Archive for the ‘Triathlons’ Category

Foot Injury: Tips and pointers.

April 27th, 2016 by Dr.Chang

Sneakers

Here is the latest copy of the APMA Newsletter “Footprints”. Focus on Foot Injury: Identification, management and protection tips from future injury.

APMA Footprints April 2016 Newsletter

cycle

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.

Foot Pain

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.mt climb

Cortisone injections occasionally may be helpful for symptomatic relief, but they do not address the cause of the pain.

2. Sesamoiditis:

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.

Leg Pain

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.

Knee Pain

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.

1. Chondromalacia

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.mark_1

Cycling tips

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)

 

Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!

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.

Walnut Creek Chimney Chase 2012

August 2nd, 2012 by Dr.Chang

Congratulations to Mark of Team Blue Ridge Foot and Ankle for his 4th place finish in the expert/pro division at the Walnut Creek Chimney Chase! Go Mark!

 

 

 

 

 

 

 

 

 

 

New Rider on Team Blue Ridge Foot & Ankle!

February 29th, 2012 by Dr.Chang

Mark Smith, a medical receptionist at our Blue Ridge Foot & Ankle Waynesboro office, will be riding in local mountain bike races this Spring wearing Blue Ridge Foot & Ankle colors!

Mark is riding in the following races:
March 18
Ohill, Charlottesville

June 9
Massanutten Hoo-Ha

July 29
Chimney Chase at Walnut Creek Park

October 20
Paranormal in Earlysville

He is riding on a really “sweet” ride-  The Cannondale Flash Alloy 29’ER 1.  Check out more details on his bike HERE.

We wish Mark good luck in all his races!   Follow us on Facebook and Twitter to hear about how he places.  Go Team Blue Ridge!!!!

Women athletes, especially those who run and do triathlons, are often told that they are more susceptible to certain lower extremity pain. But what are the unique qualities of the female physique and subsequent common injuries? This post will discuss lower extremity pain common among women due to musculo-skeletal characteristics, hormonal changes and even cultural factors. Below you will also find a few simple suggestions for reducing the risk of foot and ankle injuries. However, Ladies, injuries are cause by a variety of factors and treated in a variety of ways depending on your individual body type and list of activities. If you are experiencing foot and ankle pain, never hesitate to consult your local Charlottesville podiatrist for more information.

Female Musculo-Skeletal Factors in Injuries

There are a few factors that doctors consider when discussing female-specific injuries. Foremost, the angle that represents the relationship between the pelvis, leg and foot, referred to as the Q angle, is more dramatic in females because of women’s wider hips. Knowing this angle is important for athletes because repetitive and continual stress throughout the lower back, pelvis, hip, knee and ankle will often produce injuries in the lower part of the body, especially among women with wider Q angles. Determining whether your Q angle falls outside of the normal range may help in considering the causes of foot and ankle pain, not to mention pain in the lower back, pelvis and even the neck.  If you are concerned that your Q angle is affecting your running or causing foot and ankle pain, visit Dr. Murray and Dr. Chang for a professional assessment. They will be able to provide various suggestions, including fitting you with over the counter and custom orthotics.

Common running injuries due to a wide Q angle include patellofemoral pain syndrome or runner’s knee, iliotibial (IT) band syndrome, and shin splints. Women commonly feel pain from patellofemoral pain syndrome, otherwise known as runner’s knee, behind or around the kneecap. Runner’s knee has a range of causes – from over use, direct trauma or misalignment to flat feet. Women commonly are afflicted by runners knee due to a weak VMO muscle (vastus medialis oblique <<image>>), a muscle in the interior thigh. The good news is that it is easy to strengthen the VMO through knee extension and hip abduction exercises. Contact your Charlottesville or Waynesboro podiatrist to find the right exercise plan for you.

Iliotibial band syndrome is also a common injury found among female runners and triathletes. The IT band is made up of tissue that runs on the outside of the thigh, from the pelvis to just below the knee. While crucial to stability during activity, its continual abrasion against the top of the femur and the knee can make it inflamed, causing pain in the hip, thigh and/or knee. Often, using a foam roller can help runners prevent and heal sore IT bands. Stretching is a great preventative measure for IT band pain. Try standing straight up, and bending to the side as far down as is comfortable. Two sets of 15 repetitions on each side should work wonders. Hip flexor exercises can do the trick as well. Kneel on one knee and turn the torso until you feel a stretch on the IT band. Hold this for 5-10 seconds, and repeat 3 times on each side. Again, consult Dr. Murray and Dr. Chang or another licensed professional to design the appropriate workout for you.

Shin splints, known to doctors as medial tibial stress syndrome (MTSS), result from too much force on the shinbone and the connective tissue attaching muscles to it. If you run, chances are that you’ve had the ‘splints. Studies show that up to 15% of running injuries are shin splints, and the advertisements in the back of running magazines are certainly a good testament to that fact. Shin splints are common among runners who have flat feet or over-pronate. In other cases they are caused by tightness in other various muscles and tendons (another good incentive to warming up and stretch!) and by increasing mileage too quickly. Try your best not to increase mileage more than 10% per week; especially with the female disposition to have diminished bone density, female runners are up to 3.5 times more likely than men to contract stress fractures from shin splints.

By far, the single most important to preventing shin splints, along with all of the Q-angle injuries mentioned above, is wearing properly fitted shoes and being attentive to when your shoes are worn out. Your local shoe dealers, Ragged Mountain Running, the Charlottesville Running Company and Richey and Co. Shoes, can all provide foot assessments and expert advice about properly fitting shoes.

Age and Hormone-Related Causes of Injuries

The female Q angle can take tolls on knees, ankles and feet of all ages. High school athletes have a high incidence of injuries to the ligaments in the knees, primarily the anterior cruciate ligament (ACL) and medial collateral ligament (MCL), because they tend to lack the lateral stability and endurance necessary for optimal performance and injury prevention. Some experts write that 30% of all ACL tears occur among high school females due to the Q-Angle of the female hip. Some helpful tips for ACL/MCL injury prevention among teens include not neglecting a 5-10 minute warm up, followed by stretching, planning for rest, and staying hydrated. High school athletes can also benefit from light to moderate lateral plyometrics such as lunges and squats, and even light weight lifting.

Female-specific hormones may have great effect on female runners throughout their lives. Hormones, such as relaxin, that women release during pregnancy lead to the relaxation of ligaments. Biologically, this allows for smoother births, but these hormones can affect ligaments in the feet, leading to arch pain, collapsed arches, plantar fasciitis and over pronation. While the jury is still out on the benefits of running during pregnancy, most experts agree that easy running in moderation can be helpful for second trimester moms who are runners, as long as it is balanced with enough time resting the feet and attentiveness to overheating and hear rate levels. Consult your obstetrician to determine a proper exercise routine during your pregnancy.

Not surprisingly, pregnancy may necessitate larger shoe sizes due to swelling. Ligament laxity may permanently increase shoe sizes or altered foot shape. Cramming a new foot size into old shoes too often results in foot and ankle pain. Contact your local shoe experts to determine whether your shoe size has changed, and what the best new fit might be – your feet are worth it!

And what about running injuries during menopause? The experts are still out on whether running correlates to an easier ride through menopause. However, the precaution about menopause often is that diminishing bone density resulting from hormonal changes can often lead to osteoporosis. Boosting the amount of calcium in your diet to between 1000-1500 mg before menopause is a good preventative measure to ward off post-menopausal osteoporosis, especially for female runners. Keeping running and strength training up can keep your bones strong, help prevent bone fractures and healthy circulation, not to mention running’s other physical and emotional benefits!

Other Causes of Female Injuries

In addition to biology, nurture, or cultural influences, may be factors in female injuries as well. High heels often lead to bunions, hammertoe, ingrown toenails, sesamoid injuries, Morton’s Neuroma, back pain and other problems. Remember that good-looking shoes are not exclusive of comfort. Consider buying shoes with arch support and room in the toe box from stores like Richey and Co. Shoes.

But high heels are not the only culprits of foot and ankle pain! If your running or athletic shoes do not fit or are worn out, you can likely injure your legs, ankles or feet. Be attentive to the wear in your shoes, and buy new athletic shoes frequently – according to your podiatric experts, Dr. Murray and Dr. Chang, the appropriate shoes will prevent a host of injuries!

Unfortunately, female athletes are particularly susceptible to eating disorders, and what doctors have come to know as the “Female Athlete Triad.” The triad is made up of an eating disorder and weight loss, amenorrhea (missed periods), and osteoporosis. Poor nutrition can lead to bone loss, decreased serum estrogen levels, psychological abnormalities, and, in extreme cases, death. Those who suffer from the Female Athlete Triad may experience fatigue, anemia, depression, decreased concentration, constipation, cold intolerance, and parotid gland enlargement seen in the cheeks. If this isn’t bad enough, the boneless can cause stress fractures that will not heal without proper nutrition and self-care.

Nurture your body! Healthy eating leads to strong bones and can keep you strong, fit and running your best. Balanced and healthy diets improve athletic performance, prevent osteoporosis, and aid in the healing of injuries. Consuming a target of 1000 mg of calcium per day, with sufficient Vitamin D for calcium absorption (which can either be derived from sunlight or regulated supplements), will help prevent stress fractures. Visit our page on bone healing for more information.

So, to all the female runners out there, stay strong and inspired, and remember that consulting your doctor, fully understanding the various causes of injuries and taking care of yourself will aid in injury prevention and healing.

Comment on this post to share your thoughts or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!

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.

 

Summertime Running & Managing The Heat

July 7th, 2011 by Dr.Chang

Summer heat shouldn’t stop you from regular outside activity, but being aware of how to deal with the heat is key for comfort, safety and enjoyment of staying active in the heat. Here are some tips for summertime running, most of which you can apply to other outdoor activities, regardless of age or ability level.

BEFORE ACTIVITY:

Preparing for the heat begins before your run starts. Be sure to check the weather and heat index and to modify activity on especially hot days. Running in the morning or evening enables you to avoid the hottest hours of the day (10am-5pm). By running in the shade or woods you can avoid direct sunlight and keep yourself cooler.

Consistent hydrating will help your body deal with heat. Experts recommend drinking 2-3 cups of water during meals, 2 ½ cups of water 2 hours before a run, and 2 cups of water just before running. Alternatively, aiming for 6-8 fluid oz. of water at least every two hours throughout the day can help your body adjust to hot temperatures.

Athletic clothing is designed to help regulate body temperature and stay comfortable. Cotton can impede your body’s thermoregulation because it absorbs your body’s moisture but does not dry easily. When it’s hot outside, the human body cools down by the process of evaporating and cooling through sweating, so it is increasingly difficult to stay cool as the humidity rises because evaporation becomes less efficient. Athletic companies design sweat-wicking and breathable clothing to help your body regulate the temperatures (and to keep you smelling fresh!). Lightweight, loose fitting and light-colored clothes are best to regulate your body’s heat and to reduce chafing.

Consider the material when you reach for a pair of socks. In order to reduce blisters, wear lightweight socks. Acrylic microfiber socks absorb moisture while allowing evaporation. If you’re heading out for a long day of activity, and especially if you’re blister prone, consider packing an extra pair of socks for your upcoming adventure. If you predict moisture problems with your feet or in your shoes, try sprinkling powder like Gold Bond Foot Powder in your shoes before activity. These powders regulate moisture and prevent nuisances like athlete’s foot and fungus. The breathability of your shoes is another important consideration. We cannot emphasize enough the importance of good shoes, replaced every 350-400 miles or as needed for the management of blisters and the support of your feet and ankles.

In addition to clothing protect your skin by applying sweat-resistant sunscreen at least 20 minutes prior to your run. Sunglasses and hats protect your face and keep bugs out of your eyes. Light colored hats or bandanas can be lifesavers for people with dark or thick hair, but remember that your body loses most of its heat through the top of your head, so you don’t want to sport heavy headwear. Some helpful tricks include cooling a cap in the freezer before your run and soaking it in water mid-run.

DURING ACTIVITY:

Warming up sounds ridiculous when it’s blazing hot outside, but starting slowly (even at a walk) and building up to your normal running pace will help your body adjust to the heat. Warming up is especially important when your body is adjusting from inside air-conditioned climates to the outside heat, and to that effect, some running experts even suggest that runners limit their use of the A/C.

DRINK WATER DURING YOUR RUN! Be sure to find the right system of carrying water with you or mapping your run around public water fountains. If you are running for one hour or less, water alone should be sufficient for hydration. For a longer run, be sure to bring sports drinks or carbohydrates for adequate electrolyte and carbohydrate replacement. Studies indicate that your body absorbs chilled fluids faster, and cold water has the added bonus help lower your body temperature.

Pouring water on your face feels great in humidity, and it also helps wash away the sweat if your skin breaks out from sweating. (Note that moisture-wicking material and sunscreen that doesn’t clog your pores is great for preventing breakouts on other parts of your body too). Also try pouring water on the top of your head, the back of your neck, and on the inside of your wrists while running – sure ways to cool you down.

Be conscious of how hard you’re pushing yourself, and listen to your body. Heat stroke and heat disease are serious problems. Primary symptoms can be cramps in your legs, dizziness, excessive breathlessness, intense heat built-up in the head, headaches, nausea, disorientation, loss of muscle control, cessation of sweating, and unusual heart beat or rhythms. After initial symptoms, drinking water with salt in it, or sports drinks, can help. If you pulse is low and your breathing is growing rapid, you might have heat exhaustion. This can be due to dehydration and from overheating. STOP EXERCISING when this happens! Your body has probably sent too much blood to your skin to keep your skin cool and is not pumping enough blood and oxygen to your brain. These symptoms are serious – so slow down, drink lots of room temperature fluids, with a pinch of salt in each glass, or take a cool bath.

Remember that heat illness can be exacerbated if you already have a viral or bacterial infection, are taking medications, are dehydrated or hung over, have a sunburn, are not well acclimatized to the heat, are over exercising, have experienced heat disease in the past, are sleep deprived, and have medical conditions like high cholesterol, high blood pressure, are under stress, have asthma, diabetes, epilepsy, cardiovascular disease or smoke. Using common sense, good judgment and attention to symptoms and preexisting conditions are paramount in keeping yourself healthy and safe.

AFTER ACTIVITY:

Staying healthy, blister-free and hydrated continues after exercise too. Try not to leave your feet in sweaty, muddy or wet shoes after exercise. Be sure your feet are sufficiently aired out after your run – this will prevent getting blisters or hot spots in the future and keep your shoes (at least a bit more) odor free. Replenishing the fluids you lost through exercise is essential for both recovery and preparation for your next run. Additionally, a healthy and balanced diet, with attention to healthy levels of sodium (which enables water retention), potassium (promoting proper nerve and muscle firing), and fats (that enable thermoregulation), is as important to staying hydrated as drinking water.

Clubs, such as the Charlottesville Track Club, The Charlottesville Trail Running Club, or the Charlottesville Running Company, are active in the summer and bring the running community together. Joining these clubs can help with motivation, and running in a group can also keep you safe from the heat.

So keep being active, folks, but take care of your body by exercising right! If you have any other tips, tricks and suggestions, we’d love to hear from you. Feel free to post a comment on this blog.

 

 

Doc, why won’t my shin splints get better?

November 24th, 2010 by Dr.Chang

Compartment syndrome masked as shin pain, recalcitrant.I had a recent case that challenged my diagnostic skills. A young soccer athlete was referred to me who complained of right lower leg pain following the start of soccer practice approximately 6 weeks prior to presentation in my office. He had been initially diagnosed with “shin splints” and treated with R.I.C.E methods by his team trainer. His symptoms persisted and he was seen by his primary care doctor. The assessment was same. He was suffering from “severe” shin splints. Oral anti-inflammatory meds, R.I.C.E. and some home exercises were given. NO response then he was ordered outpatient physical therapy. A few treatments went by without relief; the patient’s primary care provider referred him to me.

My exam showed the patient demonstrated “classic” shin splint palpable tenderness along the distal medial and anterior lateral aspects of the right leg. The worsening of the pain with exercise was present, also a common finding in the shin splint injuries. With my athlete patients I will often make the patient exercise to the point of where they get similar onset of pains reported. We did so. He described pain that was both an ache and a burn in sensation at same locations above. He had strong pulses. All sensation was intact. This young man had very large, muscular calves which were very tight and turgid even in resting condition. His leg x-rays were negative for stress fracture. My next most likely diagnosis was Chronic Exertional Compartment Syndrome (CECS).  I set up a time to analyze leg compartmental pressures: resting and post exercise reading are indicated.  His were 10 mm and 38 mm respectively.

Shin splints have a variety of presentations.

This syndrome can encompass a number of overuse disorders, they all share a common finding of periostitis (bone inflammation) near the origins of the soleus and/or flexor digitorum longus muscles. Flexor origin shin splints tend to be distal medial in pain…. Soleus origin shin splints can be that but also deeper and lateral (seemingly – anterior pain in location) … This is the tricky presentation…. . Commonly, the patient demonstrates many contributing factors most notable being; structural pathology predisposes patients to excessive and unbalanced pronation during the run/gait cycle, with subsequent overuse of the muscles of the distal extremity.

The differential diagnosis for this condition includes: stress fracture, chronic or exertional compartment syndrome, sciatica, deep venous thrombosis, popliteal artery entrapment, muscle strain, tumor, and infection.

Digging deeper for some answers…

Exertional compartment syndrome is a condition in athletes that can occur from repetitive activities and progressive competitive training. The anterior compartment of the leg is the most commonly affected location. Patients describe pain also as is burning in nature, which worsens with activity and completely subsides after 15 minutes of activity cessation. It seems, initial activity places a demand for blood supply for the muscles. This results in vascular inflow, engorgement, and expansion of the muscles in a confined fascial structure or “compartment”. The result is relative compression and pain. Resting and immediate post exercise is the gold standard for the diagnosis of chronic exertional compartment syndrome. A dynamic, post-exercise reading of greater than of 35 mm Hg is highly indicative of compartment syndrome. A dynamic pressure greater than 40 mm Hg is considered diagnostic.

Conservative therapy may help in the near term, but the condition will often flare when athletics are resumed. When indicated, surgical decompression via fasciotomy of the involved compartment is definitive in correction of the problem.

What is to become of this young athlete?

Considering the failure of conservative care, and the indisputable pressures measured…. the patient elects undergo anterior leg compartment release. I expect this to fully solve his problem. For me, lessons are always learned.
On referral patients, which are a good bulk of our clinic’s sports medicine cases, I always seek a wide ranged differential diagnosis. It may walk like a duck, and talk like a duck, but some times geese can look and talk that way too. In this case, I applaud the referring provider who saw that this patient may benefit from a specialist’s point of view. I called her on my findings, diagnosis and course of care for the patient in question. I got the proverbial …. “Ah Hah..I knew it !” As it turns out here, the referring physician demonstrated more than adequate working knowledge of lower extremity. As doctors, we are not expected to know everything… but we need to be smart enough to know what we don’t know.

When Can I Run Again After a Stress Fracture ?

October 11th, 2010 by Dr.Chang

I have seen an unusually large amount of running related stress fractures recently in the office.  I thought I would blog on a common concern of my athlete patients.

A runner with a Stress Fracture, often times have a burning desire to return to running.  Some think a stress fracture really in not a “real” fracture, so return to activity should take less time.  Right?  I say maybe ……A fracture of any type is a challenge as is significantly alters ones lifestyle.  Particularly runners.  They may end up forgoing a race, a goal they have set for achievement, or just miss the “runner’s high” they get from getting out on the road.  In find that  runners often get in a hurry to get back into the activity and can cause additional injury from not waiting until the appropriate time to return.

While it is true stress fractures are not “true” and complete fractures … the condition does require similar protocols for fracture healing.  However, in my experience, the traditional fracture healing times may by truncated.

Generally speaking an osseous injury requires 6-8 weeks of protection and relative inactivity to heal adequately.  This is a “rule of thumb” benchmark which has been made over time by medical professionals based on experience, x-ray evidence and patient feedback in the healing process.  It is individual dependent, fluid, but very close to accurate in my experience.

What are the biggest factors that influence my determination of healing?  !) X-Ray evidence.  2) Resolution of pain.
So, how do I transition back to running?

What is the most accurate indication of healing? Bone healing, as with fractures, is usually confirmed on x-ray.  If the x-ray shows sufficient callus formation around the fracture and “filling” fracture by reduction of fracture line lucency, the area is healed.  This means the bone is sufficiently stable for return to activity and re-injury risks are reduced.  It is best to wait until this has occurred to return to any running type of exercise….  If your goal is to get back to running pain free, hastening your return to running is not advised.

–         Pain is improved can I run? Depending on the type and degree of the fracture, pain can improve and sometimes resolve by 2-3 weeks.  I often see most fractures being pain free at week 4.  Absence of pain is a good sign, but not a guarantee that healing is complete.   If you were to run too soon, I could create a situation requiring a return to cast or boot and possibly even surgery.

How do I get back to running? The best way to get back to running is to do it progressively and gradually. .  Expect recovery to normal to be 3 times that (at least) to what your recovery time was observed at.  This means a recovery time of 6-8 weeks is a 18-24 gradual return to activity. .  Start slow, preferably on a surface that will protect you from re-injury.  As you transition back running, try up to 1 mile only for the first 3-5 days, and then start adding mileage to your normal running routine.  Pain is always a good guide to prevent re-injury.  Too much too soon, and your body will tell you.  Don’t ignore these signs.
Anything worth doing, is worth doing right.  This is especially true in an orthopedic injury.  There will always be another race.  There will be another time to set fitness goals.  Take time to respect your body and appreciate the remarkable ability you have to affect healing to an injury.  Your body thanks you!

See our website fracture informtion pages here and here , for more information.

Back to school : Youth sports injuries and prevention.

As our children return to school many are involved with extra-curricular athletics.  In our experience, this return to school sports is sometimes plagued by injury and/or onset of foot and ankle pain.  This past week our office has seen several middle and high school teens with an assortment of foot and ankle problems related to athletics.  Here are the common ones we see:

Achilles Tendonitis

Calcaneal Apophysisitis.

Shin Splints.

Many of these conditions are a result of engagement in activity without adequate preparation and conditioning.  Our active young children are involved in sports that are becoming increasingly competitive and demanding.  I’d like to offer some TIPS for pre-conditioning and injury prevention.

  1. Warm up before exercise.  Pre-activity stretching
  2. “Fuel up” – EAT  before exercise
  3. Hydrate your body before exercise.
  4. Gradually increase: Time & Intensity of your exercise activity
  5. Cross Train
  6. Wear proper equipment
  7. Consider supporting the feet.  Orthotics or Off shelf arch supports
  8. Consult a personal/athletic trainer
  9. Have a pre-participation athletics physical
  10. Take time to rest and recover from exercise activity. Post activity stretching.
  11. LISTEN to your body…

Here is one of my favorite articles on this topic by a Sports Podiatrist.

Preconditioning Principles for Prevention of Sports Injuries in Adolescents and Children (PDF)

Stewart M Chang, DPM

Blue Ridge Foot and Ankle CLinic -Your Sports Podiatry Specialists

Barefoot running …. Are they crazy ???

August 23rd, 2010 by Dr.Chang

This week I was asked by two friends, “Should I get barefoot running shoes?”  My answer to them was maybe….

There is currently a lot of buzz in the air about this new style of shoes, however, the concept is not new.  There has always been a “fringe” group of runners who touted barefoot running for years.  In fact, there is a whole Barefoot Running subculture and boy are they serious about it.  Somehow it is now in the mainstream with new products and more media attention on this type of shoe and running style.

Some people are lucky have great foot mechanics.  They are well conditioned, experienced runners and love going in barefoot style shoes and even running “barefoot.”   However, there are obvious danger issues purely “barefoot”: glass, twigs, gravel, etc.  Also, An unshod, unconditioned foot also doesn’t have the shock absorption that it needs to run long distances on paved surfaces.

For me, the “jury is still out” on this issue.  I need to see and hear from more individuals who are in barefoot running shoes.  I can certainly see a minimalist sneaker as a competition track shoe where speed and weight is a critical thing.  Hence the racing flats.  The Nike Free…. comes to mind.  Mostly use here is for competition, not distance or endurance training.

The barefoot shoe is certainly only for the absolute best and well conditioned athlete….. not the weekend warriors.  Running barefoot may have some benefit in muscle strengthening as the muscles have to ‘tune in’ to the vibrations caused by more obvious impact loading.   These shoes must “fit” correctlyt and observe progressive mileage with time, especially if you are used to standard runner shoes.  If not….. I think you may easily injure yourself and not realize it until it is too late.  If you grew up running barefoot your tissue tolerance would have adapted over time. For someone who has grown up wearing shoes and is a natural heel striker the impact loading will be beyond tissue tolerance level and injury will likely occur.  Contact a sports medicine specialist for evaluation if you have any concerns.

I welcome anyone’s comments regarding your experiences with barefoot running shoes.

Kevin P. Murray, DPM

Stewart M. Chang, DPM

Blue Ridge Foot and Ankle Clinic – Your Sports Podiatry Specialists.


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