Shortly after my last blog, I returned the Bondi 3s. They were the most comfortable shoes I’ve ever run in, but the soles were over half worn at only 50ish miles. That makes the Bondi 3s, in my opinion, a very expensive pair of slippers.
I brought the a pair of Hoka Stinson Lites home and so far I am very pleased. Although the cushion seems less than in the Bondi 3s, the rubber compound seems much more durable. Going into the warmer months, I also like the very vented upper. This model comes with two inserts. The thicker one adds just a little more support and cushion, which feels very good in these shoes.
The warmer the days get, the less I run and the more I bike. However, my knees are still pain free and my pace continues to drop. I am very happy with the Hoka brand and the customer service I experienced at Ragged Mountain Running Shop.
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New office in Fishersville will open early 2015 @
66 Parkway Lane Suite #102
Fishersville, VA 22939Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
HOKA ONE ONE Bondi 3 Shoes
I want to give you my take on the Hoka Bondie 3 shoes I purchased from Ragged Mountain Running shop a couple weeks ago. I have a very broad background in running. In high school, I made the All American Track and Field team, competed at the Kinney Cross Country National meet (known now as Foot Locker Nationals), and attended college on a full scholarship. However, after injuries and many years away from any kind of training, my return to running has proven to be difficult and painful. My runs now are not much more than a jog.
I’ve been trying to implement running as a supplement to my cycling training for months now. Knee pain, however, has crushed my motivation to do so. This winter’s cold and snowy weather has been brutal on my cycling training. Riding a bike in 20+ degree weather against the cold wind, well, just ruins the fun of biking for me. The answer, put my running shoes on and suffer through the pain.
I’ve read and heard great things about the HOKA shoes. I also learned they are not cheap, $130.00+. I really wanted to try a pair, but thought it would be a waste of money. How could a shoe make that much of a difference? Maybe people are writing positive reviews to help justify to themselves the amount of money they spent. After a couple months, I had to try something.
Walking around the shop in several different models of the Hoka brand, I felt what many people had written about in their reviews. Walking on a cloud is the best way to put it. I thought, this is neat, but I’m not sold and it seems gimmicky. Do I really want to spend money on these?
I should also mention, my first answer to my knee pain was to not run on the pavement. Throughout my running career, I ran on grass and gravel to stay away from injuries. However, these days I find myself lazy and only finding the motivation to run straight from my house where the only option is pavement. I need lots of cushion and the Bondi 3s seems like a good gamble.
My first run in the Hoka far exceeded my expectations. I only had time for a couple miles, but that’s all it took for me to fall in love with these shoes. I had no knee pain the first day, nor the following several days. I’ve been running almost every day now for two weeks and my legs, although tired, are still pain free. This experience couldn’t have come at a better time. The several inches of snow recently have kept me off the bike, but not out of my Hokas.
I will follow up with this post over the next few months to let you know how the Bodi 3s perform. The only possible issue I see so far is that the mid foot area of the bottom sole seems to have a very soft compound rubber and therefore, may not be very durable.
Custom Functional Orthotics
Custom orthotics are the best decision people can make to improve their foot health and function. Custom orthotics are unique and specially made to your feet. Orthotics treat and correct individual foot ailments. Proper shoes fitted with custom foot orthotics are the best insurance that we can give ourselves to protect our feet.
Your orthotics are manufactured by a state-of-the-art fabrication facility utilizing the latest advancements in machinery and technology available today. The fabrication starts with an analysis of your feet and a laser casting. The image produced from this scan is sent to our lab where your device is “born”. The technicians analyze these scans and make subtle adjustments to ensure a precise fit and form. Exact models of your feet are created on an automated CAD/CAM milling machine. These models are used to form your orthotics with a high temperature pressure fit system. Then they are assembled by hand and laminated. The result is a set of orthotics made to your feet with Dr. Murray’s or Dr. Chang’s specific instructions and modifications to optimize your foot function. This process typically takes 2 weeks and you will be called when they are ready.
Please bring the shoes you plan on using the orthotics with so one of our assistants can check for a proper fit. You will be given instructions to use with the orthotics during the “breaking-in” period. A follow up appointment will be made to discuss with the doctor how the orthotics are working for you. Some patients may need more time to get used to their orthotics and some orthotics may require adjustments. Although most patients are happy with their devices immediately, we want you to appreciate the uniqueness of the human body and understand this process can sometimes take time to make the proper adjustments. Our goal is to help treat and correct your ailment so you can live a healthy and active lifestyle. Therefore, we include free adjustments for 90 days.
One set of orthotics may suffice for many of our patients, but different activities require different accommodations. Therefore, some of our more active patients order multiple pairs of orthotics. Here are a few of the reasons why:
“I need a second set of orthotics for when my other pair gets wet.” – Local runner
“I need orthotics for standing on a concrete floor all day and another pair for hiking with my family.” – Factory worker
“My orthotics really help in my athletic shoes. I wish they worked in my dress shoes.” – Local business woman (we offer the Cobra, which is an orthotic designed to work with many casual and dress shoes)
Most of our orthotics are designed to last 5 to 10 years. Depending on your particular ailment, activity, and amount of use, your orthotics may need to be refurbished (re-covered) during this time period.
First set – $395.00
Additional set – $300.00
These are the prices for non-covered orthotics; when covered by insurance, the prices are predetermined by the terms of the insurance plan.
Insurance coverage: Please verify with your insurance company that custom orthotics are a covered benefit and how your deductible and coinsurance apply.
Welcome to the Blue Ridge Foot and Clinic team. We look forward to helping you stay healthy and active.Blue Ridge Foot and Ankle Clinic LIKE US ON 887 A Rio East Court Charlottesville, VA 22901 434-979-8116 417 South Magnolia AveWaynesboro, VA 22980 540-949-5150 New office in Fishersville will open early 2015 @ 66 Parkway Lane Suite #102 Fishersville, VA 22939 Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
- Posted in Achilles Tendon, Ankle Surgery, Athletic Injury, Bunions, Children, Cycling, Dr. Kevin Murray, Dr. Stewart Chang, Foot Doctor, Foot Pain, Heel Pain, Leg pain, Orthotics, Our Community, Our Team, Plantar Fasciitis, Podiatrist, Podiatry, Running, Shin Splints, Shoes, Shoes and Socks, Uncategorized
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Enjoy daylight after work for a few more weeks.
Local Walk/Jog/Run Events this fall
Need help with your shoe selection? Click here for some help.
Orthotics are commonly suggested aides to recovery and injury prevention. Orthotic shoe inserts control the motion between the forefoot and the rear foot, evenly distributing the weight and pressure exerted on the foot. They reduce excessive motion that may occur in certain feet, they can act as a binding force that absorbs strain as pressure is exerted on them, and they can accommodate and cushion painful or injured areas. “While not everyone needs orthotics,” Dr. Murray notes, “they are a highly successful conservative treatment strategy for certain types of feet and foot conditions.” For problems ranging from structural deformities, such as bunions, to conditions such as posterior tibial tendonitis, orthotics are an economic way to both treat pain and prevent further injuries.
Through their forty years of combined experience in working with Charlottesvillian feet, Dr. Murray and Dr. Chang have found resounding success in prescribing and fitting orthotics to fit a variety of foot types and injuries. The process for getting orthotics takes some time, primarily because Dr. Murray and Dr. Chang want to make sure that orthotics are right for the health of your feet.
If you suspect that you need orthotics or if you have foot pain, a first visit will include a foot examination, as well as an examination of your shoes. That’s right, bring your shoes to your appointment. The reason being is that the number one cause of foot pain and related injuries is worn out shoes. “Shoes are just not made to be worn forever,” comments Charlottesville shoe guru, Mark Lorenzoni of Ragged Mountain Running. Lorenzoni, a veteran runner and long-time shoe salesman, argues that you should be just as wary of your daily shoes as you are of your athletic shoes. Shoes should be sized properly in regard to the width of the different parts of your foot as well as your gait, your arch, and any propensities your foot may have to pronate. Shoes support your foot by guiding its motion.
If you did not consider which shoes are best for your individual feet, or if you wore out your shoes and kept using them, you may be experiencing a host of problems. Shoes that are too loose can cause blisters or problems with your Achilles tendon; shoes that are too tight could cause plantar fasciitis or aggravate bunions and bursitis; shoes too wide could cause problems in the ankle of people who pronate, and shoes too tight could cause ankle pain in a supinator. So if you come in telling Dr. Chang and Dr. Murray that you have kept working out in over-worn or ill-fitted shoes, they may just send you back to Lorenzoni’s shop. There, a number of trained shoe experts will conduct a gait analysis and draw on their years of expertise in the industry to match your feet to the proper shoe. And a time-saving strategy may be just trying new shoes and replacing your shoes every 200-400 miles, according to the chart below. The good news is that purchasing new shoes is often a complete solution to burgeoning foot pain! The shoe mileage chart below, created by the family at Ragged Mountain Running Shop, can help you sort out when to replace your shoes.
| Shoe Mileage Chart
Over half the injuries runners and walkers experience can be directly attributed to “worn out shoes”. Worn out refers to the midsole (engine) of the shoe, which is the most important component of an athletic shoe. Don’t use the outsole/tread wear as a way of determining how much life is left in your shoes! This midsole component generally lasts about 375-450 miles of athletic use. Cut that mileage rating in half if you choose in addition to use your shoes for anything other than your running or walking exercise (i.e. “wearing around”). Here is a sample mileage chart to determine how often you might need to replace your exercise shoes.
*Created by the family at Ragged Mountain Running Shop*
New shoes, however, may not solve all your foot pain. If you still feel pain after you try out your spiffy new, well-fit shoes, it is time to visit your Charlottesville podiatrist. To get closer to the root of your foot pain problem, Dr. Murray and Dr. Chang are likely to suggest that you wear an over-the-counter shoe insert for a couple of weeks. These inserts cost between $35 and $60, and test whether your foot needs a little extra support or more specific support from an orthotic. If pain still occurs, upon the next visit Dr. Murray, Dr. Chang and their staff will assist you with taping your foot. The tape, in addition to the over-the-counter shoe inserts, will help to redistribute weight throughout the whole foot, binding it in a way similar to an orthotic to test whether a pair of custom-made orthotics will help you. Orthotics last about 5 years (depending on use), they lessen the likelihood of injuries, reduce doctors visits, and relieve pain.
The prescription for your orthotics will depend on your foot type, your condition or injury, and the intended purpose of the orthotic. To this effect, there are different kinds of orthotics. Orthotics are mainly grouped into two categories: functional and accommodative. Functional orthotics correct for excessive motion of the foot, preventing pain during ambulation. Accommodative orthotics are used to distribute weight away from a painful or injured area. Dr. Murray and Dr. Chang will scan your foot and write a customized prescription for your orthotics to fit your orthotics’ purpose and your intended activities. They will consider materials used, the rigidity of the device, and the shape of the heel or head to ensure you go home with the right product.
The process to begin wearing orthotics is gradual. It takes 2-3 weeks to work up to wearing an orthotic full time since the adjustments they make with your foot function could cause initial soreness or pain in the feet, ankles, knees or hips. It takes several months before athletes can run in orthotics comfortably. Be attentive to any pain that may surface in the initial weeks, as adjustments to your orthotics are free under a six-month warranty with the lab that makes them.
But it all comes back to shoes. Truth be told, orthotics are only as good as the shoes in which they are inserted. Make sure that your footwear is foot-friendly and accommodates orthotics. It is important to recognize that worn out shoes will negate the work of the orthotic. Note that not all shoes are made to accommodate orthotics, no matter the brand, style, or cost. Consult your podiatrist or local shoe store for more information on which shoes are compatible with orthotic devices. Although one pair of orthotics can be used in multiple pairs of shoes, most patients purchase multiple pairs of orthitcs to fit a variety of shoes.
As sand and dirt can abrade them, reducing their functional period, wash your orthotics every two weeks with mild soap and lukewarm water, letting them dry overnight before reinserting them. If you find that your orthotics squeak, remove them from your shoes and sprinkle talcum or baby powder on them, which should prevent the squeaking.
Your orthotics will work to restore your gait, posture, and to prevent a host of injuries that could be caused by your foot condition. Orthotics are affordable and last for years, and prevent a host of conditions, from runner’s knee to lower back pain. They are a highly effective, cost efficient, non-invasive, and all-around successful treatment technique. Orthotics are only helpful when used, so Dr. Murray and Dr. Chang suggest that you wear orthotics continually to reduce pain and to improve your posture and alignment.Blue Ridge Foot and Ankle Clinic 887 A Rio East Court Charlottesville, VA 22901 434-979-8116 417 South Magnolia AveWaynesboro, VA 22980 540-949-5150 Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
- Posted in Athletic Injury, Blisters, Bunions, Children, Cycling, Dr. Kevin Murray, Dr. Stewart Chang, Foot Doctor, Foot Pain, Heel Pain, Leg pain, Orthotics, Plantar Fasciitis, Podiatrist, Podiatry, Running, Shockwave Therapy, Shoes, Shoes and Socks, Stress Fractures
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A neuroma is a growth or thickening in the nerve tissue due to compression or irritation of the nerve. While neuromas can develop in different parts of the body, they are most commonly found in the feet between the third and fourth metatarsals and called Morton’s Neuroma, or intermetatarsal neuromas. Populations who wear restrictive shoes, or have foot abnormalities such as bunions, hammertoes, flat feet, or more flexible feet, are at a higher risk of developing this type of nerve damage. If you suffer from Morton’s neuroma, you probably already know this by the instant relief from the burning and aching toe pain once you take off your shoes. That’s because the width of your shoes often aggravate an already irritated nerve.
Neuromas have a variety of symptoms that vary from pain to tingling, burning or numbness, and even feeling as if something is inside the ball of the foot. Symptoms often have a gradual onset, first only flaming up when wearing shoes with a tight toe box or while engaging in activities that stress the ball of the foot. Initially, symptoms can be relieved by removing a constricting shoe, massaging the tender area, and by avoiding aggravating activities. However, as time passes, symptoms will get progressively worse. If untreated, neuromas can lead to permanent nerve damage, so consult your podiatrist early about your neuroma.
Treatment and prevention vary. First, make sure you have the proper shoes for your feet! Your podiatrist may suggest special padding techniques to relieve the pressure from the affected area. Additionally, icing, using over the counter or custom made orthotics, modifying activities that aggravate the injury, taking NSAIDs, or even cortisone injections can help. In more severe cases, surgery will be a viable option to remove the neuroma altogether.Blue Ridge Foot and Ankle Clinic 887 A Rio East Court Charlottesville, VA 22901 434-979-8116 417 South Magnolia AveWaynesboro, VA 22980 540-949-5150 Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
Blue Ridge Foot and Ankle Clinic’s employee, Mark Smith, had a strong showing at the Shenandoah Mountain 100 mountain bike race this past Sunday (watch). This was Mark’s first attempt at a 100 mile mountain bike race. Racing for the Charlottesville Racing club/Blue Ridge Cyclery p/b Reynolds GM Subaru, he completed the course in 8 hours and 39 minutes, placing him 35th out of over 500 competitors.
“I’ve been wanting to compete in this race for a couple years now, but injuries kept me from participating”, says Mark. Finally injury free, Mark was able to get a last minute entry to the race. Mark admits, “I have not been this nervous about an event in a very long time. All my friends and fellow competitors were giving me advice and it was making me more and more nervous.” Once on the starting line, the familiarity of racing calmed his nerves and the race was on. “100 miles of fun!” Yeah um, maybe for you Mark.
“All joking aside, this was a very hard race that tested every aspect of my biking skills. I didn’t want to get stuck in traffic, so I went out fast, too fast. 45 miles in, I had a hard time communicating with the volunteers at aid station 3. Luckily the volunteers were on the top of their game and just took care of me: food, drink, and a shove off in the right direction.”
Mark ran into hard times before reaching aid station 4 around 60 miles. A bad headache caused him to slow and have a hard time keeping his bike on the trail. Disappointment set in as he sat at aid station 4 with a cold wet cloth dripping water over his head and watching other racers ride by. “I was dizzy and in a lot of pain. I even contemplated dropping out.” After 10-15 minutes, Mark decided to just get on his bike and pedal slowly to the finish, well at least try to.
Approximately, 10 miles later Mark’s headache started to dissipate and he started to feel much better. “I couldn’t believe it. I couldn’t explain it. It was like my body did a complete 180.” For the last 30 miles, Mark, “put the hammer down”. Fellow riders warned him about the difficult climbs still remaining, but why slow down when you feel this good. “I felt great and was climbing stronger than I had all day. Maybe it’s the strength I developed on my back to back 100 miles to Georgia or with my teammate Barry Pugh.”
First 100 mile mountain bike race completed. When asked if he will do it again next year, Mark had this to say. “YES! I not only learned a lesson about staying in the race and finishing, I also had a blast. The whole weekend was fantastic. Chris Scott of Shenandoah Mountain Touring and all of the really helpful volunteers made this event one of my all time favorites. The trails were so much fun and at times extremely challenging. The climbs were long and hard. The competition was crazy good. Yes, these are the things I enjoy about racing. I love pushing myself and can’t wait till next year. Oh, tell Dr. Chang the custom carbon orthotics he made for my cycling shoes did great. I had no foot pain whatsoever.”
Great job Mark. See race results here, SM100.Follow up note: Mark’s calves became very sore and tight a couple days after this race. Dr. Stewart Chang treated his calves with Extracorporeal pulse activation treatment (EPAT) Wednesday. We are happy to report, Mark’s calves were immediately better and he is back on the bike. Athletes who need to stay consistent with their training should consider EPAT. Read about EPAT on this site or call us today.
Blue Ridge Foot and Ankle Clinic 887 A Rio East Court Charlottesville, VA 22901 434-979-8116 417 South Magnolia AveWaynesboro, VA 22980 540-949-5150 Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.
Microlight ML830 Cold Laser
Cold laser therapy is a relatively new technology (30 years old) when compared to acupuncture which has been used since 8000-3500 B.C. Just like the abacus evolved into the computer, slowly needles are evolving into light. Recent innovations in low-level lasers now make it possible for the average physician or consumer to own cold laser equipment. Cold lasers are sometimes called Low Level Lasers (LLL) or soft lasers.
In general, cold lasers can be used in 2 distinct ways:
- Targeting acupuncture trigger points (similar to acupuncture but without the needles)
- Broad coverage of deep tissue with laser photons to stimulate changes in the tissue
Cold Laser therapy offers a non-intrusive option to acupuncture and surgery. It also provides a non-addicting treatment that eliminates the complications of long-term drug treatment programs. Cold laser are widely use for treatment of:
- Acute and chronic pain
- Ligament sprains
- Muscle strain
- Soft tissue injuries
- Tennis elbow
- Back pain
- Carpal Tunnel Syndrome
The cold laser produces an impulse of light at a wavelength (approximate 900nm) that maximized the energy (in photons) at a desire depth, usually 10-13cm (4-5 inches) deep. This may be combined with other laser diode with a shorter wavelength (875nm) to add photons to the shallower levels of tissue. In addition, red light diode with a wavelength of 660nm may be used to add energy to even shallower levels of tissues.
The goal of laser therapy is to deliver light energy units from infrared laser radiation, called photons, to damaged cells. It is the consensus of experts is that photons absorbed by the cells through laser therapy stimulate the mitochondria to accelerate production of ATP. This biochemical increase in cell energy is used to transform live cells from a state of illness to a stable, healthy state.
Over 4000 studies have been conducted in recent years to validate the effectiveness of cold laser therapy. Cold lasers treatment systems may be cleared by the FDA.
Benefit of Cold Lasers
- Easy to apply
- Extremely safe
- No side effects or pain
- Cost effective for both the practitioner and patient
- Highly effective in treating ailments (more than 90% efficacy)
- Superior alternative to analgesics, NSAID’s and other medications
- Reduces the need for surgery
General Therapeutic Laser Biological Effects
- Increased Cell Growth: Laser photons accelerates cellular reproduction and growth.
- Increased Metabolic Activity: Photons initiate a higher outputs of specific enzymes, greater oxygen and food particle loads for blood cells and thus greater production of the basic food source for cells, Adenosine Tri-Phosphate (ATP).
- Faster Wound Healing: Cold laser photons stimulates fibroblast development and accelerates collagen synthesis in damaged tissue
- Anti-Inflammatory Action: Laser photons reduce swelling caused by bruising or inflammation of joints resulting in enhanced joint mobility.
- Increased Vascular Activity: Laser photons induce temporary vasodilation that increases blood flow to effected areas.
- Reduced Fibrous Tissue Formation: Laser photons reduce the formation of scar tissue following tissue damage from: cuts, scratches, burns or post surgery.
- Stimulated Nerve Function: Laser photon exposure speeds the process of nerve cell reconnection to bring the numb areas back to life.
Types of Cold Lasers
The fixed level of power is too low to deliver photons beyond the surface of the skin, making them ineffective in delivering photons to deep tissues. This includes laser pointers and other low cost laser diodes.
Class IV Continuous Lasers
The increase in the power of class IV continuous wave lasers increases the photon delivery to deep tissues. Unfortunately, it also increases the amount of the heat generated. This heat increases the potential risk of destructive thermal effects. Class IV laser may result in damage to the retina requiring clinicians to exercise additional FDA implemented controls to ensure patient and practitioner safety. This can include a safely lock on the device to prevent accidental exposure.
Modulated Lasers (Class II to IV) Modulating or super-pulsing the laser output power (turning it on and off in less than 1 billionth of a second) provides a unique combination of benefits. It allows the use of very high power levels (up to 50 watts) while insuring that there is no heat or damage. The ratio between the on and off times is call the duty cycle. In general a super pulsed laser class II laser can provide more power to the treatment area than a class IV continuous lasers without a risk of damage. Modulated lasers provide a good combination of safety and power.
Today, lasers are used extensively in the medical industry for everything from cosmetic surgery, eye surgery and heart surgery. The ability to put just the right amount of energy into a critical area of the human body has been a huge advancement in the medical field. Cold lasers are an important addition to these other established medical laser treatments and the recent development of low-cost professional cold lasers means that cold laser therapy will be a rapidly growing medical treatment option.
Plantar Fasciitis: Treatment Pearls
by Douglas Richie, Jr. D.P.M., President Elect AAPSM (2003 – 2004)
Epidemic Of Heel Pain:
Heel pain is the most common musculoskeletal complaint of patients presenting to podiatric practitioners throughout the country. It is well-recognized that subcalcaneal pain syndrome, commonly attributed to plantar fascitis, is a disease entity that is increasing in its incidence, owing partly to the fact that it has a predilection for people between the age of 40 and 60, the largest age segment in our population.
The orthopedic and podiatric literature have been filled with original scientific investigations and anecdotal reports about the appropriate surgical and non-surgical approach to plantar fascitis. The vast majority of these scientific articles deal with the general patient population presenting with heel pain. There is a growing consensus of opinion that plantar fascitis is best treated non-surgically with the vast majority of patients becoming asymptomatic within twelve months of the onset of symptoms.
While patience, rest and tolerance of pain are virtues recommended to the patient presenting with plantar fascitis, different treatment strategies must be employed when dealing with the athlete.This article will focus on the differences in treating plantar fascitis in athletes vs. the general, sedentary population.
Subcalcaneal pain syndrome in athletes is thought to be brought on by an overload of the plantar fascia.However, the mechanism of this overload is debated.Overload causes micro-tears at the fascia-bone interface of the calcaneus or within the substance of the plantar fascia alone.The central band of the plantar fascia is primarily affected where a hypercellular, inflammatory response occurs within the fibers of the fascia, leading to degenerative changes.
A spur may result from further inflammation but is not implicated as the primary source of heel pain.Many studies have shown the presence of spurs on the heels of asymptomatic patients.One study found that only 10% of all calcaneal spurs visible on x-ray were actually symptomatic.
Other authors have attributed “painful heel syndrome” to an entrapment of either the medial calcaneal nerve or the first branch of the lateral plantar nerve.However, the mechanism of entrapment proposed by these authors is still related to overload of the soft tissue and fascial structures on the plantar and medial aspect of the calcaneus.
Although heel pain is common, there is no commonality of opinion of the biomechanical etiology of this syndrome.Contributing factors reported in the literature include leg length inequality, pronation of the subtalar joint, restricted ankle joint dorsiflexion, weakness of plantar flexion, high arched feet, low arched feet and heel strike shock.Studies have shown that decreased arch height has shown no correlation to the development of plantar fascitis in runners.In fact, it is well accepted that the common athlete presenting with heel pain has a medium to high-arched foot.
Scherer and coworkers have given the best insight into the pathomechanics of plantar fascitis.Their study proposed that supination around the longitudinal axis of the midtarsal joint is a common feature in over 100 feet presenting with heel pain.Supination about the longitudinal axis of the midtarsal joint can occur in two primary situations:when the heel everts past perpendicular (heel valgus) or when a forefoot valgus deformity is present (sometimes accompanied by rearfoot varus).
TREATMENT STRATEGIES FOR THE ATHLETE
In most cases, the goal of the athlete is to quickly return to activities to minimize loss of fitness and performance.This will put pressure on the treating practitioner to be more aggressive than treating cases of more sedentary patients.
A survey was conducted by this author of the board members of the American Academy of Podiatric Sports Medicine two years ago to compare treatment protocols for athletes vs. standard population.The following treatment pearls were elicited:
1) Assignment to alternative activity
The athlete must be encouraged to maintain cardiovascular fitness during rest from damaging activities that may delay healing.For the runner, dancer or volleyball player, this means a complete cessation from running and jumping activities until acute symptoms subside.On the other hand, the athlete should be assigned to alternative cardiovascular fitness activities that minimize impact and loading on the plantar fascia including stationary cycling, swimming, upper body weight machines, and low resistance flat-footed stair master machines.
2) Change and modulation of footwear
Footwear analysis is critical for evaluating athletes with subcalcaneal pain.The footwear may be a contributory factor and can be utilized as a powerful treatment modality.Athletesshould be placed into shoes that have a minimal 1″ heel height with a strong stable midfoot shank and relative uninhibited forefoot flexibility.The American Academy of Podiatric Sports Medicine has a list of recommended footwear for the athlete that can be obtained on their web site:www.aapsm.org.It is well recognized that recent trends in athletic footwear have actually predisposed to greater frequency of plantar fascitis due to the fact that athletic shoes have weaker midsoles with newer designs.The popular “two-piece” outsoles with an exposed midsole cause a hinge effect across the midfoot placing excessive strain on the plantar fascia in the running and jumping athlete.These shoes must be eliminated if the injured athlete is wearing them.Careful attention must be paid to having the athlete keep shoes on in the house and during all standing and walking activities.Barefoot and sandal-wearing activities are prohibited.
3) Home therapy
Athletes are accustomed to designing and participating in their own training programs.They are willing participants in their own treatment programs. Heel cord stretching is central to the rehabilitation process to decrease load on the plantar fascia and encourage healing.The use of plantar fascia night splints has been well proven to be a treatment adjunct for plantar fascitis by placing the heel cord and the plantar fascia on a sustained static stretch during sleeping hours while preventing the normal contractures that occur in the relaxed foot position during sleep.Having the athlete roll or massage their foot on a golf ball or tennis ball is helpful to improve blood flow and break down adhesions in the injury site.
4) Custom foot orthoses
Intervention with semi-rigid custom foot orthoses has been well proven in many prospective and retrospective studies showing successful outcomes in patients with plantar fascitis.In the athlete, the use of foot orthoses should be considered earlier than in the average sedentary patient because of the fact that the athlete will be subjecting their feet to greater stresses during treatment and certainly after return to activity.Athletic footwear is more amenable to semi-rigid and rigid orthotic therapy than are casual shoes worn by sedentary patients.Sports podiatrists are more likely to employ arch taping procedures as a precursor to or adjunct to orthotic therapy.Athletes respond very favorably to the immediate intervention and relief obtained by expertly applied arch taping procedures.
5) Physical therapy
Athletes are amenable to referral for physical therapy because they are willing to invest the extra time to expedite recovery.Many athletes are used to going to the training room for hands on rehabilitation.Athletes appreciate a partnership between the sports podiatrist and the physical rehabilitation specialist.
6) Anti-inflammatory medication
Sports podiatrists should be cautioned against over-aggressive use of anti-inflammatories in treating the athlete.While it is tempting to utilize corticosteroid injections to expedite healing, athletes are often skeptical of receiving this treatment and are certainly at greater risk for sequela of over-ambitious use of steroid injections.There are reports in the literature of athletes undergoing spontaneous rupture of the plantar fascia after even single injections of their plantar fascia with corticosteroid.The conservative, biomechanical interventions outlined above should be implemented before considering injection therapy.
Athletes presenting with plantar fascitis must be treated aggressively because they have immediate needs and long-range goals that are different than those seen in the average sedentary patient with heel pain.It is important to be aggressive and employ a variety of modalities and treatments when formulating a treatment plan for the athlete.At the same time, caution should be made about the overzealous use of quick fixes, including corticosteroid injections because of the potential deleterious effect on athlete.
The cornerstone of plantar fascitis treatment for the athlete is biomechanical.Podiatric practitioners possess the greatest skill set and knowledge available in medicine today to adequately address the pathomechanics of plantar fascia overload.The use of properly casted and designed custom foot orthoses should be the cornerstone of non-surgical treatment of subcalcaneal pain in the athlete.
Resistant Plantar Fasciitis Treatment Program (Initial)
Contributed by Richard Bouche D.P.M. , William Olson, D.P.M., Stephen Pribut, D.P.M., Douglas Richie, Jr,. D.P.M.
PHASE 1- Acute Phase:
- Goal decrease acute pain and inflammation:
- absolute or relative rest- Decrease sports activity to avoid rebound pain
- ICE: 2 appliations of 20 minutes per day
PHASE 2- Rehabilitation Phase:
- Further decrease pain and inflammation:
- contrast baths
- Maintain/increase flexibility of injured (and surrounding) tissue:
- gentle stretching exercises: calf, hamstring, posterior muscle groups
PHASE 3- Functional Phase:
- Functionally strengthen intrinsic muscles of the foot
- closed chain therapeutic exercise
- Doming of Arch (towel toe curl)
- closed chain therapeutic exercise
- Protect injured area during functional activity
- stability running or other appropriate athletic shoes
- orthoses as needed
Note: this is probably the most important phase because it prepares the patient for their return to activity. Care needs to be taken at this stage not to allow the patient to overdo these exercises and stay within their limits as re-injury can easily occur.
PHASE 4- Return To Activity
Return to desired sport activity: gradual, systematic, “to tolerance”
Initiate preventive strategies:
appropriate athletic shoewear
functional exercises (i.e., pilates, plyometrics)
revise training program
Note: Be careful in the first months return to exercise to avoid recurrence of pain.
Consider shock wave therapy if there is a 6 month failure and a failure after repeated modification and remaking of orthotics.
- Posted in Athletic Injury, Cycling, Dr. Kevin Murray, Dr. Stewart Chang, EPAT, Extracorpeal Pulse Activation Treatment, Foot Doctor, Foot Pain, Heel Pain, Orthotics, Plantar Fasciitis, Podiatrist, Podiatry, Running, Shockwave Therapy, Shoes, Shoes and Socks, Uncategorized
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- Tags: Athletics, charlottesville podiatrist, Custom Orthotics, Exercise Related Pain, foot inflammation, Overuse Injury, Plantar Fasciitis, Sports Related Injuries
Common cycling injuries are often due to trying to do, “too much, too soon”, but may also be due to improper equipment, biomechanics, technique, or bike fit. As with all athletic injuries, pain that is persistent indicates a need to seek treatment from a sports medicine specialist familiar with cycling injuries.
1. “Hot foot” (numbness and burning in the ball of the foot)
Impingement of small nerve branches between the second and third or third and fourth toes can cause swelling which results in numbness, tingling, or burning, or sharp shooting pains into the toes. Loosening shoe toe straps, wearing wider shoes with a stiffer sole and using anatomical footbed with a metarsal pad will help alleviate the problem.
Besides tight shoes, another risk factor is small pedals, especially if you have large feet. Small pedal surfaces concentrate pressure on the ball of the foot. Switching to larger pedals may be the cure. Re-focus the pressure on the ball of the foot by moving the cleats towards the rear of the shoe. If your cycling shoes have flexible soles like most mountain bike shoes, they’ll be less able to diffuse pressure.
Physician-designed custom orthotics provide biomechanical benefits and can be made with built-in “neuroma pads”. Cycling orthotics are different than those for runners, as cycling is a forefoot activity, not a heel-strike activity.
Cortisone injections occasionally may be helpful for symptomatic relief, but they do not address the cause of the pain.
The sesamoids are two small “seed-like” bones found beneath the big toe joint. Injury to these tiny bones can result in inflammation or even fracture, leading to debilitating pain and inactivity. Sesamoiditis can be relieved with proper shoe selection, accommodative padding, and foot orthoses.
1. Achilles tendonitis
Irritation and inflammation of the tendon that attaches to the back of the heel done can be caused by improper pedaling, seat height, lack of a proper warm-up, or overtraining. This condition is usually seen in more experienced riders and can be treated with ice, rest, aspirin, or other anti-inflammatory medications. Chronic pain or any swelling should be professionally evaluated. Floating pedals which allow excessive foot pronation may also worsen this condition.
2. Shin splints
Pain to either side of the leg bone, caused by muscle or tendon inflammation, which may be related to a muscle imbalance between opposing muscle groups in the leg. It is commonly related to excessive foot pronation (collapsing arch). Proper stretching, changing pedals, and corrective orthoses that limit pronation can help.
Some intrinsic knee problems like swelling, clicking, or popping should be immediately evaluated by a sports medicine specialist. Cartilage irritation or deterioration, usually under the knee-cap, can be caused by biomechanical imbalance, improper saddle height, or faulty foot positioning on the pedals. Riding in too high a gear “mashing”, excessive uphill climbing, or standing on the pedals all may aggravate the problem. Cleated shoes or touring shoes with ribbed soles that limit side-to-side motion can cause knee pain if the knees, feet, and pedals are misaligned.
Pain under the kneecap. Most chondromalacia sufferers can ride at some level no matter how sever the degeneration.
2. Patellar Tendonitis
Strain of the tendon which attaches the kneecap to the leg, this injury often occurs in the novice cyclist or early in the cycling season. The first sign of a problem may be an ominous twinge after cycling in too hard a gear.
Bike fit is key; have a professional check your fit and make bike modifications as needed.
Carefully choose the shoes you will wear in cycling.
Train properly using adequate warm-up and cool-down. If you are doing “too much, too soon” and start having pain, reduce training frequency, intensity, and time.
Pain is not normal and may indicate a medical condition. Seek medical attention from a sports medicine specialist.
Before beginning any exercise program, be sure to check with your physician.
-The American Academy of Podiatric Sports Medicine (AAPSM)
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Blue Ridge Foot and Ankle Clinic
Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116
Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro, VA 22980 540-949-5150
Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming
you to our practice.
- Posted in Achilles Tendon, Athletic Injury, Blisters, Bunions, Cycling, Dr. Kevin Murray, Dr. Stewart Chang, EPAT, Foot Doctor, Foot Pain, Heel Pain, Ingrown Toenails, Leg pain, Neuroma, Orthotics, Our Community, Plantar Fasciitis, Podiatrist, Podiatry, Shockwave Therapy, Shoes, Shoes and Socks, Triathlons
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- Tags: Athletics, charlottesville cycling, charlottesville podiatrist, Custom Orthotics, Exercise Related Pain, foot inflammation, foot surgery, mortons neuroma, Overuse Injury, Plantar Fasciitis, Sports Related Injuries, Tendonitis