On Stress Fractures….

We as runners have many foot ailments – one of the most common as caused by our continuous pounding is the stress fracture.  There are other breaks in the toes:  we should know about them also in order to be educated runners just in case we see symptoms so that we could treat them properly.  I once again turn to local podiatrist Dr. Nicole Hayward for advice on what to do:

“The structure of the foot is complex, consisting of bones, muscles, tendons, and other soft tissues. Of the 26 bones in the foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones are common and require evaluation by a specialist. A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room.

What Is a Fracture?
A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures.

 

Traumatic fractures (also called acute fractures) are caused by a direct blow or impact, such as seriously stubbing your toe. Traumatic fractures can be displaced or non-displaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated).

Signs and symptoms of a traumatic fracture include:

  • You may hear a sound at the time of the break.
  • “Pinpoint pain” (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours.
  • Crooked or abnormal appearance of the toe.
  • Bruising and swelling the next day.
  • It is not true that “if you can walk on it, it’s not broken.” Evaluation by a foot and ankle surgeon is always recommended.

Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. They can also be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored. They require proper medical attention to heal correctly.

Symptoms of stress fractures include:

  • Pain with or after normal activity
  • Pain that goes away when resting and then returns when standing or during activity
  • “Pinpoint pain” (pain at the site of the fracture) when touched
  • Swelling, but no bruising

Consequences of Improper Treatment
Some people say that “the doctor can’t do anything for a broken bone in the foot.” This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:

  • A deformity in the bony architecture which may limit the ability to move the foot or cause difficulty in fitting shoes
  • Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn’t been properly corrected
  • Chronic pain and deformity
  • Non-union, or failure to heal, can lead to subsequent surgery or chronic pain.

Treatment of Toe Fractures
Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself and may include these options:

  • Rest. Sometimes rest is all that is needed to treat a traumatic fracture of the toe.
  • Splinting. The toe may be fitted with a splint to keep it in a fixed position.
  • Rigid or stiff-soled shoe. Wearing a stiff-soled shoe protects the toe and helps keep it properly positioned.
  • “Buddy taping” the fractured toe to another toe is sometimes appropriate, but in other cases it may be harmful.
  • Surgery. If the break is badly displaced or if the joint is affected, surgery may be necessary. Surgery often involves the use of fixation devices, such as pins.

Treatment of Metatarsal Fractures
Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges.

For example, sometimes a fracture of the first metatarsal bone (behind the big toe) can lead to arthritis. Since the big toe is used so frequently and bears more weight than other toes, arthritis in that area can make it painful to walk, bend, or even stand.

Another type of break, called a Jones fracture, occurs at the base of the fifth metatarsal bone (behind the little toe). It is often misdiagnosed as an ankle sprain, and misdiagnosis can have serious consequences since sprains and fractures require different treatments. Your foot and ankle surgeon is an expert in correctly identifying these conditions as well as other problems of the foot.

Treatment of metatarsal fractures depends on the type and extent of the fracture, and may include:

  • Rest. Sometimes rest is the only treatment needed to promote healing of a stress or traumatic fracture of a metatarsal bone.
  • Avoid the offending activity. Because stress fractures result from repetitive stress, it is important to avoid the activity that led to the fracture. Crutches or a wheelchair are sometimes required to offload weight from the foot to give it time to heal.
  • Immobilization, casting, or rigid shoe. A stiff-soled shoe or other form of immobilization may be used to protect the fractured bone while it is healing.
  • Surgery. Some traumatic fractures of the metatarsal bones require surgery, especially if the break is badly displaced.
  • Follow-up care. Your foot and ankle surgeon will provide instructions for care following surgical or non-surgical treatment. Physical therapy, exercises and rehabilitation may be included in a schedule for return to normal activities.”

Thanks again Nicole!  If you want to meet Nicole she will be at our event at FitU in Fair Lawn, NJ this Thursday at 7:30 PM.

Happy Running….

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On Bunions…..

Here continues my series on foot problems, many of which are made worse by ill-fitting shoes and affect runners.  I surround myself with professionals that help me help the athletes I coach and that I run with.  Thanks again Nicole Hayward:

“Even though bunions are a common foot deformity, there are misconceptions about them. Many people may unnecessarily suffer the pain of bunions for years before seeking treatment.

What is a bunion?

A bunion (also referred to as hallux valgus or hallux abducto valgus) is often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. The big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment – producing the bunion’s “bump.”

Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones over the years and slowly producing the characteristic bump, which becomes increasingly prominent. Symptoms usually appear at later stages, although some people never have symptoms.

Causes
Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion.

Although wearing shoes that crowd the toes won’t actually cause bunions, it sometimes makes the deformity get progressively worse. Symptoms may therefore appear sooner.

Symptoms
Symptoms, which occur at the site of the bunion, may include:

  • Pain or soreness
  • Inflammation and redness
  • A burning sensation
  • Possible numbness

Symptoms occur most often when wearing shoes that crowd the toes, such as shoes with a tight toe box or high heels. This may explain why women are more likely to have symptoms than men. In addition, spending long periods of time on your feet can aggravate the symptoms of bunions.

Diagnosis
Bunions are readily apparent – the prominence is visible at the base of the big toe or side of the foot. However, to fully evaluate the condition, the foot and ankle surgeon may take x-rays to determine the degree of the deformity and assess the changes that have occurred.

Because bunions are progressive, they don’t go away, and will usually get worse over time. But not all cases are alike – some bunions progress more rapidly than others. Once your surgeon has evaluated your bunion, a treatment plan can be developed that is suited to your needs.

Non-Surgical Treatment
Sometimes observation of the bunion is all that’s needed. To reduce the chance of damage to the joint, periodic evaluation and x-rays by your surgeon are advised.

In many other cases, however, some type of treatment is needed. Early treatments are aimed at easing the pain of bunions, but they won’t reverse the deformity itself. These include:

  • Wearing the right kind of shoes is very important. Choose shoes that have a wide toe box and forgo those with pointed toes or high heels which may aggravate the condition.
  • Pads placed over the area of the bunion can help minimize pain. These can be obtained from your surgeon or purchased at a drug store.
  • Avoid activity that causes bunion pain, including standing for long periods of time.
  • Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
  • Applying an ice pack several times a day helps reduce inflammation and pain.
  • Although rarely used in bunion treatment, injections of corticosteroids may be useful in treating the inflamed bursa (fluid-filled sac located around a joint) sometimes seen with bunions.
  • In some cases, custom orthotic devices may be provided by the foot and ankle surgeon.

When Is Surgery Needed?
If non-surgical treatments fail to relieve bunion pain and when the pain of a bunion interferes with daily activities, it’s time to discuss surgical options with a foot and ankle surgeon. Together you can decide if surgery is best for you.

A variety of surgical procedures is available to treat bunions. The procedures are designed to remove the “bump” of bone, correct the changes in the bony structure of the foot, and correct soft tissue changes that may also have occurred. The goal of surgery is the reduction of pain.

In selecting the procedure or combination of procedures for your particular case, the foot and ankle surgeon will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.”

Thanks again Nicole!!  For more free helpful running information, please go to my FB page:  Click Here

On Ingrown Toenails…..

Unfortunately a relatively common injury due to the repeated stress of our pounding is an ingrown toenail.  It may be annoying and trivial at first, but it can get pretty serious and then as bad as requiring surgery later.  Again I turn to the pros who know more than I do on the subject.  According to local North NJ podiatrist Nicole Hayward:

“What Is an Ingrown Toenail?

When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (the sides of the nail). This “digging in” of the nail irritates the skin, often creating pain, redness, swelling, and warmth in the toe.

If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often marked by drainage and a foul odor. However, even if the toe isn’t painful, red, swollen, or warm, a nail that curves downward into the skin can progress to an infection.

 

Causes
Causes of ingrown toenails include:

  • Heredity. In many people, the tendency for ingrown toenails is inherited.
  • Trauma. Sometimes an ingrown toenail is the result of trauma, such as stubbing your toe, having an object fall on your toe, or engaging in activities that involve repeated pressure on the toes, such as kicking or running.
  • Improper trimming. The most common cause of ingrown toenails is cutting your nails too short. This encourages the skin next to the nail to fold over the nail.
  • Improperly sized footwear. Ingrown toenails can result from wearing socks and shoes that are tight or short.
  • Nail Conditions. Ingrown toenails can be caused by nail problems, such as fungal infections or losing a nail due to trauma.

Treatment
Sometimes initial treatment for ingrown toenails can be safely performed at home. However, home treatment is strongly discouraged if an infection is suspected, or for those who have medical conditions that put feet at high risk, such as diabetes, nerve damage in the foot, or poor circulation.

Home care:
If you don’t have an infection or any of the above medical conditions, you can soak your foot in room-temperature water (adding Epsom’s salt may be recommended by your doctor), and gently massage the side of the nail fold to help reduce the inflammation.

Avoid attempting “bathroom surgery.” Repeated cutting of the nail can cause the condition to worsen over time. If your symptoms fail to improve, it’s time to see a foot and ankle surgeon.

Physician care:
After examining the toe, the foot and ankle surgeon will select the treatment best suited for you. If an infection is present, an oral antibiotic may be prescribed.

Sometimes a minor surgical procedure, often performed in the office, will ease the pain and remove the offending nail. After applying a local anesthetic, the doctor removes part of the nail’s side border. Some nails may become ingrown again, requiring removal of the nail root.

Following the nail procedure, a light bandage will be applied. Most people experience very little pain after surgery and may resume normal activity the next day. If your surgeon has prescribed an oral antibiotic, be sure to take all the medication, even if your symptoms have improved.

Preventing Ingrown Toenails
Many cases of ingrown toenails may be prevented by:

  • Proper trimming. Cut toenails in a fairly straight line, and don’t cut them too short. You should be able to get your fingernail under the sides and end of the nail.
  • Well-fitted shoes and socks. Don’t wear shoes that are short or tight in the toe area. Avoid shoes that are loose, because they too cause pressure on the toes, especially when running or walking briskly.
What You Should Know About Home Treatment 

  • Don’t cut a notch in the nail. Contrary to what some people believe, this does not reduce the tendency for the nail to curve downward.
  • Don’t repeatedly trim nail borders. Repeated trimming does not change the way the nail grows, and can make the condition worse.
  • Don’t place cotton under the nail. Not only does this not relieve the pain, it provides a place for harmful bacteria to grow, resulting in infection.
  • Over-the-counter medications are ineffective. Topical medications may mask the pain, but they don’t correct the underlying problem.”

On Ganglion Cysts….

We runners continually get odd injuries and one of them is a Ganglion Cyst.  According to my friend and runner personal trainer podiatrist Nicole Hayward: ”

What Is a Ganglion Cyst?

A ganglion cyst is a sac filled with a jellylike fluid that originates from a tendon sheath or joint capsule. The word “ganglion” means “knot” and is used to describe the knot-like mass or lump that forms below the surface of the skin.

Ganglion cysts are among the most common benign soft-tissue masses. Although they most often occur on the wrist, they also frequently develop on the foot – usually on the top, but elsewhere as well. Ganglion cysts vary in size, may get smaller and larger, and may even disappear completely, only to return later.

Causes
Although the exact cause of ganglion cysts is unknown, they may arise from trauma – whether a single event or repetitive micro-trauma.

Symptoms
A ganglion cyst is associated with one or more of the following symptoms:

  • A noticeable lump – often this is the only symptom experienced
  • Tingling or burning, if the cyst is touching a nerve
  • Dull pain or ache – which may indicate the cyst is pressing against a tendon or joint
  • Difficulty wearing shoes due to irritation between the lump and the shoe

Diagnosis
To diagnose a ganglion cyst, the foot and ankle surgeon will perform a thorough examination of the foot. The lump will be visually apparent and, when pressed in a certain way, it should move freely underneath the skin. Sometimes the surgeon will shine a light through the cyst or remove a small amount of fluid from the cyst for evaluation. Your doctor may take an x-ray, and in some cases additional imaging studies may be ordered.

Non-Surgical Treatment
There are various options for treating a ganglion cyst on the foot:

  • Monitoring, but no treatment. If the cyst causes no pain and does not interfere with walking, the surgeon may decide it is best to carefully watch the cyst over a period of time.
  • Shoe modifications. Wearing shoes that do not rub the cyst or cause irritation may be advised. In addition, placing a pad inside the shoe may help reduce pressure against the cyst.
  • Aspiration and injection. This technique involves draining the fluid and then injecting a steroid medication into the mass. More than one session may be needed. Although this approach is successful in some cases, in many others the cyst returns.

When is Surgery Needed?
When other treatment options fail or are not appropriate, the cyst may need to be surgically removed. While the recurrence rate associated with surgery is much lower than that experienced with aspiration and injection therapy, there are nevertheless cases in which the ganglion cyst returns.”

 

Thanks Nicole!!!!    Happy Running Everyone.   Please like my running coaching page:  Click Here

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On Achilles Tendinitis

Here is our 3rd in our series of nagging running injuries.  Again, I turn to my PT friend Jessica Garcia to help us with Achilles tendinitis…..

“Three blogs, three lower leg injuries, what’s up with that? While it may seem like overkill, those of us in the field of physical therapy have frequently heard the saying, “when the feet hit the ground”. The importance of this lies in the fact that as the first contact point to the ground, the feet and ankles help dictate lower extremity biomechanics. When searching for factors that may have contributed to any running injury a good starting point is the foot. Injuries march along what is referred to as the “kinetic chain”. Each runner is unique and thus the specific location for an overuse injury is determined by a multitude of factors (e.g., genetics, previous injuries, training factors, etc.) meaning that there is not an etched-in-stone-overuse-injury-sequence through which all runners’ progress. As such it is a good idea for runners to become aware of regions of the body that may become affected and learn a little about the specifics in each region. Knowledge and early warning are a runner’s best friends. So let’s look at one lower leg culprit……Achilles Tendonitis.

The Achilles is the large tendon connecting the two major calf muscles to the back of the heel bone. Under too much stress, the tendon tightens and is forced to work too hard. This causes it to become inflamed (tendonitis), and, over time, can produce a covering of scar tissue, which is less flexible than the tendon. If the inflamed Achilles continues to be stressed, it can tear or rupture.

Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendinitis. These factors include tight or weak calf muscle, unsupportive footwear, too quick of an increase in volume /intensity/hills or a bone spur that has developed where the tendon attaches to the heel bone. Correction and prevention of this condition require addressing these factors.

The classic symptom is pain along the back of the tendon especially close to the heel but there may also be limited ankle flexibility, swelling that is present all the time and gets worse throughout the day with activity, redness over the painful area, a nodule (scar tissue) that can be felt on the tendon, or a cracking sound (scar tissue rubbing against the tendon) when the ankle moves. It is also typical to notice pain and stiffness when you first get up & when you first begin your run and severe pain the day after exercise. If you have experienced a sudden “pop” in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon.

As always it comes back to the million dollar question: To Run or Not To Run and unfortunately there is no easy answer. So again we will use a spectrum to help our decision making.

Red (stop): Severe pain/swelling above heel, pain standing up on your toes

Yellow (caution): Dull pain around heel at end of run, lingers after but goes away with ice

Green (go): No pain when you pinch the tendon

If symptoms persist you can begin self-treatment using RICE the well-known and frequently disliked mnemonic for Rest, Ice, Compression and Elevation. If injury doesn’t respond in two weeks it might be a good idea to see a physical therapist or orthopedic surgeon. In most cases, conservative treatment options will provide pain relief, although it may take a few months for symptoms to completely subside. Even with early treatment, the pain may last longer than 3 months so as difficult as it may be patience is a must.”

Thanks again!  Jessica works at Ultimate Motion, located in the Gold’s Gym in Paramus, NJ.   I am proud to have surrounded myself with professionals who have helped me with my running coaching and personal running.    For more information, please go to my Facebook page:   Click Here

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Miles Are Not Important – II

Yes – the number of miles you run per year is not important. You did read this correctly.  The number of miles you run per week, month and year are not important.  It is the quality of the miles that is more important. Yes – you can’t only run speed or run only 200 miles a year, but the threshold varies per person, but it is usually not as much as you think.

From 2005-2013 I averaged 1400-1670 miles per year with only 3 or 4 months under 100 miles and massive streaks of 30+ mile weeks.  In 2014, I tore my meniscus and had to take almost 2 months off from running.  Those months were the best thing that happened to me.  As an aging runner (33+ years, 35,000 miles and 46+ yrs. old) I had to assess what I had been doing.

In late 2014, I changed my running strategy.  In addition to using the Isagenix nutritional program, I started hitting the gym 2-3 times a week for intense low-impact boot camps that emphasized core, stability, agility, balance and strength in an injury-free way.  I also lowered my mileage by almost 35% and ran 3-4x a week instead of my customary 6x a week.

The results have been staggering – all these times occurred since 2015:

5K – 18:24 -> fastest since 2010
4M – 25:26 -> fastest since 2001
10K – 39:31 -> fastest since 2008

10M – 1:06:36 -> PR
20K – 1:23:39-> fastest ever lifetime (PR – Personal Record)
13.1 – 1:30:05-> fastest ever lifetime  (PR)                                                                  4.72 – 29:22 -> fastest since 2009 (Manchester Classic-CT)

26.2 – 3:24 -> fastest at Boston; 6th-fastest ever                                                     26.2 – 3:21 ->  3rd fastest ever

And I’m going to finish this year with just over 1170 miles (after last year finishing with 1025 miles – least since 1998) with maybe 5 30+ mile weeks and one or two 100+ mile months.

So this is how I am going to train going forward – less miles, more speedwork and tempo runs and more strength training.  Father time always wins, but you don’t have to give up without a fight.

While it’s cool to hear about 25+ year streaks of not taking a day off or 3,000+ mile years, I’m sticking to what I have learned.  I want to be running when I’m in my 80’s.  So if my body reacts positively to less miles, then I will go there.  That is exactly the way I treat the runners I coach, with a balance….

Happy New Year to everyone!!!

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On Plantar Fasciitis….

When I don’t know about a subject other than suffering the injury, I turn to a professional for some clarity – here is my PT friend Jessica Garcia on plantar fasciitis:

“As runners, more than likely every one of us has had a pain in our heel or foot at one time or another and our first thoughts have been, what is it and can I still run , and probably not in that order. Typically we will try to ignore it hoping that it goes away and if it doesn’t we will look to our fellow runners or the internet for answers. Somewhere in this process we are bound to come across the term plantar fasciitis and wonder if that’s what the problem is and if so how do we fix it. So let’s take the mystery out of this thing they call plantar fasciitis.

The plantar fascia is the thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes. It is made of collagen, a rigid protein that’s not very stretchy. Plantar fasciitis is the inflammation or tiny tearing of the plantar fascia.

Tell-tale signs of plantar fasciitis include sharp pain in the heel when getting out of bed in the morning due to being in a contracted position overnight. Other symptoms include a dull ache along the arch or bottom of the foot which can be sharp, as well as a tight and painful sensation at the base of the heel.  The pain gets worse when you climb stairs, stand on your toes, stand/sit for long periods of time and at the beginning of exercise. The pain gets better or goes away as the foot limbers up but returns when exercise is completed.

The causes of plantar fasciitis can be broken down into two categories: intrinsic factors, those related to the body itself, and extrinsic factors, those “outside” the body. Intrinsic factors are decreased core strength (stable core reduces stress on spine and stops pain transference to foot), decreased flexibility of calf, hamstrings and hip flexors, and biomechanical issues including flat, high-arched feet  and increased foot pronation. Extrinsic factors can primarily be thought of as training errors: improper/worn shoes, sudden increases in training mileage or elevation; beginning speedwork; running on hard surfaces or simply overtraining.

The tricky thing about plantar fasciitis is that many people can continue to run with symptoms—the condition has to be pretty severe to make a stubborn runner with a high pain threshold stop training. Having said this, there are times when it’s better not to push through the pain. Using a red (stop), yellow (caution), green (go) spectrum the following can be used to help answer the burning question of to run or not to run:  Red: Ongoing, arch pain & tenderness that doesn’t fade even once you’ve warmed up, Yellow: Pain when you step out of bed, get up after prolonged sitting or during the first few minutes of a run, Green: Pain free all day including first steps in morning, walking barefoot on hard surfaces without an issue. Plantar fasciitis can be a nagging problem, which gets worse and more difficult to treat the longer it’s present. If pain persists it’s a good idea to see a professional. Conservative treatment significantly decreases symptoms in about 95 percent of sufferers within six weeks however fixing the problem relies on determining the responsible process.

The bottom line is that plantar fasciitis is an overuse injury. Overuse injuries are the great equalizer, taking out the elite and weekend warrior alike. Most runners experience their share of injury, and although many of these conditions can be nagging, few are more so than plantar fasciitis.”

  • Jessica Garcia is a PT in Paramus, NJ and has her own practice – Ultimate Motion

 

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