion.

 

Immediately ice the “fall down, go boom injuries.” Ice works well for reducing redness, swelling and internal bleeding in acute injuries.  It also is a great pain reliever. Acute injuries and post surgical pain and swelling usually respond well to 10 to 15 minutes of ice every few hours. This should be done for up to several weeks after an injury or surgery. Ice can be in the form of an ice pack (ice wrapped in a protective towel) or ice massage (massaging with a frozen water bottle or block of ice). 

 

Ice can also be helpful in reducing swelling in a chronic injury like runner’s knee or plantar fasciitis. Icing immediately after activity can prevent further inflammation of an already annoyed area and help in recovery.

 

So where does heat come in? Heat can be used in several different ways. Contrast baths with ice/heat/ice can be helpful in chronic injuries. Especially those joints or tendons that still have just a little inflammation or edema. Heat should never be used alone in these cases. Moist heat is best for chronic stiffness and old injuries with scar tissue. It can also help in the rehabilitation process. For example, when plantar fasciitis becomes plantar fasciosis after four to six months (which is a chronic degeneration of the plantar fascia), deep heat therapy with ultrasound or moist heat packs can help increase range of motion of the area and increase the effectiveness of physical therapy. Heat actually temporarily increases inflammation in an area, but this is often helpful in kick starting the healing process.  Heat can also be used to calm muscle spasms and relax a tight muscle. 

 

Heat causes an increase in circulation to an area, so it should never be used in acute injuries or chronic injuries with a lot of swelling. It can actually make an injury worse if there is still a little internal bleeding going on. A great way to heat a joint or tendon is to use a reusable heating pack or an electric heating pad for about 20 minutes before stretching, massage or other therapy. Heating an old injury before exercise can also be helpful in warming up the area to ready it for increased activity.

 

The simple rule of thumb is that ice is used for acute, swollen injuries and heat is used for stiff, chronic injuries. This subject is debated continuously, but I hope this discussion clears up the mystery of ice versus heat!

 

Run Happy!

Spring is finally here! That means more and more older runners and athletes are flocking to my Grapevine, Texas, office complaining of a multitude of aches and pains. 'Tis the season to overtrain and suffer from the dreaded tendonitis. What is this mysterious 'itis? Why does it effect aging athlete's more than the younger ones? Why does one person have multiple bouts of recurrent tendonitis all over their body and another does not? These are all great questions!

 

Let's start with the basics. A tendon connects your muscles to the bones. It is a flexible but really tough band of fibrous tissue. A muscle contracts to move one of your joints and transmits a force on the tendon to cause the movement. Tendons, when functioning normally, glide very smoothly when the muscle contracts. When they are irritated, they cause pain and even creaking when they glide. This is tendonitis or in easier terms, inflammation of the tendon.

 

Tendonitis can occur in any tendon, but in your foot and ankle the most common tendons effected are the ones that stabilize you foot when you run, jump and play with the other kids. These are the Achilles tendon, the posterior tibial tendon, the anterior tibial tendon and the peroneal tendons. Less likely to be irritated are the multitude of smaller flexor and extensor tendons in your feet.

 

Tendonitis is more common in your aging athletes between 40 and 60. This is because the lovely aging process causes our tendons to become less elastic and therefore less forgiving. A stress that would've been easily absorbed in our 20-year-old tendons causes tendonitis and even rupture in our 40+-year-old tendons.

 

Tendonitis is usually due to repetitive stress with an underlying biomechanical abnormality or anatomical deviation. This is why it is important to treat the tendonitis and the underlying cause before return to sport. If not, recurrence rates are high!

 

What does tendonitis feel like? Pain and swelling in the tendons usually first thing in the morning or at the beginning of an activity. The pain and stiffness often "warms up" in the early stages, but can become constant if you ignore the early symptoms. Sharp stabbing pains can occur but these are usually a sign that your tendon is so stressed it may actually tear!

 

How is it diagnosed? Usually your doctor will perform a physical exam and then rule out a bone problem or fracture with an x-ray. Sometimes an MRI is needed to rule out a small or partial tendon tear.

 

Treatment for tendonitis begins with relative rest. Take the stress off the inflamed tendon by doing alternative exercise like cycling or swimming. Sometimes complete rest is needed. Ice, anti-inflammatory medicines, bracing, physical therapy and even a cortisone injection may be needed. Functional foot orthotics are often quite helpful in chronic tendonitis because they stabilize the abnormal movements and help treat the underlying biomechanics of your feet.

 

Remember that after having a bout of tendonitis, slowly return to activity and try to avoid the overuse that caused the tendonitis in the first place! Too much, too soon, too fast syndrome is often the culprit in tendonitis!

 

Run Happy!

 

Good question! I spent four hours this week with a Retul specialist, Craig Fulk, in Roanoke, TX. He is a fantastic cyclist with a quirky sense of humor who practically killed me by making me ride the bike trainer for hours getting my fit just right. In the past, I’ve had cervical spine pain, left leg numbness and felt like I was cycling mostly with my right leg. I felt like I was all over the saddle and could never find a comfortable position. Since Ironman is my goal, I had to find the sweet spot on my saddle and try to find some more power, since I ride about as fast as an 80-year old Grandma!

 

Retul is a dynamic bike fitting computer system that helps adjust your cycling position. Most bike fittings are done in a static position. Most bike fit specialists use a tape measure and plumb bobs and cannot take an accurate measurement when the cyclist is pedaling. The Retul computer system captures the rider’s position relative to his pedaling motion and creates the most realistic replication of the rider’s biomechanics. It measures the actual pedal stroke and body position when the cyclist is riding. Retul uses a 3-dimensional view to see everything from knee extension (from the side view) in relation to knee wobble (from the front view) in order to make the best decisions on adjustments to the cyclist. I felt like I was all wired for sound! Imagine little sensors attached all over your body and then cycling. The computer model showed how pathetic I was to start and how fabulous my biomechanics were when we were finished. I think we spent an hour just adjusting my cleats! It seemed like a lot of minimal adjustments, but together it was fabulous! Who knew I could feel this good on my bike!

 

After four hours of sheer torture, I had found the sweet spot I the saddle and actually felt so much better on my bike. I even found 15% more torque from my pedaling! An added bonus that will hopefully make me a little more competitive! Here I come New Orleans 70.3 in April!