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Sunday, October 20, 2013

Ironman Lake Tahoe Race Report



Wednesday September 18, 2013

Driving through the mountains on I-80 I heard myself say, “If this wasn’t number 12, there is no way I would be doing this.”

Sitting in my truck with my P3 nestled comfortably in back I was on the way to Lake Tahoe and talking to my friend Henry on the phone. I was trying to explain what I was about to do. And I was having a hard time buying my own reasoning.

Today I was driving from San Francisco to Lake Tahoe simply to drop my bike and gear bag with Megan Lewis and SAG Monkey extraordinaire Nick.  I was then going to drive to Reno where I would spend one night in a casino hotel, only so I could get a little sleep before I had to wake up the next morning to see if I could make it to the very front of the line at athlete registration. Next I would fly to Las Vegas where I would be giving a lecture at a medical conference that afternoon. I would lecture again the next day before flying back and hopefully make it back from Reno to Squaw in time for the dinner and athlete meeting. Then of course, I would do Ironman Lake Tahoe.

Less than a week before I had unpacked my bike.  It had been in the case since I flew back from Ironman Texas in May.  Last week I assembled it and took it to Tam Bikes in order to get new cables and a new chain installed. I hadn’t even had a chance for a test ride yet.

Work and daddy-duties had been so busy that I had only done about 8 bike rides, 5 swims in the pool and 4 runs (of about 3 miles each) in the past 4 months. Pretty hard to argue that I might be ready for what was about to happen.

But as I was explaining to Henry, if I could just finish before midnight, that would be 12 Ironmans and I might finally get a “Legacy Slot” and a chance to stand on the starting line of the Ironman World championships in Kona. 

Seems like that might be worth any dose of suffering.


Thursday September 19, 2013

I woke up at 4:58 AM, 2 min. before my alarm clock was scheduled to sound.  I hobbled out of bed, put on some clothes and went down the casino elevator to find some coffee and breakfast. When I got back to the room I returned some patient e-mails and packed my suitcase. I stopped by the lobby just long enough to drop my key card in the express checkout box and choke on some casino smoke.

And away I went, back to Lake Tahoe.

Less than an hour after packing in the hotel I was in the Squaw Valley parking lot looking for athlete registration. They were still setting up tables and chairs. Goal #1 was accomplished; I was first in line for athlete registration.

This was important as registration was not scheduled to open until 9 AM. My flight from Reno to Las Vegas was at 11 AM. And Reno is about 45-50 minutes from Tahoe.

At 9 AM sharp I was handed a form which I quickly filled out and signed. I made my way through athlete registration, got my timing chip, picked up my transition bags and then ran through the expo tent the buy a visor for my brother-in-law Todd who is currently training for his first Ironman.


I then ran back to my truck and pointed it at the Reno airport. As I was driving I got a text message that my flight had been delayed by 5 hours. Not good. This meant that I would miss my first lecture.  Luckily I was able to call the airline and reschedule for an earlier flight. I would still be in good shape.


A few hours later I landed in Las Vegas and went to the Wynn hotel and casino to check in. Once I got to the room I showered and changed into my suit.  I checked in with the International Foot and Ankle Foundation conference administrators and rechecked my talk to make sure everything was in order.

A couple of hours later I was at the podium lecturing on tarsometatarsal fracture dislocation patterns and how not to miss them. I sat through the closing lectures and 9 PM headed back up to my room to get some sleep.


Friday September 20, 2013

I woke up at 4 AM so that I could review the slides for my next talk.  After a quick review I went down to the exhibit hall floor so that I could spend some time in the DG Instruments booth.  DG instruments currently licenses and markets the surgical instrument which I invented. So I try to spend some time in the booth to see if any surgeons have questions about the instrument, or its use in surgery.

Later that morning I gave a lecture on lateral process fractures of the ankle. I was able to attend a few more lectures before had to fly back to Reno. Unfortunately on my way to the airport I received a message that my flight was delayed.  Switching flights wasn’t going to help.

At about 9 PM I was picking up my bike and gear bag from Nick. Because Nick is the official Ironman Lake Tahoe SAG Monkey, I said, “I appreciate your help, but certainly hope I don’t see you on Sunday!” 

At about 10 PM I was knocking on the door of the awesome ski cabin arranged by Andrew Muff. I met Dana and Christine who were super nice.  But I was in bed before I met anybody else. 

Saturday September 21, 2013

Shortly after I got up, the rest of the housemates started to trickle through the kitchen. We all had coffee before heading out for breakfast.

At that point, since I had just assembled the bike and had new cables installed, I was still hoping to get to take the bike out for a short test ride. But now it was raining. I was already worried about the cold, so I wasn’t willing to soak my cycling shoes (or anything else) just to verify that the guys at Tam Bikes did a great job. I chose to trust instead.

After breakfast, I went to pick up some last minute supplies and see if I could find some additional layers. Dana and I found a ski shop that had some consignment gear. I found a used medium weight cycling top for $20 that fit just right. I also found some glove liners for $12.  Perfect! $32 worth of insurance to insulate me from the predicted chill.

Back at the cabin I packed my bags and prepped for the gear drop off.  All of this was fast and simple as I have detailed race-day packing lists. I even have pre-packed zip-locks with the proper contents for each of the special needs bags. By packing them in advance, I think (and worry) way less than I used to. 

FYI: I will post my soon-to-be-no-longer-top-secret Ironman Packing List and Tips. (Feel free to swipe and deploy.)  Such a list will significantly decrease your day-before anxiety.

Because it was raining and I had packed all of my cold weather clothes in my transition bags, I was on my way to transition donning a trash bag as outerwear. But better to freeze today, instead of tomorrow. 

Because it was raining today and predicted to be freezing overnight, I had trash bags covering my handlebars and seat. Certainly didn’t want to start the day on a wet saddle or gripping frozen handlebars. 

As I racked my bike I noticed the guy next to me had no bags to cover anything. So I offered, “Hey would you like a couple of bags to cover your seat and bars?”

“Sure! Just one,” he said.

“Why just one.” I asked.

“I just need to cover my drive train to make sure it won’t still be frozen on the first descent.”

That was a thought I really didn’t need to hear.

I wandered off to find Andrew who had finished racking his bike and dropping his swim-to-bike T1 bag. We headed to Squaw to drop our T2 bags and meet the rest of the group from the cabin. I made an emergency sweatshirt purchase at the expo, realizing I that I had nothing warm (other than a wetsuit) to wear to the start.

By the time we got done at Squaw I was completely soaked and freezing cold. I was having a hard time imagining what it was going to be like to get out of Lake Tahoe and hop on a bike when it was this cold.  To make matters worse, as we were driving back to the cabin, it started to snow.


At the cabin I took a hot shower and later sat in the hot tub to warm up. There was ice on the deck and railing. The snow slowed, the stars began to twinkle. It was serene and beautiful. It just wasn’t Ironman weather.

Sunday September 22, 2013
Race Day

I woke up at 3:45 AM. I quickly put on my clothes, grabbed my gear and headed downstairs. Two peanut butter and jelly sandwiches and two cups of coffee later I was ready to go. We left the house of 4:30 AM heading for the squaw Valley parking lot to catch the shuttle buses to the swim start. 

Once I got to transition it was a simple routine. Drop the special-needs bags and put air in the tires. I pealed the trash bags off my bars and seat.  I kept the trash bags to cover my feet.  I had been warned that the sand was going to be extremely cold.  Knowing that my wetsuit was going to be much warmer than my blue jeans, I slipped into my wetsuit, but kept my sweatshirt on.   I heard someone say that it was 25°.

I put the trash bags over my feet and then put my socks back on to help insulate me from the sand when it was time to head down to the start. 

I dropped my green morning clothes bag and then went onto the beach in search of the 1:30-1:40 swim corral.  Normally (when untrained) I would swim 2.4 miles in about 1 hour 25 min. to an hour and a half.   But I figured with the altitude (and my paltry 30 hours of acclimatization) I would be lucky to make it in 1:40.

Swim 2.4 Miles

By the time the cannon fired and the athletes started filing into the water I was really cold. In fact, I was shivering. It was the first time I have ever been shivering while wearing a wetsuit. I wished that I had brought a neoprene swim cap and booties. 

As my wave started to approach the starting gait, I wandered over toward the fence to discard my socks and trash bags. And then the gods smiled upon me. There in the sand was a size large pair of ScubaPro neoprene booties. I quickly put them on and tucked them under the legs my wetsuit.

I suddenly felt much better and in the water I went. I checked the clock only to make sure the new how much additional time and needed to account for to ensure that I made it in before midnight. It was about 10 min.
As I waded into the water I found it interesting that sixty-something degree water actually feels considerably warmer than twenty-something degree air. But that didn’t last for long. 

There was an eerie fog hanging over the surface of the water that made it nearly impossible to see the buoys. Not being in any particular hurry I was not overly concerned about this. I figure all I had to do was keep moving in the right general direction in order to eventually get there.

I wasn’t swimming particularly hard because I didn’t want to strain anything. After all, I was in no shape to be doing this anyway. But after about 15 minutes I was shivering so much I was actually concerned about my capacity for finishing the swim. So I then decided to try swimming hard for about a quarter of a mile to see if I can get my heart rate up high enough to bring my core temperature up.

Note to self: if not accustomed to altitude, swimming hard at elevation is a bad idea. 

After only 5 or 10 min. of cruising through the pack of swimmers at a brisk pace I started having some mild spasms in my lungs. This quickly subsided when I slowed back down. 

I would just have to be cold.

I’m almost ashamed to say that this was actually the first time I have ever set foot in the water of Lake Tahoe. Probably not a great idea in terms of Ironman preparation but it is the truth.

The thing that I did notice more than anything else is that Lake Tahoe is ridiculously beautiful. It was cold but I was still enjoying it. I could see all the way to the bottom. And every time I took a breath I could see the freshly snowcapped mountains peering through the fog. Physically it was unpleasant. But aesthetically it was wonderful. I would consider it almost a fair trade.

On the 2nd loop I could see better, but I was getting hypothermic. My swimming was simply reduced to watching the buoys drift dry and thinking, “OK #8...I can make it #7.  OK #7...I can make it #6.  OK #6...I can make it #5.”

Soon enough I was out of the water. 1 hour 31 min. Not great, but good enough.

“One down. Two to go!” I thought. 

T1

I came out of the water andf I was thrilled to see the SF try club wetsuits stripping crew. It was really great to see familiar faces. That was when I was no longer curious if I was hypothermic. I knew it. 

The volunteer looked me straight in the face and said, “Can help you get out of your wet suit?” And I just stood there thinking about it. I knew that I had to get out of my wet suit yet I did not want to peel off the neoprene and be exposed to the cold anymore. Fortunately she was smarter than I was and just started helping me out of it.

When I made it into the men's change tent, it was warm, but it appeared as though they were having some sort of Guinness Book of World Records contest to see how many naked men they could shove in a telephone booth. In that respect it was relatively unpleasant. But at least it was warm...

I started to untie my transition bag and realized I was having trouble. I tied the bag like shoelaces so that it's easy to get it undone. But it wouldn't budge. I thought it was that my hands were numb. So then I tried to bite into the cords with my teeth. That was when I realized the entire draw cord had frozen solid into a block of ice.

I ripped the bag open (but was not happy about this). I was worried that would end up losing some of my swim stuff since I couldn't close it back up.

I dried off as much as possible and got into every layer I had packed in my bag. Tri shorts, tri top, arm warmers, compression socks, my new/used cycling top, SFTri windbreaker and glove liners. I put on a fleece hat under my aero helmet, with vent holes taped shut.  

I ran out through transition to find my bike and get going.

Ride 112 Miles

I figure getting on the bike and starting to pedal would help me warm up. I was wrong about that. It wasn’t until I hit the big hills about two hours later that I stopped shivering. 

But all said, it was going well.  I was being conservative, watching the watts and keeping well within the limits that I knew I could sustain.  I just kept telling myself, “All you have to do is NOT do anything stupid and you can make it.”

Near the end of the first loop of the bike course I did something stupid.

I was on the final climb, creeping uphill at about 3 mph. I was only passing the long line of athletes who had given up and traded pedaling for walking. And I was barely going faster than those who were walking their bikes. 

I head my head down, intently focused on pedaling and keeping enough momentum to make it to the top of the climb. Suddenly I heard, “GO SF Tri!, GO SF Tri!” It was a huge crowd of SF Tri members, many of whom were in their Sf TRi colors. Except for Miguel Mendoza...he of course was wearing a Buzz Lightyear costume. 

Miguel ran up next to me and started shouting Go Chris Go!!! You can Do it! GO, GO, GO!!!!!!” 


And so I went...

I upshifted two clicks, stood of the saddle and went as hard as I could. It seemed as though Buzz himself was catapulting me to the top of the hill.  I flew by the long, crawling line of bikes at about 10 or 12 miles per hour.  

I heard some waning cheers as I crested the final hill to start the descent.  As soon as I sat back in the saddle, I felt a sharp pain radiate from my butt cheek at the way to may left knee. I instantly knew I had pulled my hamstring. 

With every rotation of the cranks it felt a sharp twinge. “Way to go idiot!” I said to myself, “You just blew it.” 

I knew my day was over.  There was no aid station on the descent or I would have stopped. While on the descent I started trying to determine the cleanest exit. 

Knowing the course and the extent of road closures I was fairly certain that if I pulled out any time soon I would be waiting for most of the day just to get a trip back to Squaw from the Sag Monkey. 

Since I had nothing to lose, I figured I should just try to make it for the next 10 miles to see if the pain got any worse. It did, but not by much. 

So then I thought I would go another 10 miles to see if it continued to get worse. It didn’t.

When I was on the road approaching Squaw Valley I got passed by one of the pro women. It was Angela Neath on her final loop.  A year ago I attended a workshop and met Angela. That weekend I did a long run with her and her boyfriend. “GOOOOO ANGELA, GOOOOOOO!” I shouted.

Just seeing her inspired me. I thought I could at least finish the bike. As Angela turned left toward the bike finish I continued onto the second bike loop. I realized that if I altered my position just a little, my hamstring didn’t hurt very much. So I just focused on keeping the low-pain position and a high cadence. 

A few hours later, rolling by the lake at the bottom of a short hill I saw “100 MILES” painted on the road. I knew I would finish the bike. This realization was the spark I needed. It grew like a freshly kindled camp fire into the sudden roaring belief that I “might” actually be able to make it through the run, too. But only if I had enough time. 

T2

I stopped at the dismount line and handed my bike to a volunteer. Limping toward the change tent I realized that most of my limp was actually due to my back and neck. The awkward position required to quiet the hamstring had really cramped my back and neck. 

But I know from experience that all of my back and neck issues will relax from running just the opening few miles. I decided that I would head out on the run course. If the only thing I got was to loosen the back and neck, it would be worth it, even if I had to DNF.

Run 26.2 Miles

When I saw the clock I realized I had 6 hours and 28 minutes before midnight. I did the math. 

At Ironman St. George last year a long day of drinking vile “Perform” taught me an unpleasant, buy useful lesson. Even when throwing up 2-3 times per hour, I can walk 4 miles per hour. That means I can walk a marathon in 6 hours and 33 minutes.

I thought to myself, “If you can just run 10 miles, only 10 miles, at 5 mph, you can walk the rest and get in before midnight. 10 miles in 2 hours. On a good day, you can run 13 miles in less than 1 hour and 30 minutes. 10 miles in 2 hours should be a snap. That is the new goal...10 miles in 2 hours. And you won’t have to come back in a year seeking redemption. Instead, you could be in Hawaii!”

I started to run. 

I watched my Garmin making sure to stay exactly on pace...11:30 per mile. This would allow me to walk through the aid stations and still stay on target. 

“Just run 1 mile. Stay on pace. Just run 1 mile.” I kept telling myself.

As I passed the first aid station I realized I was now standing up straight. My neck hurt, but my back was better. “Just 2 miles, run 2 miles.”

As I pushed off to start running again, I felt a sharp jolt in the back of my leg. Burt once I was actually running, it didn’t really hurt. 

Peter and others from the SF Tri club began cheering as I passed by. I was running.  Peter gave me a high-five. 

“Just run 3 miles.”

“Just run 4 miles.”

When I made it to mile 5 the pain in my hamstring was escalating. It was hurting with even the slightest up hill. But I knew I would make it. 

I ran all the way to the turnaround and at mile 11, then I started to walk. And I almost started to cry. 

I couldn’t believe that for 50 miles on the bike I had only thought about the logistics of my impending, unavoidable DNF.  I had even thought of the story I would write on the blog (in place of this one) discussing excuses, ill-preparedness and failure. 

But I had just run eleven miles and would walk to the finish with time to spare. 

Night fell. Cold descended. I reapplied all the layers from the morning bike ride. Used cycling jacket, windbreaker, glove and fleece hat. A volunteer handed me a headlamp. 

I was cold, and it was dark, but I was going to finish.

On the final 3 miles it was foggy and really cold. I was shivering, pretty much the same as when I came out of the Lake early this morning. But I was in motion. The volume of noise increased as I made the final few turns through Squaw Village.

I walked amidst the cheering crowds and I fought back the nearly overwhelming urge to retain my dignity by jogging down the finish chute.  One foolish act was enough. “Just walk...no jogging...no further injury.”

The lights were bright, the cheers were loud and the hands were many that offered a victorious high-five as I walked to the finish. 

As I crossed the line I heard Mike Riley say “Christopher Segler...YOU...ARE...AN IRONMAN!”

And just like that, Ironman #12 was done.  16 hours, 28 minutes and 23 seconds. 

A volunteer wrapped me in a mylar blanket. She asked if I was okay. Someone else said “congratulations” and placed a medal around my neck. I said, “I’m okay, but really, really cold.” My teeth were chattering. 

“We need to get you to medical,” she said.

I nodded. 

Once I got the medical tent, they had a “warming area” where I waited for help. I was cold, tired and really hungry.  I just wanted to go to bed. 

After a few minutes, I stood up and one of the medical personal said, “wait...where are you going?”

“I am going to get my bike and my gear bags. I am going home.”

She replied, “...but, where is your bike tag, where is your family?”

I answered “my bike tag is on my bed at the cabin. I am here by myself.”

In an excited voice she said, “But you are hypothermic, you can’t just walk out of here! You could die just walking across the parking lot!”

I titled my head to one side and said, “Of all the dumb things I do, and all the ways I imagine I might die, walking across the parking lot at Squaw is just not one of them.”

“Thank you. And good night.”

Dr. Christopher Segler is a 12-time Ironman Triathlon Finisher.  His podiatric sports medicine practice caters to athletes who think that there has to be way to stay fit, keep training, yet still heal an injury. He often lectures at medical conferences on the treatment of complicated running injuries, running biomechanics, and subtle fracture patterns of the foot and ankle. Next year he will be volunteering with other SF Tri Club members at Ironman Lake Tahoe. If you have a question about a running injury you can call him directly at 415-308-0833.  You can also learn more about running injuries at www.AnkleCenter.com and www.DocOnTheRun.com

Friday, July 19, 2013

How Can I Tell if My Foot is Broken?


Hi My Running Doc,

A couple of days ago I accidentally kicked the wall with my right foot. My foot still hurts and it is bruised.  I read on your website that bruising can be a sign of a metatarsal fracture. How can I tell if it is just bruised or if my foot is actually broken? I would love to have your expert opinion!

Thanks!
David, Houston, Texas.



Hi David, 

Bruising is a Bad Sign
It is true that bruising is a bad sign when it comes to foot and ankle injury. When you actually fracture a bone, the bone cracks and bleeds quite a lot. That blood diffuses throughout the soft tissue under the skin. What you see is a bruise. That is part of the reason that a bruise can be so concerning for a fracture in the foot. 

In fact the sort of bruising pattern that the picture of your foot shows is often indicative of a fracture or broken bone in the foot. Given your pattern of bruising it is more likely that you have a metatarsal fracture or a fracture in one of the bones in the little toe such as the proximal phalanx phone.


Myths about Foot Fractures

1.  If you can walk on the foot, it can’t be broken.  FALSE!

This may be one of the most widely perpetuated myths about foot injury on the Internet. I have seen many patients with serious fractures that are walking on the foot. Some patients are limping and obviously in a tremendous amount of pain while other patients with fractures or broken bones barely feel any discomfort at all. This is not a reliable indicator of whether or not you have a broken bone in your foot.

2.  There is nothing you can do for a broken toe.  FALSE!

This is also absolutely not true. While it is true that most fractures in the toe will heal uneventfully, there are things you can do to speed healing and decrease your risk of complications. Fractures of the bones in the toe can move if not properly stabilized. Certain shoes will speed healing. Taping the toes to provide stability and immobilize the fracture will also help. But some toes should never be taped together. 

Without the proper treatment of a broken toe, the fracture can fail to heal leading to what physicians refer to as a nonunion. A fracture that never heals correctly can lead to pain, disability and interfere with your ability to run or even walk without pain.  Occasionally patients that take the approach that “nothing can be done for fractured toe” just end up in surgery later.  For the most part this is avoidable if the toe treated correctly.

Diagnosis and Treatment Options

If you are suspicious that there might be a broken bone in your foot (or in one of your toes) it is best to figure out whether or not it is actually broken.  The best option is to have an in-person evaluation by a sports medicine specialist such as a sports podiatrist.  The second option is to have a remote consultation with a sports podiatrist via webcam. A third option is an attempt at self-diagnosis. This video on YouTube can show you how to perform self-diagnosis of metatarsal stress fractures. This same video would apply in your case if the pain is located where you’re bruising is in the foot.

If you see a physician in person or via webcam or you perform your own self-diagnosis and think that you probably have a fracture then you should get x-rays. X-rays will not only confirm (or rule out) a broken bone in the foot but it will also give you an idea of the severity of the problem. There are some fractures that absolutely must be treated surgically. Others simply need a fracture walking boot in order to stabilize the fracture and allow it to heal. And occasionally it is necessary to use crutches. 

But not all fractures are the same. So if you have pain and bruising after this sort of injury and suspect that you have a fracture in your foot it is important to determine whether or not there actually is a broken bone, and treat it appropriately. As long as you treat the fracture correctly you should be able to heal and then get back to running.


Dr. Christopher Segler, D.P.M. is board certified, American Board of Podiatric Medicine. Because he is an active marathon runner and 10-time Ironman triathlon finisher, his practice focuses exclusively on helping runners get back to running as quickly as possible. He travels back and forth between San Francisco, Houston, and Hawaii so he can often to help Texas and California patients with running injuries.  He also provides web consultations via Skype for injured runners who who are too busy to drive to a podiatry office. If you are in San Francisco and have a question about a running injury, you can reach him directly at 415-308-0833. If you live in Houston and think you have a stress fracture, your can call him at 713-489-7674. Visit our Houston Doc On The Run Practice. Learn more about stress fractures here.



Sunday, July 14, 2013

Does running barefoot put me at risk of toenail fungus?


Hi My Running Doc!

I have heard that going barefoot in locker rooms can put me at risk of a fungal infection and toenail fungus. Does running barefoot also put me more at risk of a toenail fungus infection? 

Thanks!
Jimmy, San Francisco, CA
Hi Jimmy, 

Great question!  The short answer is no... running barefoot does not actually put you more at risk of getting a toenail fungus infection than running in running shoes.

But before we explain that, let's explain why there is such a high risk of getting a fungal infection from a gym locker room.  People work out at the gym all day long. Most of them shower once they are done. 

So the floors in the locker rooms are continually coated with water dripping off of freshly showered athletes. This leaves the floors in the gym locker rooms perpetually moist. This moisture creates the perfect environment for fungal growth. If you walk around in there barefoot the chances are good you might pick up a fungal infection in the form of athlete's foot.

The same organism that causes athlete's foot is also the same organism that causes fungal toenail infections.

In order to get a toe nail fungus infection you must have a couple of conditions present at the same time.

1. Active fungus and/or fungal spores.
2. Trauma to the toenails.

Much like a gymnasium locker room, running shoes are actually the perfect incubators for toenail fungus. Your feet are like little heaters warming up the inside of the shoes to the perfect temperature for fungal growth.  When you exercise, your feet sweat. The inside of the running shoes are also dark and devoid of sunlight. All of this creates the perfect environment for toenail fungus to grow.  

When you run, the ends of your toes and hence the toenails can bump up against the inside of the shoes. Many marathon runners have witnessed this first hand in the form of black and blue toenails after a long run. It's not a large amount of trauma, just a small amount of repetitive trauma that can cause bruising under the toenail.

If you have this sort of trauma to the toenails when you have foot fungus growing inside your running shoes, the fungal spores and live fungus can get underneath the toenail and start to grow. The result is a  fungal toenail infection.

You know you have thick yellowing discolored toenails indicative a  toenail fungus infection.

When you run barefoot you're unlikely to have trauma to the toenails in the presence of a large amount of toenail fungus or fungal spores that are often coating the inside of running shoes. And in this respect, you're actually a lower risk of getting a toenail fungus infection when running barefoot as compared to when running in heavily used running shoes.

Dr. Christopher Segler, DPM is a marathon runner and 11-time Ironman triathlon finisher.  His podiatry sports medicine practice focuses on convenient rapid treatment of running injuries. He is often invited to speak at medical conferences on the topic of barefoot running biomechanics. You can learn more about running related toenail infections and laser treatment of toenail fungus at www.LaserToenailSanFrancisco.com   If you have a question about a toenail fungus infection or barefoot running injury you can call him directly at 415-308-0833

Thursday, May 30, 2013

What to Consider in a Minimalist Running Shoe


Hi “My Running Doc!”

I recently read the book “Born to Run.”  after reading it, I became intrigued and have decided to try some minimalist running shoes. However a lot of stuff that I read online says that might get injured if I run barefoot or in minimalist shoes. 

As a little background, I am experienced marathon runner and have been running for decades. I have a neutral foot type and never had any serious running injuries. 

Do you have any recommendations on how to safely choose minimalist running shoes so I can run with a more natural running form to convert to more of a minimalist style?

Thanks!
Peter
San Francisco, CA



Hello Peter,

Great question!  There are a number of different types of minimal running shoes that  you can choose from.  But before you can make a reasonable choice on which you would be right for you you have to understand the basics of “minimalist shoes.”

I define a minimalist running shoe as one that has lightweight construction, minimal support and a decreased forefoot to rearfoot drop. 

In case you’re not familiar with minimalist running shoe construction is important to point out that the “ forefoot to rearfoot drop” is the difference in height of the heel as compared to the forefoot. Standing barefoot is a 0° drop.  A running shoe with a zero-degree drop is flat. Any shoe that has no more supporting material under the heel than under the forefoot will have a 0° drop. 

A standard running shoe has a 12 mm drop. This means that there is 12 mm of material under the heel, lifting the heel up relative to the forefoot.  Proponents of minimalist running argue that all this extra material under your heel is what forces you to land as a heel striker when you run in these type of running shoes.


Vibram FiveFingers® are the shoes that many people think of when they hear about barefoot running.  The argument for this type of shoe is that you get the most sensitive ground feel, and hence a running experience that is the most consistent with true barefoot running. However you are protected by a pliable rubber outsole. These shoes certainly fit the criteria of a minimalist shoe in that they have very little support, they’re very light weight and they have a zero-degree drop (meaning the heel is no higher than the toes.) 

Given that most people are accustomed to walking and running in shoes that have a slightly elevated heel, they can at risk of injuries like Achilles tendinitis and even potentially stress fractures if they switch to rapidly to a barefoot running style.

Men's Kinvara 4





There are other shoes however which will help you learn how to run without the drastic change in forefoot to rearfoot drop.  Another extremely  popular minimalist running shoe is the Saucony Kinvara. The Kinvara has a 4mm drop, is very light (7.7 oz.) and is very supple.  it allows a good ground feel and lends itself the natural running form however it still maintains a modest amount of support. It allows a bit of insurance in the sense that if reform starts to fall apart and you begin to convert into a heel striker you at least have some cushion to protect you.

Another good option is Newton Running shoes. Newton’s are unique in that they have elastomeric lugs under the forefoot that help encourage you to land as more as a forefoot or midfoot striker.  For a neutral runner like yourself, the Newton Gravity Trainer would be a good choice. It weighs 9.1 ounces and has a 3mm forefoot to rearfoot drop. Newton running shoes are designed specifically with the intent to help runners learn how to convert to more of a natural running style. In fact Danny Abshire, the founder of the company is also authored a book which helps teach runners to convert their running style away from heel striking to potentially more efficient stride. 

I think Danny has the right approach. I myself run in Newton running shoes for speed workouts and for tempo runs.

However I also incorporate a couple of different kinds of running shoes based on the workouts that I am doing. I run in Kinvaras for some moderate runs.  I also run a more of a typical cushioning type of running shoe when I do long runs, or any run where I expect that I might walk. Reason for this is simple. Most people it is spent their lives in elevated heel shoes can develop a tight Achilles tendon. Walking in shoes with a 0° drop can lead to Achilles tendinitis quite rapidly. As someone who trains continually and almost always has an Ironman on the schedule I can afford to develop any issues. I consider using multiple types of running shoes as cross training for my feet. I believe it decreases the risk of injury.

If barefoot running form is a new adventure I hope you will find it to be helpful in developing a more efficient stride and ultimately a more enjoyable running experience. 

Dr. Christopher Segler, DPM is a marathon runner, 11-time Ironman triathlon finisher and is Board Certified,  American Board of Podiatric Medicine.  He lectures at medical conferences to help teach other podiatrists and sports medicine doctors about barefoot running biomechanics and the treatment of competent running injuries. His practice is limited to runners and triathletes. He performs remote consultations for runners all over the world via telephone and Skype. He also sees patients in person in both San Francisco, CA and Houston, TX.  If you have a question about a running injury that doesn't seem to be getting better, you can reach him directly at 415-308-0833. 


Sunday, May 26, 2013

Heel Blister: To Pop or Not To Pop?


 


Hi Dr. Segler,

I've had this blister on my heel for the past three days and it has gotten slightly larger.  I'm wondering if I should allow more time for it to heal or pop, drain, etc?  What's the fastest way to get it healed?

Sincerely,
Ryan M. 
San Francisco, CA

Answer:

Hello Ryan,

A blister on the inside of the heel can be painful when running or even walking.  If you are currently training for a marathon, the last thing you want to do is stop running just because you have a blister on your heel.  But obviously the blister has to stop getting bigger before it is going to heal.

There are only a couple of reasons that a blister continues to get bigger.

1. Friction. If you are continuing to rub the inside of the heel in the same way that cause the blister to form in the first place, the blister will continue to get bigger.

2. Compression. If you repeatedly press on the blister,  the fluid with in the blessed blister will try to disperse outward. Since the fluid is all contained inside the blister, this will continue to separate the layers of the skin from the pressure applied to the blister when the fluid tries to move. This causes the blister to continue to enlarge.


The redness at the border of blister tells me that the fluid is being compressed and further separating the layers of the skin (indicated by red arrows). This of course hurts and makes the heel blister bigger.

If you pop or drain the blister, it will increase the risk of infection. If you pop (or drain) the blister it will feel slightly better in the short term, but it might take slightly longer to completely heal.  As long as all of the irritation to the blister is removed, your body will resorb the blister fluid and heal the blister.

The blister in these images appears to be flat enough that it could be offloaded with some simple pads that could be obtained from a local pharmacy.  The idea is to place felt pads around the blister. By removing the pressure that is being applied to the blister when you walk, it will stop enlarging and it will start to calm down.

If a pad is applied to the heel, it will place all of the pressure around the blister, instead of on the blister. This will significantly decrease both the compression and friction of the blister.  If the oval pads that you find at the pharmacy are not large enough, you can simply cut two of them in half and then apply two separate half-oval pads to completely surround and protect the blister.

Here is an image of the proper pad placement with the red area indicating a blister:


Once the blister has completely healed your next task will be to identify the cause of the blister.  Obviously will not want this to happen again. If you have just gotten a new pair of shoes you want to make sure to break and then more gradually the next time. If your shoes were to loose, obviously want to tie them slightly tighter so that your heel isn't sliding around inside the running shoe. And if the blister happened after running a race (where you were dumping water on your head to stay cool) or from running in the rain, you want to make sure that you avoid getting your feet as wet the next time.

Heal that heel fast so that you can get back to running!

Dr. Christopher Segler, DPM is a runner, 11-time Ironman triathlon finisher and is Board Certified,  American Board of Podiatric Medicine.  His practice is limited to runners, triathletes and other active young adults. He travels frequently lecturing to other physicians at podiatry conferences about the treatment of complicated running injuries.  He performs remote consultations for runners all over the world via telephone and Skype. He also sees patients in person in both San Francisco, CA and Houston, TX.  If you have a question about a running injury that doesn't seem to be getting better, you can reach him directly at 415-308-0833. 



Sunday, May 12, 2013

3 Reasons to x-ray a stress fracture from running.


Dear MyRunningDoc, 

I have been ramping up my mileage as part of my marathon training. My foot has been sore and aching when I run. Someone told me that stress fractures don't normally show up on an x-ray until they start healing. If this is true, is there really any point to getting an x-ray if I think I did get a stress fracture from running too much?  

Adam J.
Houston, TX

Answer:
Great question!  This is a question I often hear from runners in San Francisco and Houston. Most runners are busy and don't wont to waste their time going to a podiatry office getting an x-ray of their foot unless they really think the x-ray will change what they need to do to get the foot to stop aching and  heal. (And of course, get back to running and training). But when you suspect a stress fracture, there are good reasons to get an xray.

3 reasons to get an x-ray of your foot if you think that you have a stress fracture.

The 1st reason to get an xray of your foot is to make sure that the metatarsal has not actually cracked all the way through the bone or broken into pieces. 

The 2nd reason is to confirm that the metatarsal, if it is broken, is still in a good position that will heal correctly. If the bone is moved out of place after it has broken that it will not heal correctly and will result in what doctors call a “malunion.” When the metatarsal bone heals in an abnormal position it will alter the way that forces are distributed across the ball of the foot. An unnatural distribution of forces across the ball of the foot will put other metatarsals at risk of problems later. It can also increase the chances of nerve compression that can lead to a neuroma

The 3rd reason to get an xray of your foot when you suspect you have a stress fracture is for peace of mind. Having an x-ray confirms that the bone is not actually broken and will not likely get worse if you are walking on the foot as it heals. A fracture walking boot is made to protect a stress fracture and allow you to walk while the bone heals.  if you have had an xray of the foot and confirmed that the bone is not completely broken, and you suspect that it is just a stress fracture, then you can treat it as such and feel confident you’re not going to make things significantly worse if you walk on the foot while protected in a fracture walking boot.


Dr. Christopher Segler, D.P.M. is board certified, American Board of Podiatric Medicine. Because he is an active marathon runner and 10-time Ironman triathlon finisher, his practice focuses exclusively on helping runners get back to running as quickly as possible. He travels back and forth between San Francisco, Houston, and Hawaii so he can often to help Texas and California patients with running injuries.  He also provides web consultations via Skype for injured runners who who are too busy to drive to a podiatry office. If you are in San Francisco and have a question about a running injury, you can reach him directly at 415-308-0833. If you live in Houston and think you have a stress fracture, your can call him at 713-489-7674. Visit our Houston Doc On The Run Practice. Learn more about stress fractures here.