We hope everyone had a safe and injury free walk/run during the Cooper River Bridge Run this past weekend! We would like to get back to basics with proper running form so that you remain injury free for the spring and summer months. Here are some nice tips to help avoid injury and keep you on your feet.
Starting with the foot: Where should you contact
Some say to run on the ball of your foot, others say contact the ground with the heel. I take a middle of the road approach. Studies have shown that good long distance runners usually contact with the midfoot. Slower runners contact between the midfoot and the heel, faster runners a bit further forward. Only sprinters or short to middle distance runners should contact the ground with their forefoot or the ball of the foot. While there may be exceptions to the rule, this is a good way for most beginning and intermediate runners to start out. It allows for better shock absorption, less stress on the calf muscle and Achilles tendon, and better rolling forward onto the next stride. Your muscles will then be used in a manner that is similar to how you walk, and this is the pattern of muscle firing and contact pattern which the muscles are accustomed to.
Hips & Head
This part is hard to think about: Where are your hips when your foot hits the ground. Some people have suggested that your foot should be under the center of gravity of your body when it strikes the ground. A line from your head through your hips should end up at your foot. Keep the head fairly straight and look ahead. Turns to the side should be done carefully and usually mostly from the neck up to avoid twisting your body and making you unstable in your forward progression.
This is what you use when you haven't obtained a jogging baby stroller. Actually, it is where you allow your arms to swing. First, and most importantly, don't tense up and carry them stiffly with your hands balled up into a fist and your elbows completely bent. Relax. Carry your arms at your side somewhere between your waist and your chest. Make sure they are not too high or too low. One arm swings forward while the other one goes backwards. This occurs opposite to the foot and leg motion. Sprinters on the track move their arms in a straight forward-backward motion. Most longer distance runners use a slight arc as they swing their arms, but the better ones don't waste motion by moving too much from side-to-side. In other words, they don't swing their arms excessively in front of their body.
The knees do not have to come up very high for long distance runners. Only sprinters or those of us chugging up a hill have to left our legs high.
One of the biggest problems of form in long distance running is overstriding. Make sure that you don't do this, it can lead to a host of problems including Achilles tendonitis, ITB pain, and iliopsoas muscle pain.
While some like to tell you how to count your breathing in seconds both in and out, we will just tell you to keep breathing, deep and regular. In most cases your breathing will take care of itself, as you run faster, you'll breathe faster. And yes, most runners are mouth breathers or at least nose and mouth breathers. It would be impossible to take in adequate oxygen just breathing through your nose.
Uphills and Downhills
Slow up a bit on the uphills. In general it is a bad idea to try going faster. Move your arms a bit more to help you imagine that you are cranking your way or pulling yourself up hill. Shorten your stride and chug on up. You can think of the little train that could and repeat "I think I can" on the way up a big hill.
On the downhill, be careful. Go slow. The biggest risk, is to your knees. Your quadriceps do the bulk of the braking and be overworked without you being aware of it. If you are racing, then you may lean forward a bit and fly down the hill in a short race, but certainly be more careful in training. In fact many runners who use hills as part of their training will walk down the hill while recovering to run up the hill once more. This is a good way to rest and recover while avoiding the excessive knee stress that downhill running can cause.
If you have any lingering pain in your feet after the Cooper River Bridge Run please contact us at: www.carolinafootspecialists.net
Choosing the right custom foot orthotic for overpronation
Are you a runner and have not had success with custom orthotics in the past because they were uncomfortable and too rigid? If so please read on and learn about the best material that Sports Podiatrists can use so that your orthotic is comfortable as well as provides the correct amount of support.
Q: What materials are available for orthotics and which are the best?
A: : In order to understand why certain orthotic materials are typically recommended by podiatric physicians, it is important to understand the fundamental goals in orthotic therapy. The purpose of the functional orthotic is to accurately and precisely position the foot throughout the gait cycle so as to promote proper function. Its function is not merely to support the arch, as is often the case with commercial appliances or arch supports purchased in retail stores. The functional orthotic is prescription fitted and is very effective in alleviating symptoms and establishing proper alignment. In order to achieve the desired and expected results from the use of functional orthotics, several steps must occur. First, a detailed range of motion and muscle testing examination is performed by your podiatrist. The purpose of this is to measure and quantify the motion of all lower extremity joints, identify abnormalities such as excessive laxity or limitation of motion, and determine the weightbearing and non-weightbearing functional positions of these joints. The muscle testing portion of the examination is performed in order to determine muscle groups which may be excessively weak or tight and to determine their part in the overall cause of injury, symptoms or biomechanic problem.
Following the examination, a non-weightbearing neutral position cast or three dimenstional image of the foot is taken. The specific method of casting or imaging is critical and must be done accurately in order to achieve an accurate impression of the foot in its neutral position. The negative casts or three dimensional image (email) are then sent to an orthotic laboratory accompanied by a prescription written by your podiatrist indicating not only the specification of the foot pathology that needs to be addressed, but also the materials to be used and the dimensions and accessories to be used in the manufacture of your functional foot orthotics. The manufacture of functional foot orthotics is thus a multi-step process involving detailed and intricate cast correction, orthotic fabrication and application of additional items prescribed by your podiatrist for the treatment of your specific condition.
In order to achieve the desired results, the functional foot orthotics must be made from materials which have the ability to resist the pathologic symptom-producing forces which have ultimately produced the injury. Typically, plastics or graphite are used, both offering a range of flexibilities, designed to appropriately resist abnormal injury-producing forces while allowing comfort and compliance so as to be compatible with the sport. The plastics that are used are generally made of a family of materials called polyolefins, the most common being polypropylene. The thickness of these materials ranges from 1/8" to 1/4". These materials range from quite flexible and compliant to relatively rigid. Graphite also ranges from quite flexible to quite rigid and is generally one-half as thick and one-half as heavy as orthotics made from polyolefin materials. The flexibility, or compliance, of an orthotic is a subjective choice determined by the requirements of your sport and the degree of rigidity required to resist the abnormal forces resulting in injury. Highly flexible devices are used when the forces imposed are relatively minor or the requirement of the sport mandates a compliant device. However, these materials possess shorter life spans due to the cyclic fatigue inherent in an orthotic device that has a high degree of flexibility. More rigid orthotic devices are used when more significant forces are present or the sport of choice is compatible with the more rigid device. More rigid devices have the advantage of being quite durable and can often last for many years without modification or adjustment. Typically, stop-start complex motion and/or cutting sports (ie. soccer, basketball, aerobics, tennis) require more compliance in an orthotic device, while repetitive-motion sports such as walking or running are quite compatible with more rigid devices.
Soft materials such as Neoprene, various open- and closed-cell foams or similar cushioning materials may be used in conjunction with functional foot orthoses to provide both support and comfort. A patient should always discuss these options with their podiatrist and even entertain the possibility of having more than one pair of orthotics using materials of different flexibility and/or covers as determined by the requirements of their sport, the constraints of their shoe gear, and their overall comfort.
Successful orthotic treatment should always include an orthotic device that is effective in reducing eliminating symptoms and is comfortable to wear. By selecting the appropriate flexibility material and cover material, both of these goals can generally be achieved.
Our foot specialists at Carolina Foot Specialists are active athletes that have experienced a majority of the foot ailments that patient's present with in the office. When custom foot orthotics are dispensed a detailed plan includes the proper break in period as well as a plan to get patient's back to their chosen sporting activity. We have a policy where orthotics can be refurbished or remade within a six month period of time if required to insure that our patient's are please with the custom orthotics that they have received.
For more information of a variety of foot conditions please refer to our website at www.carolinafootspecialists.net
Baseball And Your Feet
Based on a document produced in cooperation with the: American Podiatric Medical Association.
For more than a century and a half, America has carried on a love affair with baseball. Kids slam fists in their first gloves, and dream of one day playing in the big leagues. For a few, the dream comes true. The rest of us keep the fantasy alive through youth leagues, on adult softball teams, or pickup games with friends. We pledge allegiance to our favorite major league team, sharing the triumph or agony of every win and loss.
More than following big league baseball, we all want to play the game ourselves--to hear the crack of a base hit, execute an around-the-horn double play, or shag a screaming liner. But like all vigorous exercise, baseball and softball should be played sensibly and safely. Improper preparation and technique can lead to injury, especially to the lower extremities, which take us around the bases and under fly balls.
Before the First Pitch
Most American kids begin playing organized baseball at age 6 or 7. If a child is in generally good health and has no preexisting physically compromising conditions, baseball is relatively safe with proper instruction in the game's fundamentals.
Weekend warriors who pick up the sport again in adulthood are less apt to be in optimum condition than younger athletes, and should take it slow before jumping right into a game. Anyone who is more than 40 years old, diabetic, a smoker, or has any physical disability should see a family physician before taking the field. People with existing foot problems should see a podiatric physician specializing in sports medicine, who can perform a gait analysis and assess any risk inherent in a sports regimen.
Because baseball and softball involve quick starts and stops, it's important to loosen up before the game. Even the youngest children should make sure to do some simple stretching, running and playing catch before the game to avoid muscle pulls or other problems.
Before playing pickup games, make sure the field is free of hazards like holes on the base path, which could cause a foot or ankle injury. Sticks, rocks, and other debris on the field cause players to trip, risking injuries, and should be removed.
Shoeing Up for Baseball
Young players will do well to wear molded cleats rather then steel spikes. They should be gradually introduced before being worn in a game. A young player needs to get a feel for cleats, which should not be worn off the field.
While the improved traction of cleats may enhance play, it also leaves the ankle more susceptible to twists and turns. Any child with preexisting foot conditions should see a podiatric physician before putting on cleats. Never put a child in hand-me-downs; ill-fitting cleats increase the danger of ankle injuries. When sizing cleats, make sure the feet are measured by a footwear technician, and always wear a game-size sock when trying them on.
In some competitive baseball leagues, the use of metal spikes is permitted for players more than 13 years old. Spikes must be understood as dangerous weapons on the base paths; they require a certain level of maturity to be worn safely. They are not necessary for casual play, and should not be worn unless in league competition.
Spikes, which technology has made lighter and more flexible these days, perform the same function as cleats, but engage the ground differently. They too should be worn on a limited basis until the feel of how they engage the turf is understood. Unfamiliarity with spikes can lead to ankle twists and turns in a competitive situation.
When wearing cleats or spikes for the first time, watch for irritation, blisters, or redness, which could indicate a biomechanical problem in the legs or feet. Pain is a clear indicator of a problem. If cleats cause pain, discontinue wear for two to three days; if it returns, see a podiatric physician specializing in sports medicine for evaluation.
Preventing Baseball Injuries
One of baseball's most exciting moments comes when a batter stretches a single into a double by beating the tag in a dust-kicking slide. Sliding is a fun part of the game at all levels, but proper technique is crucial to avoiding foot and ankle injuries, especially when bases are firmly secured to the infield. Coaches at all levels should make sure their players are well schooled in proper sliding. Careless slides can result in sprains and even fractures of the lower leg and feet.
Pitchers also need to be coached on the proper way to come off an elevated mound with their back foot and land on an incline with the front foot. The repetitive motion of pitching can lead to overuse injuries to the feet and ankles. Pitchers experiencing pain in their windup should take a few days off before returning to the mound.
Catchers too are susceptible to overuse injuries by squatting behind home plate for every pitch. Again, coaches should teach their catchers how to alter their stance to vary weight displacement.
Today's trend of trying to achieve perfection by year round sport participation may result in an overall increase in injury. This is not just a lower extremity phenomena but is often seen in young pitchers having both elbow and rotator cuff injuries serious enough to lead to surgery while still in high school.
Lower Extremity Injuries and Treatment
Contusions. A baseball will inevitably make contact with a player's foot and ankle, whether it's a pitched ball, foul tip, or line drive, and sliding base runners often run headlong into a infielder's legs. Usually this contact results in contusions, which are not often serious injuries. Ice packs and a few days' rest will usually help the contusions, or bruises, feel better.
Sprains and fractures. Stretched or torn ligaments, known as sprains, can occur from running the bases, or pivoting to make a play. Sprains may cause extensive swelling around the ankle just like a fracture. Immediate treatment from a podiatric physician is crucial to quick healing. Fractures, where the bone has cracked or broken, often require casting. After a sprain or fracture, a podiatric physician can prescribe a rehabilitation regimen to restore strength to the injured area before returning to the sport.
Plantar fasciitis. Catchers are particularly susceptible to arch pain, commonly traced to an inflammation called plantar fasciitis, on the bottom of the foot. A podiatric physician can evaluate arch pain, and may prescribe customized shoe inserts called orthoses to help alleviate the pain.
Heel Spur Syndrome. A related condition, to which catchers are also susceptible, is heel spur syndrome. Often related to plantar fasciitis, heel spur syndrome occurs when the plantar tendon pulls at its attachment to the heel bone. This area of the heel can later calcify to form a spur. Many times the ligament pulling on the heel creates the symptoms, and not the spur itself, especially after getting up from resting. With proper warm-up and the use of supportive shoes, strain to the ligament can be reduced.
Achilles tendinitis. The stop-and-start of baseball often creates pain and tightness in the calf, and aggravation of the Achilles tendon. Again, regular stretching of the calf muscles gently and gradually before and after the game will help minimize the pain and stiffness.
Shin splints. Shin splints usually stem from an inflammation of the muscle and tendon attached to the shin, caused by stress factors. Treat shin pain with cold compresses immediately after a game to reduce inflammation. Proper stretching and strengthening exercises should prevent the onset of shin splints.
If you are a runner/or walker and experiencing continued pain on the top of your foot you may be suffering from a stress fracture. Women seem to be more susceptible to stress fractures of the feet. Factors that predispose women more than men include a history of amenorrhea (lack of menustral cycles), osteopenia of bone, too small of body mass in the legs, and diet that may be too low in calcium.
The most common site of stress fractures that we see in our practice is the metatarsal bones in the foot. Additional factors that can contribute to stress fractures are worn out shoes, speed training, changes in running surfaces, and overtraining. Just this week I was able to diagnose two patients with stress fractures. These two patients actually were not runners but recently went to Disney world and did a tremendous amount of walking in flip flops. The combination of the long distance walking and the wrong shoes caused a hairline fracture in the metatarsal bones of the foot.
Clinically patient that I see will have pain and swelling on the top of the foot for more than two weeks. Initial x-rays may not show a stress reaction of the bone. It can take 10-14 days for a stress fracture to show up on a X-ray. In about three to four weeks bone callus (thickening of the bone) will indicate a healing stress fracture. It takes 6-8 weeks for a stress fracture to heal. We will place patients in a cam walker boot or surgical shoe in order for the bone to properly heal.
To decrease your risk for developing stress fractures replace your shoes every 300-400 miles, try to run on softer surfaces, and increase your calcium intake. You can do low impact exercises such as swimming and biking during the healing phase. It is very important to not run through the pain which can delay the healing time of the fracture.
In conclusion if you are experiencing pain and swelling on the top of the foot and it is not improving in two weeks with rest, ice, and NSAIDS, have it evaluated as soon as possible in order to correctly diagnose your foot condition. This will enable you to return to your chosen athletic activity sooner and not suffer through a chronic injury.
PRP (Platelet Rich Plasma)
Do you suffer from Chronic Heel Pain?
If so Carolina Foot Specialists will begin to offer a minimally invasive option for chronic stubborn plantar fasciitis.
A new state of the art treatment for chronic heel pain that our practice will offer is PRP (Platelet Rich Plasma) injections. The procedure is in the office setting under local anesthesia and involves taking a small amount of blood from the patient, similar to giving blood for a routine test. The vial of blood is subjected to very high speeds in a machine called a centrifuge. A yellow material is obtained containing cells called platelets, that are very abundant with factors that aid in healing. These growth factors are believed to decrease the inflammation causing plantar fasciitis. The platelets from the patient's own blood is injected into the area of pain in the heel. Patients are then fitted for a removable walking boot with light weight bearing to prevent putting excess weight on the heel for one week or less. After that, they advance to sneakers, and although the range of time for pain relief is variable, it can be appreciated as early as 10-14 days.
For more information please contact our office at carolinafootspecialists.net
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