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….


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.

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, 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.

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 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.

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.”

Shin Splints -Why the Pain?

I turn again to my running physical therapist friend Jessica Garcia here in Paramus, NJ for answers to those nagging shin splints!   Here you go:

“Anytime we get lower leg pain we are quick to say that we have shin splints but is that actually true or have we just grown accustomed to saying that because it’s what we have heard.  Shin splints has become the go to term for any lower leg pain that we get below the knee, either on the outside front part of the leg or the inside of the leg. Shin splints are the bane of many athletes, runners, tennis players, dancers and military recruits. They are much more common among beginning runners who build their mileage too quickly but can also affect seasoned runners who abruptly change their workout regimen. Shin splints can be summed up in 4 words….. Too Much, Too Soon.

Shin splints, (most commonly known as medial tibial stress syndrome), were always considered a soft tissue injury but with new information it is now thought that the cause of shin splints may actually be repeated stress to the bone. With running the tibia (bigger shin bone) bends backward slightly on impact with the ground, putting compressive forces on the inner side of the bone. The body responds to this but this process can take several weeks to months during which time the bone is even more vulnerable. Shin problems are more common in less experienced runners because the bone has not yet adapted. Did a light just go on?

Be careful, shin pain doesn’t always mean you have shin splints. It can be a sign of another problem, 2 conditions in particular, with potentially greater ramifications. The first of these is Compartment Syndrome– a swelling of muscles within a closed compartment which creates pressure. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.  Symptoms include leg pain, unusual nerve sensations and eventually muscle weakness. Compartment syndrome can be either acute or chronic. Acute compartment syndrome is a medical emergency.

The second, one that evokes fear just at the mere mention, is a Stress Fracture-an incomplete crack in the bone. The pain of shin splints is a generalized ache that may be worse in the morning because the soft tissue has tightened up overnight. They are at their most painful when forcibly lifting the foot at the ankle or flexing the foot. By contrast the pain from a stress fracture becomes focused on a smaller area of the bone and is sharp or burning in nature. The pain may be noticed more during the run eventually hurting while walking or even when you’re not putting any weight on it at all. They may feel better in the morning because the bone has rested overnight. If you suspect you have a stress fracture you should get it checked.

There can be a number of factors that cause shin splints, those related to the body and those related to training errors.  When shin splints strike it is best to stop running completely or decrease your training, depending on the extent and duration of pain. The initial focus is on decreasing the inflammation and once that is achieved it turns to reducing the relative amount of stress on the tibia. This can be accomplished by increasing flexibility and strength, reducing impact, wearing the correct footwear, cross training and,  once returning to running, avoiding hills and hard surfaces, avoiding running the same direction on a track, gradually increasing mileage, gradually increasing intensity and increasing stride frequency.

Most runners don’t want to interrupt their training unless absolutely necessary but the decision is not a clear cut one. In an attempt to help patients make this complicated decision I use this simple spectrum:  Red zone(stop): localized tenderness, sharp burning pain, pain with hopping, pain with walking, Yellow zone (caution): Tight aching pain when running; goes away when you stop, hopping isn’t painful, Green zone (go): Completely pain free while running. In most cases shin splints are often not serious however, call your health care provider if: you have pain even with rest, icing, and pain relievers after several weeks, you are not sure whether your pain is caused by shin splints, the swelling in your lower leg is getting worse or your shin is red and feels hot to the touch. So while in many instances you could run, the question becomes…. should you run?  If there is any hesitation when answering this question err on the side of caution. If you think having to rest because of a mild injury is difficult, you don’t even want to think about what it would be like with a full blown one.”

Thanks, Jessica!   Happy Running……

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Winter IS Half OVER!

Do you realize that winter is half over?  That means 2 things.  Yes, we have a few more weeks of cold weather, snow and black ice to deal with.  But it also means that you are suddenly that much closer to your 5K or whatever race you have been planning for this year!  Do you have a plan?  Are you executing your plan? Are you ready to commit?

February, 2017

This is the key month to your winter training.  This is when you get your schedule together, run your base miles and also make sure you have all your gear ready to go for the year.  Do you need to order new supplements?  Do you need new shoes?  Did you plan out your running schedule?

March, 2017

Your spring races should be on your calendar.   Everything should be ready to go.  If you don’t have a schedule yet, this is the time to get one immediately.  If you can’t plan on your own, are you ready to hire a coach to help you or join a local team or club?  For the beginner, did you find your couch to 5K program yet?

April, 2017

Your races are already here!  Did you plan and execute your plan properly?  Only you will know at this point.  The rest of the year lies ahead and all I can ask at this point is, “Are you ready?”

Happy Running

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On Running Shoes….

One of the first 5 questions I ask people is: “How old are your shoes”?  Inevitably, 60% of the answers are something like: “These are 5+ years old” OR “I last wore these 9 years ago”, etc.

It is very important that you have a grasp on your running shoes.  I estimate that 60% of ailments that beginner runners get are caused by faulty running shoes.  The shoes are too old age-wise, they are not the right ones, they have too many miles on them, etc.

Running shoes have a life – both in “shelf” and in miles.  If they sit around for years in a dark closet, unused, they start getting brittle.   They may look new, but will not react positively.  Secondly, for average training shoes, you need to change them between the 350-400 mile mark.  For track/light shoes, it is about half of that. If you wait much longer, you risk injury.  One “cheat” is to simply write the date you started using the shoes on them so you could track how long you had them.  Keep a running log so that you know how about how many miles are on them.

When it is time to replace, please go to a specialty running store.  Do you go to a general practitioner to treat your ears?  No – you go to a throat, nose and ears specialist.   The same goes for your running shoes.  Sorry , Foot Locker and Modell’s; this is where I am particular about things.

The specialty running store will give you a gait analysis and evaluate whether you over or under pronate; whether you are a foot or heel striker, whether you need a stability or neutral shoe – this is their specialty.  Yes – you may pay a couple of dollars more – but if you can get personalized service, it is well worth it.  Then, once you know what shoe fits you, then you can order replacements on-line.

Locally, in northern New Jersey, I recommend the Runner’s House as my favorite store.  There are many others:  Road Runners, New Balance, Sneaker Factory, Fleet Feet and the various Running Companies.  Either way, please find one near you and have them help you – treat your feet.  Many will also let you wear them and return them if they don’t work well for you within a certain amount of time.

Remember – your feet are IT when you are a runner, so take care of them!

#running #runningstore #runnershouse #runninglog