If you are a frequent visitor to Foot and Ankle Associates of North Texas in Grapevine, TX, you probably already know about orthotics. Maybe you have even purchased orthotics. A foot orthotic is an insole placed into the shoe that helps control foot position.

There are two main types of orthotics: Functional and accommodative. These can be prefabricated; like Lyncos that are popular at Healthy Steps or custom; which the doctor fabricates unique for your feet. A functional orthotic controls foot movement and helps a person walk in a way that best supports joints and muscles. An accommodative orthotic helps distribute foot pressure evenly over the bottom of the foot.  Most patients use a functional orthotic and usually these are custom for long term usage.  A functional orthotic can be useful for many problems and are used to balance the biomechanics of your feet. Think of them as an in-shoe tire realignment for your feet. Accommodative orthotics are very useful to distribute stress in the elderly, diabetic and arthritic populations.

In the foot care aisle at your local drug store or grocery store, you may have seen readymade orthotics for sale.  Does it really matter whether you buy store bought orthotics or custom orthotics from your podiatrist?   Well, some people may be able to get away with wearing store bought orthotics for a period of time. We often even start our treatment plans with these type of prefabricated devices, so we can get you on the road to better foot health right away; but most patients do need custom for long term control of their foot type. When you think about the long term health of your feet, custom orthotics are the way to go!  Store bought orthotics are made to fit many foot problems for a large variety of people; one size fits all usually means one size doesn’t truly fit anyone!  To be truly effective, an orthotic must be fitted for YOUR particular needs.  Wearing an ill fitted orthotic is not only a waste of time, but it can also make your foot problems worse.  Over time these problems can lead to leg, knee, hip, and even back problems. Store bought orthotics tend to not offer long lasting comfort.  If you find yourself buying store bought orthotics every few months because of foot pain, it may be time to schedule an appointment to see one of the doctors at FAANT. Your podiatrist will produce orthotics that fit only YOUR feet.  The materials used will be those that are best suited for your walking and running needs.

Everyone deserves special treatment! With a real custom orthotic that is exactly what you have. Yes, custom orthotics can be costly, but so can surgery from walking incorrectly over the years.  I’m always amazed that some insurance companies will not cover orthotics, but will pay for surgery! Doesn’t make any sense!! Think of the orthotics as an investment and an investment in your health is one of the best choices you can make for yourself.

I had a great question this weekend at a running forum in Grapevine. One of the runners had lateral knee pain that came and went with no obvious cause. She thought she had ITB (iliotibial band) syndrome (sounded like symptoms her friend told her about) but she had been doing stretching and icing with no avail. What else could she do? Is it possibly from her shoes? Is rest enough?

Let’s talk about ITB syndrome.

The most common cause of lateral knee pain in runners is ITB syndrome, related to repetitive friction of the band sliding over the lateral femoral epicondyle as the knee flexes and extends.

Runners may complain of a sharp or burning pain about 2 cm superior to the lateral joint line (above the outside of your knee); exam may reveal tenderness to palpation there. Swelling and redness are usually not present unless it is severe.

Runners who are predisposed to this injury are typically overtraining. They often have underlying hip abductor muscle weakness; leg-length discrepancies may contribute to ITBS. They also have been found to have either a really high arched foot (cavus foot type) or an extremely flexible flat foot.

Acute phase treatment includes relative rest, ice, and anti-inflammatories. Physical therapy modalities like ultrasound and e-stim can also be helpful to break the inflammation cycle. In cases of severe pain or swelling, corticosteroid injections may be used.

During the subacute phase, stretching of the ITB is emphasized, along with soft-tissue therapy for any myofascial restrictions. Orthotics and shoe gear changes are also often indicated. Many patients actually are running in too heavy or too stabilizing shoes, especially if they have a cavus foot type.

The recovery phase focuses on a series of exercises to improve hip abductor strength and integrate movement patterns.

The final return to running phase is begun with an every-other-day program, starting with easy runs and avoidance of hill training, with a gradual increase in frequency and intensity. Remember: too much, too soon, too fast is what got you hurt in the first place!

Rest alone is usually not enough! This can be a painful chronic injury. Surgery can be considered in refractory cases, but this is rarely indicated.

All my sarcasm and initial reservations about comfort, fit, or suitability for running were muted after my first few walks and my first run in them, which was interesting. They give you a truly free feeling while running, but the thicker ones were better on the pavement.

My verdict on the “Invisible Shoes” is this. They are a great tool to mix into your running training to strengthen your feet, but definitely not an every day shoe for me. I like the little more cushion of the Hattori better and feel more stable in them. As I sprinkle the “Invisible Shoes” into my training just a little more I will update my thoughts going forward.

Best advice is to sprinkle them in your training. Start with walking for a half mile or so then increase by about 10% each time you wear them. Walk around in them for at least 2 weeks prior to even trying to run in them. Take is easy! No more than 200 yards running the first day and, again, increase by no more than 10% each time.

If it hurts or feels overly tired, STOP! Take it back a notch. Overuse injuries can still occur with minimalist shoes if you progress too quickly. Just like every minimalist shoe, it takes time to strengthen your feet and get used to them. Do the exercises I prescribe to strengthen your feet for barefoot running. Focus on your form and build up SLOWLY.

Thumbs up to the “Invisible Shoes” but they should carry a warning label that warns against “too much, too soon, too fast” syndrome!

Wow! What a great panel discussion put on by Saucony in Boston last Thursday night. I love going to Boston during marathon week. It's like Marathon Mecca! The whole city seems to buzz with running excitement. Boston will always be my favorite marathon. 

I had the privilege to be part of the discussion of the evolution of minimalist running and how to transition from stability or motion control shoes to a more minimalist shoe.

The panel consisted of Michael Sandler, who wrote a fabulously crazy but poignant book on Barefoot Running and how it saved him after a severe accident; myself discussing how to strengthen your feet in order to even attempt transition from minimalist shoe gear or barefoot running as well as reminding runners to proceed with caution; Spencer White, head of the Saucony human performance lab, discussing in depth the biomechanical basis for the development of minimalist shoes and how they actually strengthen your feet over time; the legendary coach Dr Jack Daniels, doing coach chalk talk on a white board in order to discuss how to integrate minimalist running as a training tool; and last but not least, Collin Dibble, the owner of Marathon Sports in Boston discussing how to fit runners into the correct minimalist shoe and how retailers have a responsibility to caution and educate consumers on how to slowly integrate these shoes. Whew! What a panel! A fabulous educational experience for all present. I could listen to Dr Jack Daniels telling stories for hours. 

After the panel spoke individually for 10-15 minutes each, then it was time for Q&A. Great questions from the audience showed they were actually paying attention. Even Amby Burfoot from Runners World asked a biomechanics question!

Then it was time to separate into small groups and talk with the runners’ one on one. I was happy to see that I drew a small crowd that wanted to discuss everything from how can I strengthen this muscle or that area to how can I transition safely or can I even think about doing this? Great discussion with a local pedorthist who will probably send me hate mail because I told him he was crazy to be running in a graphite orthotics. A few local podiatrists were also in attendance and I was surprised but delighted that they actually agreed with me that everyone does not need to be in orthotics permanently if their biomechanics can be rehabbed instead of permanently braced. We had a lively discussion about this highly controversial subject in our industry.

Let's briefly discuss this alternative thinking. A runners does too much, too soon, too fast and ends up with let's say plantar fasciitis. Traditional thinking is PF is most likely caused by abnormal pronation. Treatment is to put him in a more stable shoe with orthotics to brace his foot, start stretching, anti-inflammatories, rest and lots of ice. Now what? He's better in 6-8 weeks. Now he wants to start running again. Traditional thought is that his underlying biomechanics predisposed him to have the injury so we should leave him in the stiffer shoes with orthotics. What if he really doesn't have a significantly jacked up foot? Maybe just a slightly over pronating foot? Do we have an alternative to offer him? Yes! Now the hard work starts. Lots of strengthening exercises for the medial and plantar foot and lower leg musculature coupled with balance and proprioceptive training followed by lots and lots of stretching. Then slowly wean him off his orthotics and stability shoes over a period of 3-4 months and transition to a more minimalist shoe gear.

Easy? No! Worth it? Yes, if he wants to find his inner gazelle. No, if he really doesn't care about changing the way he runs to be lighter, faster, and in the long run, less pounding. Can everyone do this? No way! Only about 15% of runners will work that hard to change their running style after an injury, so I don't worry about the orthotics labs going out of business.

That's just the tip of the discussion going on in sports medicine today about the trend of minimalism that is sweeping the running world. Hmmm. Sounds like more blogs to come. 

Part one talked about why shold you embrace minimalism?

A better approach to minimalism is to realize that your feet are weak in their current state and you need to add a foot and leg strengthening program to your current regimen. A strong core is imperative for good, efficient running form. The stronger the core, the longer you can hold good posture as you run down the road in search of your zen.

Six Simple Exercise to Stronger Strides

Here are six simple exercises you can do daily to improve your intrinsic foot strength. I recommend you walk around your house barefoot for five minutes to warm up your feet. Then really warm up your foot muscles by pretending your big toe is a marker and writing the alphabet with your foot. Do this twice. Now you are ready to begin strengthening your feet.

These six simple exercises can help you strengthen the intrinsic muscles of your feet and lower legs to help you transition to a minimalist running style. Remember to also stretch your quads, hip flexors, hamstrings, and calf (gastrocnemius and soleus) as well as your plantar fascia after these exercises to warm down.

Small incremental increases in stress make us stronger. Large incremental increases in stress lead to overuse injuries! Achieve your natural stride slowly and carefully to stay injury free.

Watch the video if you need help with the exercises!

EPAT is the most advanced non-invasive treatment for musculoskeletal pain. Extracorporeal Pulse Activation Treatment is a new way to conquer chronic heel pain. Pressure waves stimulate the metabolism, enhance circulation and accelerate the healing process without surgery. Dmaged tissue of the plantar fascia or Achilles tendon gradually regenerates and eventually heals. Here are the top 16 frequently asked questions about EPAT.

The Top 16 FAQ’s About EPAT Therapy for Heel Pain

‘Tis the Season to Have a Bunionectomy Fa-la-la-la-la-la-la-la!

Seriously! The holidays are upon us and it seems like everyone in Grapevine, Texas, is on my operating schedule or is having some kind of elective surgery with one of my surgeon friends. My family always wonders why my schedule gets completely crazy just when the rest of the world is taking a vacation? Why is it that we do more bunionectomies in November and December than the first two quarters on the year? You may think it is because they have family around to help them, but that’s really not the main reason. It is a little invention of the insurance companies called the deductible.

It used to be that no one wanted surgery over the holiday season. That was when deductibles didn’t exist. Now, policies are written with high deductibles and co-pays. Imagine that if you have met your deductible and your out-of-pocket for your health insurance, any elective procedure is free until the end of the year. January 1, you have to pay again! This has caused the mad rush to the podiatric surgeon as well as any other surgeon in town. Even the plastic surgeons are affected, because people have money in their flex spending or health savings accounts that they lose if they don’t use it before the end of the calendar year. Crazy!

So, you decide to join the masses and have your foot fixed that has been annoying you or out-right crippling you for years. What should you do to survive the holidays and not end up with a bad outcome?

Listen to your doctor. Non-weight bearing or partial-weight bearing means just that. Stay off your foot! A short trip to the mall or football game is not a good idea.

Ice, ice and more ice! Ice and elevation are your friends. They will decrease your swelling and ultimately keep your pain under control.

Limit holiday parties. Just because you are invited to a billion parties does not mean you have to go. Pick one or two small parties and send regrets to the rest. People will understand, even your boss!

Shop before surgery or embrace the internet. I did all of my holiday shopping in one night on the internet last year. A quick side tip is that if you do binge shop, don’t be surprised if you get a call from your credit card company. They just want to make sure it’s not fraud. Using Pay-pal will avoid this.

Order a catered holiday meal or teach your children to cook. Almost every nice grocery store can cater a meal your family will love. As for cooking classes, do it from the couch and turn off the smoke alarm!

Don’t over eat! You are resting, so your portions should be smaller. Most people gain 2-5 pounds over the holidays. Inactivity makes this worse, so be diligent about what goes in your mouth!

Rest and relax. You have taken care of your family for years. Pull out the tiara and a little bell. It’s time some one waited on you. If you live alone, invite a friend to stay for a few days after surgery so you have some help.

And last tip, listen to you doctor! Patients who follow their post-operative instructions are much more likely to have good to excellent outcomes!

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!

This morning I spoke at the DFW Sports Medicine Symposium in Arlington, TX. What a great crowd! Over 300 physical therapists, athletic trainers and sports medicine physicians from all over Texas gathered to discuss advances in the medicine of sports.

Plantar Fibromatosis. Wow, that's a mouthful! What is it? A lump in your arch that is firm and doesn't move. They usually start out as a very small pea sized nodule that increases in size over time. Most people don't even notice them until they get big enough to be annoying in your shoes or when walking barefoot. They can happen to anyone, but are most commonly seen in middle-aged to older patients and are much more common in men than woman. It is also more common in the Caucasian population than other ethnicities.

Most people come into the office complaining of a painful lump in their arch and are very concerned it is cancer. It is actually just an exuberant growth in the plantar fascia (a.k.a. the ligament that holds up your arch) or extra fibrous tissue. We really don't know why they occur, but it is thought that some kind of trauma plays a role in the formation of the nodules. I often see them in pilots and runners who have constant repetitive trauma to this area. Family history is also a factor. As many as 50% of patient with plantar fibromas also have nodules in the palm of their hands known as Dupuytren's contractures. There has been some correlation with medications like beta-blockers and anti-seizure medications. One study even linked an excessive amount of vitamin C with fibrous disorders. Patients with a history of chronic liver problems, diabetes, seizures and alcohol abuse seem to have a higher rate of plantar fibromas.

Treatments vary, but fall into three categories:
1. Do nothing: the nodules are annoying but usually self-limiting. They do not grow indefinitely, so if you can put them down as life's minor annoyance, most patients choose to just leave them alone.
2. Conservative or Non-invasive: Vigorous stretching, accommodative orthotics, physical therapy, and topical transderamal Verapamil.
3. Surgery: injections with a corticosteroid can be helpful to decrease the inflammation around the nodule, but if they are large and painful; most go on to surgical excision.

What should you do? A personal question, that only you with the help of your doctor can answer. In my opinion, if the nodule is small, leave it alone. If it is increasing in size, then it should be addressed.  If the nodule is of moderate size, with no intrasubstance calcifications on x-ray, and is annoying; a three to six month trial of transdermal verapamil coupled with an accommodative orthotic and physical therapy can be helpful. If it meets these criteria and is a little soft, then a steroid injection may also help decrease the size. If the lesion is large, painful, or has intrasubstance calcifications on x-ray; then excision is most likely your best option. Simple excision is not enough with these lesions, removal of not only the lesion, but a large margin is necessary to decrease recurrence rates.

If you have a painful lump in your arch, seek the advice of your podiatrist. Help is only a phone call or mouse-click away!

Great question! I hear this question at least several times a month from my active, athletic patients. Of course, my first response is always, “Are you able to run now?” This is not sarcasm, but a true fact finding mission. If you are unable to run before your surgery, due to the pain in your bunions, then if you can run afterwards - I am a hero! The same goes for the opposite. If you are running pain free before surgery, and really only want your bunions fixed due to the fact you think your feet are ugly, if you can’t run afterwards - you really don’t like me very much!

Let’s talk about this a little more in depth. A bunion is the result of undue stress on the big toe joint, which causes a protuberance of bone or tissue around that joint.  Bunions can be very painful, inhibit normal walking, and make it difficult to fit into some shoes. Contrary to popular belief, bunions are aggravated, not caused, by tight shoes. They usually are due to inherited faulty foot mechanics which put abnormal pressure on the front of the foot.  Pain is the primary reason patients seek medical attention for bunions. A majority of bunion surgeries are performed on women because they wear tight-fitting, high-heeled shoes that worsen the underlying foot problem and cause abnormal stress to the joint.

There’s good news for anyone considering bunion surgery. A survey in 2003 by the American College of Foot and Ankle Surgeons (ACFAS) had surgery performed by a foot and ankle surgeon to correct bunions within the past 6 to 24 months found more than 90 percent of patients who had the procedure say they experienced significant pain relief, increased their physical activity, and would recommend it to others.

Many runners who can benefit from the surgery avoid it and continue to endure pain because they have heard that surgery doesn’t work and is excessively painful. Their biggest fear is that they may not be able to ever run again! The truth, as evidenced by the survey results, is that advanced surgical techniques have allowed us to effectively correct bunion deformities with excellent outcomes in terms of pain relief and improved quality of life.

Ninety-six percent of the survey respondents identified pain relief as a desired outcome of the surgery, and 86 percent also said they hoped to improve their walking and increase their physical activity following surgery. On a scale of 1 to 10 with 10 representing “much pain,” the survey respondents averaged a score of 7 when assessing their pain before surgery, and the average score dropped to 2 when they assessed their pain six months after the operation.  Ninety-two percent said they were able to increase their physical activities -- walking, golf, tennis, exercise -- and 90 percent said they would recommend bunion surgery to others. 

That being said, in most cases, we can treat the pain caused by bunions conservatively. In fact, we feel strongly that surgery should be a last resort. We surprise many bunion patients with our ability to help them avoid surgery when they have been told previously they have no choice but surgery. A custom foot orthotic to off weight the bunion in your shoes is often very helpful. Many patients run for years pain free in orthotics before they decide to have surgery. If you have tried all conservative treatment, however, and bunion pain is causing pain or limiting your activity, surgery as you can see, can be a very effective option.

If the pain in your bunions has caused you to decrease or eliminate running from your life, contact our office for alternatives. Do not let the pain in your bunions change your life!

Run Happy!

Craziness! Earlier this week I was fortunate to carve out a 4 hour block of time for a long cycling workout. Being new to the sport of triathlon, 50 miles was the longest bike ride of my life! It was a really long, hot ride! The funny part was the only part of my body that hurt during and after the ride were my feet! Why is it that my feet hurt instead of my butt or legs? Turns out, I am not alone. Foot pain is much more common in cyclists than most of us realize. Biking is much gentler on my body than running, but your feet do take a pounding!

Let’s investigate foot pain in cyclists just a little. I experienced a burning pain in my forefoot after about 40 miles that did not go away until about 2 hours after I got off my bicycle. Why did this happen? In my case, I sized my cycling shoes too small for the training plan. My shoes fit well when I started, but as soon as my feet started to get hot; they swelled and literally got squished by the stiffness of the shoes. At 40 miles, the nerves in between my toes were pinched and all my toes went to sleep then started to burn like they were on fire! This is commonly called metatarsalgia, traumatic neuritis or parasthesias.

Foot pain like I experienced is actually not uncommon in cyclists. This can be caused by improper placement of clips, poorly sized shoes and certain foot deformities that require more support in the shoes. Luckily, most foot pain can be solved by bigger shoes, metatarsal padding, different socks or custom foot orthotics. Burning pain can be a sign of a Morton’s neuroma, an early stress fracture or lumbar radiculopathy (a pinched nerve in your back), so if your burning does not go away with simple solutions, quickly seek the advise of your podiatrist or sports medicine physician.

Other foot related problems seen in cyclist are plantar fasciitis and Achilles tendonitis, which in the early stages are usually solved by raising your saddle or turning it slightly askew. Often, we wait too long to address an injury because we think it will miraculously solve itself. Long standing foot pain often requires more aggressive treatments with custom orthotics, physical therapy, injections or even surgery in severe cases.

Thankfully my foot pain completely resolved with slightly bigger shoes, a thinner sock and a small metatarsal pad. My upcoming long rides on the way to a half-Ironman triathlon in the fall should be much more comfortable and pain free!

Cycle on....and keep tri-ing!

Houston Rocket's Yao Ming's career may be over due to a non-healing foot fracture. He was sidelined during the playoffs on May 8th with a hairline fracture of his navicular. As of today, this has not healed properly. The nature of his non-union and his prognosis is being kept quiet by the team physicians, but it is evident that there is a problem. Most stress fractures heal completely in 6 to 8 weeks. This is not the 7 foot 6 inch center's first fracture. He has been out portions of the last three seasons with stress fractures in his leg and foot. Perhaps his lanky frame just can' handle the stress of the NBA? Why is it that some fractures don't heal?

Looking at his present injury, stress fractures of the navicular (the cornerstone of your arch) are often slow to heal due to three factors, blood supply to the bone itself, underestimating the extent of the initial fracture so delaying aggressive treatment and too much abnormal stress on the healing bone. Other medical issues can delay bone healing like lack of Vitamin D, poor calcium uptake and many other systemic problems like diabetes, hypothyroidism and peripheral vascular disease. Many of these fractures are actually missed due to lack of specific x-ray findings. Many fractures are actually misdiagnosed for months. Plain film x-rays are often read as normal so the fracture is missed until symptoms increase. Early symptoms can be diffuse and non-specific so the index of suspicion is also low. A bone scan, MRI or CT scan can identify the specific fracture. CT scan is often the most helpful in identifying the extent of the fracture and guiding treatment. For a non-displaced stress fracture, cast immobilization is the first line therapy. Studies have shown that non-weight bearing immobilization in a cast for at least 6 weeks is usually around 80-86% successful. For those that do not heal this way, surgical fixation of the fracture can be helpful and a bone graft may be needed for long standing non-unions. New technologies like electronic and ultrasonic bone stimulators and injectable platelet rich plasma can help even the most stubborn fractures.

Follow up care for a navicular fracture often includes physical therapy and custom foot orthotics. Abnormal biomechanics of the foot often are one of the causes of these fractures, so biomechanical control is crucial to distribute the abnormal stress so an athlete can return to sports and have a lower risk of recurrence.

Yao Ming has had multiple stress fractures during his career increasing the likelihood of traumatic arthritis from avascular necrosis (not enough blood supply to heal so the bone crumbles) in his foot causing him to retire. The next few months will tell the tale for this multi-million dollar All Star. Can he heal his fracture and return to sport? The Rocket's fans are praying for divine intervention to cure their dominant center. 

It happened again today in my office. A woman came in asking for bunion surgery. She had put up with the pain in her big toe for years and finally had had enough. Many years ago her family physician told her to wait until she couldn’t stand the pain in her foot before discussing surgery with a podiatrist. Like many physicians, she assumed any pain in the great toe accompanied by a bump was a “bunion” or Hallux Abducto Valgus. Unfortunately in this case, she was wrong. The patient actually has Hallux Limitis also known as osteoarthritis of the great toe joint. If she had sought treatment many years ago, her joint may have been salvaged. Now her joint was so destroyed that she needed a joint replacement or fusion. Not what she wanted to hear! In her mind, she came in the office asking for a simple bunionectomy and left needing a joint replacement. She regretted not seeking the advice of a podiatrist earlier.

So what’s the difference between Hallux valgus and Hallux limitis?

Hallux valgus is a crooked big toe joint. Over a period of years, the great toe becomes much friendlier with the second toe and drifts toward and eventually under or over the second toe. At the same time, the first metatarsal (long bone connected to the great toe) drifts towards the center of your body making the distinctive bump. This starts out as a minor annoyance, but then quickly becomes a shoe problem with rubbing on the bump. Most people seek the attention of a podiatrist when the bump is rubbing in their shoe and becomes painful. If the deformity is allowed to progress, the great toe joint can actually start to dislocate and you will start to experience joint pain and degeneration.

Hallux limitis is wear and tear arthritis or osteoarthritis of the great toe joint. Many people are predisposed to have this problem by the underlying biomechanical function of their joint. It becomes much worse after an injury or repetitive trauma from things like high heeled shoes, ballet or some sports. The symptoms are different than Hallux valgus. Hallux limitis usually starts with a feeling of stiffness of the joint. It can be accompanied by swelling and redness. This usually progresses to a decrease in range of motion, a distinctive crunching feeling when moving the joint and then a bump that forms usually more toward the top of the joint, not the side like Hallux valgus.

Hallux valgus and Hallux limitis can occur together in a more complex foot deformity. Usually the bunion deformity has progressed and then is injured by repetitive trauma or a distinctive injury. This starts the progression of the arthritis change. Bottom line: don’t ignore pain in your great toe joint. Treatment of Hallux limitis early can save you from needed a fusion or joint replacement!

Why is treatment of Hallux limitis so important in the early stages?

Once you have destroyed the cartilage in your joint, there is nothing a physician or surgeon can do to make more cartilage. Research is underway trying to replace or regrow cartilage, but we are many years from a solution. Hallux limitis in the early stages can be controlled with a functional shoe orthotic to control the biomechanics. A clean up procedure known as a cheilectomy can help remove all the debris from the joint and get rid of much of the crunching. This will slow down the progression. Some patients can really benefit from a surgical procedure to realign and shorten the metatarsal to give the joint better biomechanics and more joint space. Unaddressed Hallux limitis leads to complete joint destruction and the need for a fusion or joint replacement.

The flip side to this story is that patients with Hallux valgus or your tradition bunion can often delay treatment until they start to have pain. Bunions in the early stages are a cosmetic concern, but the joint is usually not damaged until the later stages. It is important to address Hallux valgus when it starts to hurt so the joint is not permanently injured, but a bump, in the absence, of pain can wait.

The take home message is to have your great toe pain examined by a podiatrist. A full examination including functional biomechanics and x-rays can determine whether your pain is from Hallux valgus, Hallux limitis or a combination. Only then can you make an informed decision on treatments for your foot deformity and pain. Waiting until you can’t stand it anymore is a recipe for unhappy outcomes! If you have great toe pain with or without a bump, don’t delay.

See your podiatrist today so you can keep running happy!

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

Physical activity is always encouraged, but working out too hard too fast puts your body at risk for injury. When starting to work out or changing your workout routine, make sure you give your body time to adjust to the new stresses. It takes time for your muscles and bones gain the strength necessary to absorb the impact of running, jumping, and jarring. When your muscles fatigue, they no longer distribute the forces along the entire bone and the bone has to carry an increase of load. This will lead to fractures. Sometimes even changing the surface you run on can lead to injuries. If you are used to running on the grass or a softer surface, changing to cement or concrete surfaces will force your body to absorb more of the impact. You may not notice the bone fatigue initially but over time, you may develop a small crack in the bone or stress fracture.

Stress fracture pain is usually experienced with increased activity. Therefore, one may notice the pain to get worse the more they work out. The pain also occurs earlier in the workout as the fracture progresses. Initially the pain will subside with rest, but as the fracture increases in size the pain will become more constant. The pain may also be elicited by palpating the area over the fracture. Sometime a doctor may use a tuning fork to elicit the pain. The fork causes vibrations in your bone, and if a fracture is present it will cause pain. If no fracture is present, the tuning fork will not cause pain. Your podiatric physician will also take x-rays to rule out any other complications. The stress fracture will often be unapparent on a x-ray because the crack is so small. Therefore, the physician may need to order an MRI or bone scan to further assess the injury.

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

This is a guest blog by Dr Peter Wishnie.....Run Happy! And with less stress :)

The more biomechanics research I read, the more I believe that for some runners they may be helpful. I'm not saying I completely support their use just yet, but I'll keep you posted! The research is quite good and anecdotal evidence from all my triathlon peeps is good!

Here is a video that outlines the basis of Newton shoes.

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

Run Happy! And don't be afraid to try new things! Especially hot pink shoes!

Let's take a closer look. Your heel swings from side to side as your foot moves. When the heel swings correctly, your foot can flatten and regain its arch as you walk. (normal pronation with resupination) But if your heel swings too much, your foot may flatten more than it should. (overpronation) Over time, such excess movement causes many foot problems. And yes, some people do walk normally, but not many.

When the heel hits the ground, its outer edge touches first. Soft tissues (muscles, tendons and ligaments) relax. Your foot is able to flatten, adapt to uneven surfaces, and absorb the shock of touchdown. During midstance, your heel is below the anklebone, and the front and back of your foot are aligned. Your foot easily bears your weight. As the heel lifts, it swings slightly to the inside. Muscles, tendons, and ligaments tighten. Your foot regains its arch, allowing your toes to push your weight off the ground.

Too Much Movement Causes Strain!

When your foot flattens too much (overpronation), some bones are forced to support too much weight. The muscles pull harder on these areas, making it more difficult for tendons and ligaments to hold bones and joints in place. Over time, you may develop swelling or pain on the bottom of your foot or near the heel. When your foot flattens too much, the ankle and heel do not align during midstance. The foot strains under your body's weight. This aggrevates the growth plates and makes kids have foot pain.

Abnormal biomechanics causes overpronation. This is easily controlled with a custom orthotic. That is why most biomechanical foot pain and deformities are treated conservatively with custom orthotics. Change the biomechanics, decrease the stress and take care of the pain from the strain.

Custom orthotics with vigorous stretching can make your child walk as close to normally as possible. Some kids still run a little funny due to the growth process, but at least when aligned they don't strain and won't complain of pain!

So soccer moms, if your child runs funny and is complaining of foot, ankle, knee, leg or back pain....it definately can be their feet.

Let's check them out before the season becomes a wash!

The Debate Continues....On and On....

They are at it again. The debate that has been going on since the late 1970’s when custom orhtotics became the mainstay of treatment for plantar fasciitis. “Millions in Potential Health Care Savings: Prefab Orthotics Found More Effective” was a press release today from a company that...guess what?…makes an off-the-shelf arch support! Are you kidding me???

Now don’t get me wrong, I think there is a place for prefabricated arch supports in our treatment plans and not everyone needs a custom orthotic; but to say that prefab is BETTER than custom is ludicrous! Let's use common sense! They sited a poor study done in California on patients with plantar fasciitis and then backed it up with a totally flawed study from 1996! That’s all they have??? What about the millions of patients that have been helped by custom orthotics across the country? Several thousands right here in the Dallas/Fort Worth area!

Just another ploy to get patients to potentially waste their money on off-the-shelf inserts prior to visiting their podiatrist! A copay is much cheaper and I am so sick and tired of seeing peolpe waste hundreds of dollars on things they find on-line. Then spend months in physical therapy or even need surgery to try to conquer their plantar fasciitis; when they could have gotten better much faster IF the first thing they did was call the podiatrist!

I’m done venting, but for more information on why custom orthotics work check out my patient information pages.

I was returning this morning from Ft. Lauderdale and going through security with a few hundred other sun-kissed travelers when it hit me that most people were actually BAREFOOT going through the security line. I had my trusty socks on, but the majority of people were barefoot on carpeting that probably saw at least several thousand stinky sweaty feet a day. Disgusting! Don’t people realize that walking barefoot in an airport even for a short period of time puts their health at risk? I guess not. 

Let’s talk about this. You would never walk barefoot in an airport bathroom, right? No. That would be completely gross to most Americans. Yet, the bathroom floor probably is cleaner than the carpeting in the security line. The bathroom floor gets cleaned several times a day with disinfectant. The carpeting in security might get vacuumed once or twice a day, but most likely gets actually cleaned very sporadically and only when something gets spilled. I can’t confirm this because the TSA agent working the security line had no idea when or even if the carpeting was ever cleaned!

What’s at risk? Let’s make the assumption that you are a very healthy person with no chronic diseases that would hamper your immune system. What could you possibly pick up from a dirty carpet? Let’s just talk about the really common things because the list could actually be quite lengthy!

A very smart person once said that a goal not written down is just a mere wish.  I passionately believe this is true and have proven the power behind written goals in many aspects of my personal and professional life. In fact, this year I was planning on running the Sacramento Marathon, but fell in a pothole and broke my foot just a few months before the race! The fact that my foot was broken did not deter me from trying to reach my goal (Yes, I am that stubborn). I cross-trained; swimming and biking for hours, trying to keep my cardio fitness intact, just so I could indeed run this planned marathon. It was the week before the race when my husband interjected just a little common sense (please don’t tell him I said he was right) and he asked me why I was so hell bent on running Sacramento? There were so many other races on the schedule and I had only recovered from my stress fracture 3 weeks prior and done a long run of only 16 miles. I really did not have any good reasons to tell him except for the fact that I had written it down as a goal almost 6 months prior and I was determined to reach that goal. Common sense intervened (maybe I’m not that stubborn after all) and instead I did my first triathlon, all that biking and swimming was good tri training, then I picked a marathon 2 months later that I could run after adequate training. Goals are a powerful thing. Running goals can take on a life of their own and guide our training.

I challenge all of you to do a goal writing exercise to determine where running fits in your life. Think about lifetime goals; perhaps qualifying for Boston or just to finish an entire marathon; then break down your goals into smaller segments. Try to ascertain how you will reach that lifetime goal by achieving smaller goals; write down your 5 year goals, your 3 year goals, your 1 year goals, and finally your immediate  goals. It is hard to run a marathon without starting a running program, perhaps training for your first 5K can be your quarterly goal, then a 10 or 15K for 1 year goal, then build up to the marathon or a faster marathon from their. Again, looking at lifetime goals by themselves is often overwhelming; but broken down into smaller increments  become very doable!

Look at your goals then start a reasonable plan to meet them! Not only are you more likely to meet your goals if you write them down, but you are also less likely to get injured if you follow a plan.

Run Happy! And reach For Your Goals!

HEEL PAIN (PLANTAR FASCIITIS)

This syndrome is most commonly caused by several factors, including, but not limited to:
-Tight calf muscles
-Increase in body weight
-Sudden change in the amount of intensity of exercise
-Improper or worn out shoes
-Abnormal foot biomechanics (excessive pronation or supination)
Due to any of the above factors, the plantar fascia (the ligament that holds up your arch) is pulled or strained so that a portion of this very strong ligament starts to tear or fray like a rope at its weakest point (where it attaches to you heel bone). This tearing causes microscopic internal bleeding in this area. Your body reacts by causing inflammation, which in turn causes irritation to the nerves, bursae and muscles in this area. As the inflammation occurs, the body tries to heal itself by depositing calcium in the area of the tear. This creates the “spur”. Not everyone will have a visible spur on x-ray, especially in the early stages. The spur is not the cause of the pain! It is just a tangible sign that extensive tearing has occurred. The tearing and straining is the cause of the pain and then the nerve becomes inflamed which makes the pain more sharp and long-lasting. The straining must be stopped, along with the inflammation, in order to resolve this problem.

Diagnosis of plantar fasciitis is made with a physical examination including a biomechanical exam. X-ray are recommended to rule out a stress fracture or tumor in the area. Shoe gear is also evaluated. (Don't forget to bring your running shoes to your appointment!)

Treatment initially includes all of the items listed below. If any of these treatments increases your pain, please call or contact the office. It has been estimated that 85% of heel pain can be eliminated by non-surgical treatements; but these take time and effort on the part of the patient and doctor. BE PATIENT! Your heel pain did not appear overnight, and it will take a while to totally eliminate the pain.

Conservative therapy can include:

1. Ice (at least 15 minutes twice a day);

2. Stretching (your doctor will give you calf and arch stretching);

3. Anti-inflammatories (either orally or in an injection); and

4. Arch supports/Taping/or orthotics.

Remember that treating the biomechanics of your feet treats the underlying cause where the other treatments are only treating the symptoms! Some people need physical therapy, night splints, and casting for relief. Conservative treatment often takes 4-6 months to eliminate plantar fasciitis.

Surgical treatment is the last alternative, after conservative therapy has been exhausted. Extracorporal shock wave therapy (ESWT) is a relatively non-invasive surgery that is quite effective, but deemed experimental by many insurance companies. If you are interested in more information about ESWT, click on the word underlined above.

There are two common surgical approaches to heel pain: the traditional approach (removes the spur) and the endoscopic approach (lengthens the ligament to reduce the strain and therefore reduce your pain). If your pain is not eliminated by conservative treatment after 4-6 months, we will discuss which approach is best for you.

Remember, the earlier you seek medical help for heel pain, the faster it will go away! If you have pain more than 5-7 days in a row in the same spot, call or contact our office for an appointment.

Need help with stretching? Go to our video  Donnie and Dr Crane amatuer video heping you stretch your way to pain relief on YouTube! You are not allowed to make fun of our amatuer photography!

Run Happy! And treat your heel pain early for the fastest results!

There are general rules for injury prevention that must be followed to avoid loss of training due to injury. Consistency and gradual incremental increases in overall athletic stressors are the key to any successful training program.

Causes of injury 

Probably the main cause in distance running is the volume of training, especially if there is insufficient rest between sessions. This is the classic “too much, too soon, too fast” syndrome. Research has indicated that there is no link between speed and injury in distance runners, unless of course an appropriate warm-up routine has not been followed. Don't overdo it! The amount of training you actually carry out plays a key role in determining your real injury risk. Studies have shown, for example, that your best direct injury predictor may be the amount of training you completed last month. For example  if May is a heavy training period, watch out in June! This relationship may seem strange at first, but it simply reflects the fact that vigorous training produces tired muscles which may not be able to stand up to further training stresses. Fatigued muscles also do a poor job of protecting their associated connective tissues, increasing the risk of damage to bones, cartilage, tendons, and ligaments.

Many injuries occur due to weak muscles or muscle imbalance. Assessment of muscle strength and balance and regular sports massage can be an integral part of a sports injury preventative strategy.

Resistance strength training can make muscles less susceptible to damage. This can be achieved in the gym or at home in your living room with a few dumbbells and a core ball.

It is important that any exercises are specific to your sport. In distance runners, adding hill training to your strength program can be a valuable tool for injury avoidance if carried out properly. Core stability exercises are an extremely useful tool in preventing muscle imbalance, especially in woman.

Remember that to achieve your running goals, you need months and years of successful running free of injury and illness. Pay attention to your body and all of these tips to ensure that you’ll continue to pound the pavement injury free for years to come!

Run Happy!

55 million Americans experience one or more foot problems every year! Many fail to seek medical advice early and develop more complicated foot conditions that can be severe and difficult to treat. One of the most common foot problems is heel pain. It is estimated that 15% of the adult population complains of heel pain, which includes one million runners who experience heel pain (plantar fasciitis) every year. The American College of Foot and Ankle Surgeons has stated that heel pain has reached epidemic proportions in weekend athletes. This common condition is typically ignored, especially by athletes. People tend to seek treatment only after the problem becomes severe and disabling or when they just can’t run. When foot health concerns are ignored, simple conditions can develop into more serious problems affecting the ankles, knees, hips or the back. A simple functional orthotic is the answer for many people experiencing this kind of foot pain.

Orthotics are devices which fit into the shoe to aid the foot and allow it to function more optimally. "Functional orthotics" are usually relatively rigid in shoe braces that are designed to control motion and correct the function of the foot. Individuals with flatfeet, tendonitis, plantar fasciitis, knee, hip and back problems  and certain foot deformities, may benefit from functional orthotics.

Will orthotics help my foot problems? The goal of the functional orthotic is to control the abnormal motion in the foot, improve foot function, decrease the pain in the foot, ankle, knee, hip or back and to add support. The orthotic should make standing, walking, or running more comfortable. The orthotic must be rigid to help control the motion in the foot and add support. If the orthotic is soft, the weight of the body would collapse the device and it would no longer function.

Functional orthotics are a successful treatment for many problems affecting the lower extremity. In a recent article in the Journal of the American Podiatric Medical Association, 75% of patients surveyed had good to excellent results from functional orthotics. This includes 17% who felt the orthotics "cured" their pain. Less than 10% had no relief. The most commonly treated condition in the study was a painful heel. Over 20% of patients surveyed were treated for a painful heel and 20% were treated for a painful arch. Fourteen percent of the individuals were using orthotics for flatfeet. Other conditions treated with orthotics were knee, hip and back pain, foot arthritis, bunions and high arches. Tendonitis was not specifically evaluated.

Individuals with plantar fasciitis (heel and arch pain) who also have flatfeet usually respond best to orthotics. People with high arches may require orthotics as well, but they do not respond as well. Orthotics can help slow the progression of bunions and hammertoes, but they will not prevent this process. Orthotics may help with some pain at a bunion, but they will not "cure" the bunion. When the motion in the foot is contributing to the problem, orthotics are generally recommended.

Podiatrists are the most common prescribers of orthotics, but pedorthotists, orthotists, physical therapists and sometimes chiropractors will also provide orthotics. Remember that the device is only as good as the doctor taking the mold and writing the prescription. Make sure that your practitioner is trained in foot biomechanics and experienced in orthotic therapy.

Orthotics are a staple in the treatment of the majority of foot pain. When utilized for the correct indications, orthotics are highly successful in controlling foot pain and can add pep to your step! Orthotics have helped Plaxico Burress conquer his chronic injuries and they may help you!

Run Happy! And Thank God Football Season is almost here!!!!

So we all know that to prevent blisters, you need to minimize friction. This begins with shoe selection. Shoes should fit comfortably, with about a thumb's width between your longest toe and the end of the shoe. Remember that this is often your second toe, not your great toe! Narrow shoes can cause blisters on the great toe and little toe. A shallow toe box can lead to blisters on the tops of the toes, while loose shoes can create blisters on the tips of the toes. Shoes that are too big can cause sliding of your foot which can blister the soles as well as the tips of your toes.

Always try on shoes in the afternoon or evening, because feet tend to swell during the day. Walk or run around the store before buying them and then wear the shoes around the house for 1 to 2 hours to identify any areas of discomfort. It often helps to break in shoes by wearing them for 1 to 2 hours on the first day and gradually increasing use each day.

Socks can decrease friction between the feet and shoes. Coolmaxx or synthetic moisture wicking socks or even special double-layered socks can minimize shearing forces. These can wick moisture away from the skin more effectively than wool or cotton can, further decreasing the likelihood of blisters. You can also carry extra pairs of socks to change into if your socks become too damp on a long run.

Another preventive measure is to use padded insoles or moleskin to decrease friction in a specific area. Drying agents can also help. Foot powders and spray antiperspirants are inexpensive ways to decrease moisture. For severe sweating, there are prescription antiperspirants you can get from your physician that provide even more effective drying.

A study of West Point cadets revealed a more than 50% decrease in blisters in those cadets that used spray antiperspirant before running, but many experienced some skin irritation; so test the antiperspirant on a patch of your foot before trying this on the run.

A thin layer of petroleum jelly or Body-Glide can also be applied to the feet to decrease friction. Conditioning the skin by gradually increasing activity tends to lead to formation of protective calluses rather than blisters.

Blisters are a fact of life in distance runners. Almost one in three marathon runners experience blisters at some point in their training.

So how should a blister be treated?

1. If the blister is small and not painful, leave it alone! Place a small band-aid or piece of moleskin over it to protect it and treat the cause so it will not become bigger.

3. Once your blister has been drained, you should treat it as an open wound. Dress it daily with a bandage. Keep it dry and clean for a couple days and if you engage in the activity that caused it in the first place before it heals, take care to provide extra padding and secure the area to prevent any rubbing that may irritate the wound. Change the dressing anytime it becomes moist or soiled and keep an eye out for infection.

When should I see a doctor for a blister?
If you experience increased redness, swelling, pain, or green or yellow discharge you should take it to your physician immediately to make sure it's not becoming infected.

Bottom line: blisters are a common annoyance for many runners. These tips should help you conquer this pesky problem before it slows down your run.

Run Happy! And hopefully blister free!

Stop in at Healthy Steps and check out our display of men’s and women’s sandals!

Men’s Cross Trac (sandal with forefoot and ankle strap) $100.00

A few helpful points:

Beveled outsole helps promote natural stride

****Please note****Crocs Orthosport sandals do not accommodate custom or OTC orthotics because in most cases you don't need them!

Summer comfort! Run Happy!!

What it is: Kinoki Detox Foot Pads, $19.99, www.buykinoki.com

What it claims to do: The foot pads collect “harmful toxins” from your body while you sleep, says the manufacturer, by “cleansing and detoxifying your skin’s outer layers,” boosting your energy level and improving your health and wellness.

Unfortunately these don't work.....no miracle detox and feeling of invigoration....perhaps just great marketing......

Decide for yourself...Here's the full story

Bottom Line:  While Kinoki foot pads probably won’t hurt you, they likely won’t help you either. Save your money and put it toward a nice safe pedicure at Healthy Steps!!

Run Happy!

Just do it! I may sound like a commercial, but it is good advice. Today should be the last day you try to use lame excuses to continue being fat, tired and a cardiac risk! Write down you excuses. When you look at them on paper, you realize most are ridiculous and can be overcome. Starting an exercise program can be a monumental challenge, but we are all up to it! I guarantee you will thank me in a few months when you are closer to your ideal self than you thought possible!

Run Happy...and often! It gets easier!

I was almost apoplectic! Injected his tendon or even around his tendon?! In my world, that’s almost borderline malpractice; but I can’t fault the physician, she obviously didn’t know any better and was trying to treat the patient. Bottom line: Go to a sports medicine physician. We would all tell you the same thing: injecting the Achilles tendon can lead to spontaneous rupture which would basically end his running days. Look at poor Dan Marino…a ruptured Achilles tendon ended his Hall of Fame career!

Let’s talk about Achilles tendon injuries. They are very common especially in runners with high arched feet or very flat feet. Both of these foot types put way too much torque on the tendon and will cause a wear and tear tendonitis that eventually becomes tendonosis without proper treatment.

Tendonitis results from overuse. Long-standing tendonitis becomes tendonosis (degeneration of the tendon) which is much harder to treat. This overuse can happen over a period of time or can happen over a weekend.  Those of you who exercise regularly or are in training for an athletic event, as strong as the Achilles tendon is, this work horse could use a break every once in a while!  With chronic, long term, sustained use, this tendon becomes strained.  It also can become just as strained with whom we fondly refer to as the “weekend warriors”.  You know who you are!  You are the ones who think it perfectly o.k. to hike the Appalachian Trail or take the steep way down the Grand Canyon over a three day weekend because “it was there”! Marathon runners who decide they can run the Western States 100 without the proper training….you can't hide for long....I will find you....

The simplest form of treatment can involve rest, heel lifts, icing, inserts, night splints, custom orthotics and anti-inflammatories.  More complex forms Achilles tendonitis can include immobilization through a boot or cast, physical therapy, and in the most resistant cases, surgery. Active release myofascial release is very helpful. Thank God for David Bloom at Restoration Physical Therapy and Dr. Darryl Laney at Laney Chiropractic in Keller! Most of my long-standing Achilles tendon injuries are successfully treated with aggressive PT and manipulation on top of orthotic control. The longer you have it, the worse it gets.  Do not let it get that far. Tendonosis is a chronic degeneration that can lead to splitting of the tendon and long term disability!

Thinking of waiting to see if it works itself out or are trying to work through the pain?  Let us help you reconsider. Chronic Achilles tendonitis (tendonosis) results in degeneration and breakdown within the tendon and this, in turn, can lead to a partial tear or full rupture.  Now that will put you out for more than a couple months!    If you are experiencing a nagging pain or swelling to the Achilles tendon or the back of the heel, call or contact the office to have it evaluated.  It is that simple!

The rising popularity of flip flop sandals and Crocs shoes, has brought escalator safety concerns for children in the United States to the forefront. As a physician and mother of three small girls, a few questions came to mind. These two types of shoe gear have been lumped together as increasing risks, but is this a truly fair assessment? What is the truth about the risks involving our children and escalators? Is awareness enough to protect our children? Do the shoes our children wear on escalators matter?

Let’s start with a look at the numbers. In the United States there are an estimated 35,000 escalators with approximately 245 million riders daily. The Consumer Product Safety Commission estimates that about 10,000 people go to the emergency room every year after accidents on escalators and 20 percent of these injuries involve entrapment of feet, hands, or shoes. That’s approximately 2,000 emergency room visits per year for such entrapments, which usually involve softer shoes or bare feet.  The fact that these figures have been fairly constant for the past 15 years, long before the advent of Crocs, seems to nullify the idea that somehow Crocs are more susceptible to such entrapments than other soft footwear.  Given the number of kids wearing Crocs today, it only stands to reason that eventually an entrapment would occur, as Crocs are not immune to rider missteps resulting in being grabbed by escalators, any more than flip flops, jelly shoes, sandals or soft running shoes.

What puts our children at risk? The fact that escalators are dangerous to small children has been well known for years. In fact, in 1997, in the Journal of the American Academy of Pediatrics, it was reported by a group of physicians from the Department of Pediatrics, New York University School of Medicine and the Pediatric Emergency Service, “Children are at risk for sustaining severe injuries on escalators. Young age, inadequate adult supervision, improper activity while riding on the escalator, and escalator-related mechanical problems all increase the risk of injury. Public and parent education directed toward escalator safety issues may help to reduce escalator-related injuries in children.”  The largest incidence of injury was reported to be involving children between 2 and 4 years old (50%) with the average age being 6 years old. It should also be noted that 60% of children fell prior causing their injury.

The action of stepping off the escalator is associated with an increased risk of injury. Young children may remain standing on the escalator and allow their feet to slide off at the end, instead of actually stepping off. The small size of a child's foot may increase the risk of it slipping into the gap where the last step slides into the comb plate. While stepping off an escalator may seem like a simple and natural task to an adult, the developmental level of young children limits their ability to both anticipate and coordinate this action. In addition to feet becoming entrapped during the process of stepping off, children's small extremities may become lodged between two steps or between a step and the side-rail.

We can continue to ride escalators with our children if we follow some simple safety tips from the Consumer Product Safety Commission:
1. Loose shoelaces, drawstrings, scarves and mittens can become entrapped. Make sure a child’s clothing does not put them at risk.
2. Always hold children’s hands, just like crossing the street!
3. Do not permit children to sit or play on the steps.
4. Do not carry children in strollers, walkers, or carts. Use the elevator.
5. Always face forward and hold the handrail. If you fall, you put your child at increased risk!
6. Avoid the edges of the steps where entrapment can occur.
7. Always pay attention and alert while riding with your children, note where the emergency shut off is.

Prevention of escalator-related injuries is the key and efforts should be focused in two directions. Safety education for parents should include and give specific guidance regarding injury prevention about riding on escalators. Increased parental supervision should be encouraged, such as hand-holding or even carrying of young children while riding on and especially while stepping off escalators. Children should be taught not to run, play, or sit while riding on an escalator and of course, children should face forward and hold the handrails.

The bottom line about escalator injuries is that no matter what shoes a child is wearing, if the parents are not supervising them closely, injuries can occur. There is no specific correlation between shoes and injuries; they occur even in the best of circumstances usually due to inattention and children’s unsafe behavior. Parents need to be diligent about watching their children and following the guidelines to provide a safe ride for all children on escalators.

What’s the Deal with Runner’s Knee Pain?

I had an email last week from a relatively new runner asking who they should see for their knee pain. I asked if they twisted, fell, or jammed their knee or if it was just a wear and tear injury? They confided that as they increased their mileage and distance, their knee pain started to increase. New shoes helped, but didn’t fix their nagging pain. Sounds like a biomechanical problem to me! But it could still be a traumatic injury they can’t remember…especially if they were out dancing on tables on a Friday night ... Just kidding!

Seriously, mechanically induced knee pain is extremely common in runners. A good analogy is that if you need a tire realignment on your car, the struts can wear out. In fact, you may have no acute foot and ankle problems at all and they can still be the cause of your symptoms.
The best way to assess a runner’s knee problem is to start with a sports medicine orthopedist who can rule-out a primary knee problem, like a tear in the meniscus (cartilage), ligaments or tendons. If a primary knee problem is ruled-out, but you just keep having this nagging pain; or if your tendonitis keeps recurring in spite of being compliant with physical therapy and rest; it’s time to look elsewhere for the cause.
Your feet affect the function of all their contiguous structures or in English, everything they are connected to. Yes, your feet can even cause back and neck pain!

How? Your feet affect your postural control. Postural control is the ability to maintain the body’s center of mass over the supportive foot, a.k.a. being able to keep your balance. Often, balance or proprioception is lost in patients with chronic foot and ankle instability from an underlying congenital foot type. This leads to lack of postural control which leads to knee, hip and back pain a.k.a. postural symptoms. Many studies have concluded that a functional orthotic reduces postural sway and improves stability, therefore reduces further injury in patients with congenital or acquired foot and ankle instability.

Bottom line, if your knee pain is chronic and you have ruled out a primary knee problem, look to your support structures known as your feet.

…..Run Happy! And be sweet to your feet (and knees too!)