1. Change Your Running Route to Include More Hills – Remember that the Talmadge Bridge  has an almost 6%  gradient, and your body will use your muscles much differently when tackling this run than your average Lowcountry flat runs
2. Keep a Steady Pace Going Up – While some people think they need to blast through the incline, this ends up being very inefficient and wastes a lot of energy. Save that energy for the decline, when you can use gravity to help really improve your time.
3. Drink Plenty of Fluid Before the Race – Dehydration can cause blood volume to drop off causing your body’s ability to transfer heat to decrease, and speed up your heart beat.
4. Do Not Use Brand New Shoes for the Bridge Run – Make sure to break in new shoes for a period of 1-2 weeks of shorter runs before race day.
5. Make Sure You Get Enough Electrolytes – As you exercise your body will lose sodium through sweat. You can get electrolytes through either tablets, tomato juice, or Gatorade.
6. Rest Before the Race – While you should definitely get lots of rest the night before the race, sometimes pre-race jitters can interrupt your normal sleep pattern. Make sure to get your long nights of sleep the 2-3 days before the race, that way you’ll still have plenty of rest despite those sleepless pre-race nights.
7. Warm Up Using Dynamic Stretches/Static Stretches After the Race – Dynamic stretches increase your range of motion, think Ankle Pops, High Knees, Butt Kicks and Low Lunges. Static Stretches will help with cool down, try Groin Stretches, Calf Stretches and Hamstring Stretches.
8. Have a Carbohydrate Heavy Meal the Night Before the Race - Think pasta. Carbohydrates are a great source of energy, and your body loves this, otherwise your body is forced to use stored fat, which uses more of your bodies energy.
9. Find a Committed Running Partner – Not only can a running partner provide encouragement, but they are also help you improve your form and are great pace setters.
10. Replenish Lost Electrolytes – If memory serves right, the Savannah Bridge Run has free beer after the finish line. One beer after a workout will actually rehydrate you faster than water, because the salts, sugars, and bubbles in beer enhance your body’s ability to absorb the water content!

Now you are ready to conquer the Savannah Bridge Run! We’ll see you at the top!

Remember that pain in your feet and ankles is not normal, so if you are experiencing pain please call Atlantic Foot & Ankle Specialists to schedule an appointment, 912-355-4557 or go to our Appointments page here.

Dr. Christin Runkel, DPM

I spent this past Sunday like many Americans, watching a football game with my family at a local restaurant.  As the referees determined yardage and the players fought to gain it, my attention flew to the actual playing field, the grass beneath their shoes.  Before the introduction of hybrid, genetically improved grasses, the field was made of AstroTurf.  As I glanced around the room during the game, I could not help but wonder how many former football players had suffered from a condition called turf toe. And it just so happens to be Atlantic Foot and Ankle Specialists’ Foot Problem of the Month, so get ready to be conditioned for some knowledge!

Common Turf Toe Injury

Turf toe is a hyperextension injury of the big toe joint where it is bent forcefully upwards. It occurs in people who play contact sports on artificial surfaces, which is how turf toe acquired its name. Today, it typically occurs in athletes who have increased range of motion in the ankle and or wear flexible shoes. The forceful upwards motion of the toe causes ligaments under the toe to be stretched and damage usually occurs to the surfaces of the bones making up the big toe joint.

Symptoms of turf toe include swelling and pain at the big toe joint with tenderness upon stretching the joint upwards. The athlete can initiate treatment by icing the injury, apply a compression bandage, and or wear a shoe with a firm sole that will not allow bending. The next step is to contact a podiatrist with experience in sports medicine. The medical professional will obtain either X-rays or an ultrasound to rule out fracture. A variety of treatments can then be implemented.

Treatments usually include taping/strapping the toe and or orthotics to prevent movement, anti-inflammatory medications (NSAIDS, such as Tylenol) , and beginning a rehabilitation and strengthening program. The recovery period usually takes about 4 weeks, depending on the extent of injury. If the athlete returns to activity prematurely, they may develop hallux limitus, which is arthritis at the big toe joint.

If you or a friend are suffering from turf toe, please contact Atlantic Foot and Ankle Specialists at 912-355-4557. And please feel free to visit our Facebook page and remember to “like” Atlantic Foot and Ankle Specialists.

Being a runner myself, I know the need a runner experiences to be able to run. That being said, with some lower extremity running injuries, a runner may need to stop running temporarily.  Temporarily is the key word, as my goal for any of my patients is to keep them as active as possible during treatment. This series will explore the most common running injuries that I see, as well as how to treat and prevent them.

Part 4 of 4 – Black Toe AKA Runners Toe

What is Black Toe AKA Runners Toe?

Although you can get a black toenail from a sudden, painful trauma that causes bleeding under the nail, for runners it’s not typically the case. The dark discoloration for runners is a chronic, repetitive trauma to the nail caused by the foot constantly hitting the front of the shoe.

Symptoms

• Blood pool (hematoma) in between the toenail and nail bed
• Pain
• Pressure from blood built up
• Loosening of toenail

Common causes:

• Running
• Repetitive trauma where the longest toe (the 2nd toe is most common) hits the shoe when running

Treatments:

• For Hematoma/ Blood pool with no pain or no loosening of toenail- no Rx- wait for new toenail
• If no hematoma with pain and loosening of toenail- cut back with sterile nail clipper or see podiatrist

Prevention:

• Get shoes that fit properly- make sure that you have at least 1/4 space between your longest toe and end of the shoe
• Try on shoes at the end of the day with the sock that you normally run in (trying on shoes in the afternoon will ensure you get a proper fit, as foot swelling is at it’s greatest)
• The injured toenail(S) will be prone to develop fungus so use topical anti-fungal ( not a cream) to prevention the development of fungus- see web site for details on fungus treatments

Common Running Injuries: Part 1 of 4 – Stress Fracture can be found here.

Common Running Injuries: Part 2 of 4 – Plantar Fasciitis can be found here.

Common Running Injuries: Part 3 of 4 – Hallux Limitus can be found here.

The 3rd most common running injury is called Hallux Limitus. The term hallux limitus is Latin with Hallux referring to the big toe and Limitus meaning decreased or limited motion of the joint. So, put together, there is limited motion in the big toe joint.

Symptoms:

• Limitation of motion of the big toe joint
• Swelling
• Stiffness in big toe
• Bone mass or Bump on top of the big toe
• Bone spurs
• Skin irritation from the top of the shoe
• Compensation elsewhere in the body for the lack of motion that is needed for walking
• Cannot bend or push off from the big toe so have a tendancy to put more pressures on the outside part of your foot causing pain on the outside of the foot

Common Causes:

• repetitive trauma causing small bone spurs
• injury
• inherited foot structure

Treatment:

• Custom orthotics to equalize pressure: a cut out in made in the orthotic under submet 1 to allow and increase motion of the big toe
• NSAIDS: anti-inflammatory (such as acetaminophen)
• Surgery to clean the joint and remove spurs

Recommendation:
The best non surgical treatment for Hallux Limitus, in addition to anti-inflammatory medication, is custom orthotics. There are 2 main reasons for this is:

1. They help increase available range of motion within the first metatarsal phalangeal joint by altering and improving mal-alignment and improper biomechanics.
2. Prevents compensation which can lead to additional foot trauma and cause other injuries.

The most common orthotic modification is something referred to as a kinetic wedge/ submet 1 cut out.  However, for more advanced or end stage hallux limitus (usually termed hallux rigidus at this stage), restriction of motion is necessary with something called a Morton’s extension.  Either way, orthotic therapy is critical to addressing faulty mechanics and attempting to eliminate pain while maintaining activity levels.

Common Running Injuries: Part 1 of 4 – Stress Fracture can be found here.

Common Running Injuries: Part 2 of 4 – Plantar Fasciitis can be found here.

Being a runner myself, I know the need a runner experiences to be able to run. That being said, with some lower extremity running injuries, a runner may need to stop running temporarily.  Temporarily is the key word, as my goal for any of my patients is to keep them as active as possible during treatment. This series will explore the most common running injuries that I see, as well as how to treat and prevent them.

Part 2 of 4 – Plantar Fasciitis

What is plantar fasciitis?

In the early stages, plantar fasciitis is defined as having inflammation of a ligament on the bottom of the foot. As it becomes chronic, it is called plantar fasciosis and described has having ligament degeneration with thickening and scarring,  and sometimes the development of a heel spur.

Plantar fasciitis is a common injury because the heel bone is a connecting point for several ligaments, tendon, muscle with nerves surrounding the area.

-the ligament is inflexible
-when stressed, there is a pull from the heel bone causing pain
-some patients will develop a heel spur from the chronic pulling

Symptoms:

Early Stages-

• Pain after first step in the morning or after sitting for long period. The pain improves after walking.
• Bruise like feeling on the bottom of the heel
• Throbbing
• Feels like you walk on a pebble

Later Stages -

• Pain gets worst and is constant
• Shooting pain and numbness

Common causes:

• Over stretching of the plantar fascia because of over-pronation
• Limb length difference
• Tight hamstring
• Improper footwear
• Abnormal bio-mechanics

Treatments:

Early Stages-

• Stretching
• Use of a night splint
• Anti-inflammatory (such as acetaminophen) by mouth or injection
• Custom orthotics- Best long term outcome is achieved this way

Later Stages-

• Stretching
• Surgery
• ESWT (Extracorporeal Shock Wave Therapy) and Custom Orthotics – This combination provides the best long term outcome.

Prevention:

• Good athletic shoes that fit correctly and that are not worn-out (6 months old is ancient in shoe terms) If you live in or near Savannah we recommend Fleet Feet for great running shoes (it’s worth the trip).
• Control your bio-mechanics using custom orthotics (for more info on custom orthotics follow our Pedorthist, Demon Thompson on Twitter here.)
• Be more aware of surface you run on. Hard surfaces cause more damage over time.

If you need more in depth information on plantar fasciitis please order a free copy of our heel pain book. There is no obligation, and no strings attached. We hate spam as much as you do, and we respect you privacy. You can also order your copy by phone 1-888-398-9525.

Common Running Injuries: Part 1 of 4 – Stress Fracture can be found here.

Common Running Injuries: Part 3 of 4 – Hallux Limitus can be found here.

As a runner you want to make sure you have properly fitted shoes, and that the shoes are made to compensate for your natural gait cycle (whether you are a pronator or supinator.) If you live here in Savannah, I highly recommend Fleet Feet, they have an excellent staff that is fully trained to fit you with the right running shoe.  However, a better running shoe may not always solve the problem.

If there is pressure and pain under the toenail, see your podiatrist. Drainage from a blackened nail can be a sign of melanoma and should not be ignored. For more information or to make an appointment visit www.atlanticfeet.com and you can also follow me on Twitter @Demon_Cped.

Bulluck at a Giants practice.

New York Giants Line Backer, Keith Bulluck, suffered a turf toe injury in week 3 of the 2010 season against the Tennessee Titans.  Bulluck has missed the last two games, week 4 against the Bears and week 5 against the Texans.  He has been having improvement in his symptoms and has been participating in practices.  Bulluck may return back to play soon.

Being a runner myself, I know the need a runner experiences to be able to run. That being said, with some lower extremity running injuries, a runner may need to stop running temporarily.  Temporarily is the key word, as my goal for any of my patients is to keep them as active as possible during treatment. This series will explore the most common running injuries that I see, as well as how to treat and prevent them.

1- Metatarsal Stress Fracture: A little crack in the bone, this is by far the most common injury that I see.

Symptoms

• Swelling top of foot
• Pain on top of forefoot
• Does not stop you from running. Is painful during, but especially after a run
• No bruising
• Gets progressively worse
• Pain does not go away completely after 1-2 days of rest, but foot feels better

Common Causes

• Overtraining: increasing the intensity or duration of running too rapidly
• Bio-mechanical instability

Treatment

• X-rays – used, but we typically do not see stress fracture on x-rays
• Ultrasound – this is a better diagnostic imaging test for stress fracture
• Walking Boot – No hard casts are necessary, so the patient can stay more active
• Bone stimulator: this helps bones heal faster so patients can get back to running. (My patients loves me for this one!)
• Custom orthotics
• Limit your activities

Prevention

• Early Detection. My best recommendation is to seek medical attention at first symptoms.  You might not like the fact that I may put you in a walking boot for 10 days and no running for 8 weeks, but it will prevent complete bone fracture.  While you are in a boot- Cross training is done and after only 10 days you can run again.

• Get bone density test. A bone density test uses X-rays to measure how many grams of calcium and other bone minerals are in a bone. This is a good predictor of your risk of fractures.

• Labs: get a Vitamin-D level check ( 59 % of population are deficient in Vitamin-D). Vitamin D is key to keep bones strong, it aids in the absorbing of calcium. Vitamin D also helps to prevent cancer and autoimmune diseases. Vitamin-D level is crucial, especially in women, as it can prevent Breast Cancer. Vitamin-D level  is not a routine test that physicians perform, but you should ask your doctor about it.

• Easy does it: Increase the intensity and duration of your training gradually to allow your bone to adapt.

Common Running Injuries: Part 2 of 4 – Plantar Fasciitis can be found here.

Common Running Injuries: Part 3 of 4 – Hallux Limitus can be found here.