Monday, January 25, 2016

Chi Running for Chronic Foot Pain

Are you training for an upcoming race or can't run as long as you want? Is your foot and ankle hurting you after just a few miles? If this is the case then you may consider taking a look at your running style and posture.

Over the past four years I have personally used this running technique rooted in Tai Chi which has helped me avoid foot pain and allowed me to run longer distances. 

ChiRunning focuses on posture, leg swing, the position of the pelvis and a forward lean. Here are the basics:

Run Tall.  When you're standing straight, your joints are in alignment and your skeleton is supporting your weight. When you run, you want to keep this alignment so your skeleton continues to be involved.
It's common, however, for runners to slump the shoulders or bend at the waist, which then requires the leg muscles to support most of the body weight, instead of the stronger skeleton. By maintaining good posture, you lessen the amount of work your legs have to do and move more efficiently.

Lean Forward.  By adding a slight forward lean when you run, your body falls forward and you use gravity for your propulsion instead of your legs. This lean also helps keep your body in alignment, with your foot landing under you.
To do this, lean from your ankles, not your waist, and keep your spine straight. The lean is subtle; don't lean so far forward you are out of control or actually falling.

Land on the Mid-Foot. To keep your posture in alignment--which helps reduce injuries--while you're leaning forward, land with a mid-foot strike when you run. You want your foot to land underneath or slightly behind you, in line with your hips and shoulders.

Run from Your Core. To reduce injuries, it's vital to keep your pelvis level. You do this by engaging your core muscles while you run.To level your pelvis, try this simple exercise: Stand against the wall and try to press your lower back into the wall. Watch what happens to your pelvis. You have to engage your lower abdominal muscles in a vertical crunch movement. Remember that feeling in your body and try to maintain it as you run.

Relax, Relax, Relax. It's common for runners to tighten up their shoulders or other muscles as they get tired. But all that stiffness and tension wastes energy and makes you less efficient. When you feel your technique slipping, ask yourself: Where am I tense, and what can I do about it?
Sense and respond with the correct adjustments, which might be as simple as straightening your arms and shaking them out or reminding yourself to lower your shoulders. In my book, I recommend a series of pre-run body looseners--such as shaking out your arms and legs, ankle rolls and hip and pelvis circles--to help your muscles learn to stay relaxed when you are running and throughout the day.

Danny Dreyer has developed this running technique and if you have time purchase his book callled,
" ChiRunning: A Revolutionary Approach to Effortless, Injury-Free Running.

Thursday, January 21, 2016

Diagnosing and treating Heel Pain with Diagnositic Ultrasound

   One of the most common foot conditions that we see at Carolina Foot Specialists is heel pain.  . Researchers have reported that plantar fasciitis occurs in 2 million Americans a year and 10 percent of the population over a lifetime.3
It is important to understand that not all heel pain is the classic, “Plantar Fasciitis.” The differential diagnosis may also include Achilles tendinitis, autoimmune inflammatory syndromes, stress fractures, nerve entrapment, apophysitis, arterial insufficiency, tarsal tunnel syndrome, infection, bursitis, fat pad atrophy, trauma, and simply overuse syndrome.
Dr. Saffer and Dr. Brown have been utilizing diagnostic Ultrasound for the past 10 years.  When it comes to the use of ultrasound in the diagnosis of plantar fasciitis, our Sports Podiatrists firmly believe it is easy to perform, in-office, and can aid in diagnosing the specific form of foot or heel pain that is presented.
Ultrasound has afforded our practice the ability to diagnose fasciitis, fasciosis, plantar fascial tears, inferior calcaneal bursitis, cortical stress fractures and abscesses (with a vertical toothpick embedded in the calcaneus). If a cortisone injection is required especially for plantar fasciitis/plantar fasciosis our specialists have a virtual pain free technique and are able to directly visualize the injection pinpointing the area of pathology. This is all done in the office setting and typically takes a few minutes.
We feel that the gold standard for evaluating heel pain in the office setting is Diagnostic Ultrasound. If x-rays are needed we have that technology in our offices as well.
Once you become comfortable with the modality, you will soon realize that the placement of your injections without ultrasound guidance can be “misguided.” In our experience, we realized that at times were were not placing injections deep enough into the tissue and often injected at a site that did not house the inflammatory changes. Needless to say, missing the target will not net optimal results  Additionally, if you are injecting steroid into an area of “non-pathology,” you run the risks of possible injection into the subcutaneous tissue which could lead to fat pad atrophy
Once you become comfortable with the modality, you will soon realize that the placement of your injections without ultrasound guidance can be “misguided.” In my own experience, I realized I was not placing my injections deep enough into the tissue and often injected at a site that did not house the inflammatory changes. When you depend on patients’ subjective experience as to where the maximum pathology exists via palpation, you soon find that they often will report pain in an area adjacent to and at other times distant from the actual site of pathology. Needless to say, missing the target will not net optimal results.
   Additionally, if you are injecting steroid into an area of “non-pathology,” you run the risks of the effects of local fibrolysis of the fascia and/or the subcutaneous tissue (fat pad atrophy).
Our practice is moving into newer minimally invasive technology for chronic heel pain. Our Sports Podiatrist have been trained in the “Percutaneous Plantar Fasciotomy.” This procedure is developed by Tenex and is a minimal incision that removes diseased tissue. No sutures are required and can be done under local or IV sedation at a surgery center or hospital. For more information on diagnostic Ultrasound and Tenex please our  Heel Pain Center at

Tuesday, January 19, 2016

Baseball And Your Feet

Baseball And Your Feet
America's Pastime

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.