Will orthotics help heel pain when running?

This morning I received an inquiry from a runner in Marin who is training for the Dispea. He asked a common question:

"I have severe left heel pain especially after a 5-8 mile run. I am training for the Dipsea. Advice? Should I consider orthotics?"

Answer:
Custom orthotics can certainly help to alleviate many forms of heel pain including the most common type which is plantar fasciitis. Custom orthotics in fact are one of the best ways to slow do pronation and decrease stress to the large ligament on the bottom of the heel called the plantar fascia. If you over-pronate and repeatedly tug on the plantar fascia as your arch height changes, you get inflammation of the plantar fascia... known as plantar fasciitis.

A long run can place a tremendous stress on the plantar fascia and the heel bone. Most people with plantar fascitis will have pain in the bottom of the heel on days following running. Usually the pain is worse with the first couple of steps when they get up out of bed. They can also get a sharp pain in the heel when they start walking after sitting at a desk for a while.

Custom orthotics are one of the best treatments for this type of running-related heel pain. But that doesn't necessarily mean that it is best to get custom orthotics and keep running. You must get an evaluation with a running focused podiatrist first.

The concern is that you might have something worse than plantar fasciitis. In this case, the runner reports heel pain that is "severe" following long runs. Plantar fasciitis would usually be worse (and more annoying) the day after a long run, but not necessarily severe. It would be important to get x-rays and take a look at the heel bone (calcaneus) to be certain that you are not at risk for stress fracture in the heel bone (calcaneal stress fracture).

It is also possible that there is a cyst in the heel bone that is causing the problem. In the simplest of terms, a calcaneal cyst is a hollow or fluid filled pocket that develops within the heel bone. When running, the walls of the cyst can flex slightly causing pain and inflammation in the heel bone itself. In some cases the heel bone can flex so much that it cracks or fractures. This is actually much worse than a calcaneal stress fracture.

With a quick set of x-rays and an exam by an experienced running podiatrist, heel pain can be effectively treated. With all of the conditions that effect the heel, the sooner the best treatment is chosen and starts, the faster you will finish your goal race, wether it is the Dipsea, the Vineman or the San Francisco Marathon.


Dr. Christopher Segler is an Award Winning Foot & Ankle Surgeon, 5-Time Ironman Finisher and a sports medicine podiatrist who makes house calls for busy runners, triathletes and active professionals in San Francisco, Marin, the East Bay and the Peninsula. If you have a question about running related heel pain, you can call him directly at (415) 308-0833. You can also learn more about custom running orthotics at AnkleCenter.com and DocOnTheRun.com.

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Top 5 Reasons to Avoid the Emergency Room When You Sprain Your Ankle In San Francisco

Ankle sprains are the most common of all sports injuries. Everyday nearly 10,000 people show up with painful, swollen rolled ankles. Although the Emergency Room may seem like a logical choice when you sprain your ankle, there are five reasons that you might want to reconsider.

1. LONG WAIT

The average time a person waits in the emergency room is over six hours. If you have an ankle sprain, the wait could be even longer. The reason is simple. A sprained ankle is not a life-threatening emergency. Every person who shows up in the Emergency Room with a suspected heart attack, stroke, appendicitis, or whomever gets transported to the hospital via ambulance is marked as a higher priority. Its easy to understand when you’re sitting at home reading this, but not so easy if you are sitting in the ER waiting room with a throbbing ankle.

2. COST

Care provided in the ER is expensive. In fact, the ER is the most expensive place for the delivery of health care in the United States. The hospital knows that many uninsured patients show up there with very real emergencies that cost a fortune to treat. If a guy with no insurance gets run over by a car, the ER can’t simply turn him away just because he can’t pay. As a result the Emergency Room fees are priced high enough to recoup some of the costs of indigent care. In a sense, when you go to the ER, you are paying your bill and the bill for the guy next to you who can’t pay. You could expect to pay as much as $1,500 for an ankle sprain work-up in the emergency room. If you sprained an ankle and are searching for the most expensive option, this would be it.

3. ANKLE SPRAINS ARE LOW PRIORITY

The fact is that ER docs are busy saving lives. When your complaint is just a painful swollen ankle, you can’t expect to get the same sort of attention as the patient in the stall next to you who’s going into cardiac arrest. You aren’t going to die today from an ankle sprain. In the ER physician’s mind, an ankle sprain is no big deal and one that can be treated later by a specialist. You can only expect basic first aid and a referral to a specialist. You just cannot expect specialized care in the Emergency Department.

4. MISDIAGNOSIS

ER docs are the most skilled at treated lief-threatening emergencies. But they are not that focused on non-life threatening injuries. You really wouldn’t expect the best treatment for a stroke from an ankle surgeon. By the same token, you can expect an ER Physician to provide the best treatment for your sprained ankle. An award winning-study at the University of Utah found that subtle fractures of the ankle are more than 10 times as common as previously thought. These fractures are frequently misdiagnosed as ankle sprains. Don’t expect an emergency doc to diagnose this type of ankle injury correctly. Without the right diagnosis, you won’t get the best care.

5. INADEQUATE TREATMENT

The number one risk for continued pain, ankle instability and continued ankle problems is inadequate ankle sprain rehabilitation. Because the ER docs don’t focus on ankle injures, they typically give you some basic first aid, a brace and instructions to follow-up with an ankle specialist. The ER doc fully expects you will get the care you need from an ankle specialist later. But many people don’t. The reality is that the final stages of ankle treatment are the most important. You must have an ankle expert guiding you back to strength and health.

If you sprain your ankle, you should know that most ankle sprains will fully recovery...if treated correctly. You need the best treatment to make a full recovery. If you want to see yourself running instead of limping on a weak ankle, you have to start with expert care. Knowing that the ER will send you to a specialist anyway, you can save weeks of recovery, just by starting with an ankle specialist to heal your ankle sprain fast.

Dr. Christopher Segler is a San Francisco based foot surgeon and nationally recognized foot fracture expert. In 2004 he won an award from the American College of Foot & Ankle Surgeons for his research on the accurate diagnosis of difficult to identify fracture patterns in the foot called Lisfranc's injuries (also called tarsometatarsal fracture dislocations). In 2005 he won an award from the American College of Foot & Ankle Surgeons for his research on the accurate diagnosis of difficult to identify fracture patterns in the ankle called Lateral Process Fractures. If you suffered an ankle sprain that needs the very best treatment as fast as possible, he can see you at your home with an emergency house call visit at your home or office. You can also learn more about the typical experience of an ankle sprain patient in San Francisco here. If you have an ankle sprain and just have a question about whether or not it needs to be treated, you can reach him directly at (415) 308-0833.

Custom Orthotics For Runners by San Francisco Podiatrist

Running places a tremendous amount of stress on the feet and legs. When you train for a marathon, the goal is to create just enough stress to stimulate an increase in running endurance without so much stress that an injury results. Running injuries like shin splints, stress fractures and tendonitis are common as mileage and intensity increase during training.

Slight imbalances in the foot and ankle can result whenever there is too much pronation. Other mailalignments (such as a forefoot that is slightly tilted relative to the rearfoot) can lead to increased stress to certain bones in the feet. At the same time, any of these biomechanical problems can increase tension and overuse of tendons that lead to tendinitis.

Although I get lots of requests to make orthotics for marathon runners and triathletes here in San Francisco, I am often surprised how many athletes don't really understand what an orthotics is and how it works. A custom orthotic made for a runner is not just an arch support or a shoe insert with extra cushion. Custom orthotics are custom made footbeds (custom built based on a foot doctor's prescription) that control abnormal motion and correct mechanical imbalances.

You can learn more about custom orthotics on our website or by simply watching the video below.



Dr. Christopher Segler is an award winning foot doctor practicing podiatry and specializing in running biomechanics in San Francisco. He specializes in house calls to help busy athletes who don't have tim to get the foot doctor. He makes housecalls all around in San Francisco, Mill Valley, Palo Alto, Berkeley, Corte Madera, San Rafael, Oakland, and San Jose. If you are a runner with a history of nagging injuries, arch pain, flat feet, or tendonitis, he can come right to you to make your custom running orthotics that will not only decrease your risk injury. If you just have a question about custom orthotics made for runners, you can call Dr. Segler directly at 415-308-0833.

Good News for Ironman Arizona Athletes!?!?

This week, the dam that holds the water in man-made Tempe Town Lake burst. That may seem like bad news for a triathlete. Unless you have ever been swimming in that lake.

There is a reason that they don't let people swim in the lake right next to the University campus. The stagnant water is just plain filthy. The first time I went for a dip there was in 2007 at Ironman Arizona. The day before swim practice began I walked up to the edge and saw a two-foot long carp munching on some pond scum.

I asked another athlete about the water quality. He said, "My understanding is that the city has organized a method to fight the stagnation in the lake by allowing 2000 athletes to splash around in the water this weekend." Great.

During the swim I made an effort to leave the water in the Lake. A guy a met at registration was not so lucky. He took in a couple of accidental gulps. That small error led to several bouts of vomiting out on the bike course.

Although I do hope the dam is repaired in time for Ironman Arizona 2010, I have to say that I also hope the unintentional draining of the lake will mean the cleanest water conditions on record for the race. But even if the water looks clean, I plan on keeping my mouth shut during the swim.

Dr. Christopher Segler is a sports medicine podiatrist in San Francisco currently training for Ironman Canada and Ironman Arizona. He makes house calls in the bay area to treat stress fractures, Achilles tendonitis, and other triathlon-related injuries. Learn more at San Francisco's best running injury prevention site.

Should I take Calcium if I have a Stress Fracture in my Foot? San Francisco's Running Doc Explains

If you are running and get a stress fracture, you likely want that bone to heal as quickly as possible. When you break a bone in the foot, the bone has to heal just like any other injury. Although calcium is the mineral that makes bones strong and visible on x-rays, it is not the only factor in bone healing. For this reason it is particularly important to make sure that you eat a healthy well-balanced diet when you are healing a stress fracture in the foot.

We know that your body needs many different nutrients to heal a stress fracture. For example, vitamin K is important in the clotting process right after a bone breaks. Vitamin C is essential to collagen formation that is an early step in the formation of soft bone callus that precedes the deposition of calcium where the bone broke. Calcium gets laid down in the repair of the fracture, but supplemental calcium won't be absorbed well without Vitamin D. Lysine is an amino acid that helps you incorporate calcium into the bony matrix as the fracture heals.

The medical literature is conflicting about whether or not supplements help bones heal faster. However there is general agreement that know that adults need about 1000 mg of calcium and 800 I.U. of Vitamin D daily for good bone health. Many nutritionists suggest that you will get all of this in a standard healthy diet. Having said that, there is very little risk and much potential benefit with taking some extra calcium.

Obviously your body will be working harder to repair the fracture by laying down calcium as the bone heals. You could take some Calcium and Vitamin D to help make sure you healing fracture has all the calcium needs. Just be certain that the Calcium supplements you take also have Vitamin D.

Dr. Christopher Segler is a runner, multiple Ironman Finisher and Sports Medicine doctor in San Francisco who focuses on running injuries. If you have a question about a possible stress fracture in your foot from running. you can post a question or call him directly at 415-308-0833. For more info on running injuries see San Francisco's best running injury site.

Do I Need X-Rays if I Sprained my Ankle?

San Francisco's Ankle Expert Explains When You Need X-Rays

If you are out trail running in Marin or Golden Gate Park and roll your ankle, your first thought is going to be whether or not you will be able to run with a sprained ankle. If the ankle is bruised and swollen, you will also probably wonder whether or not you need an ankle x-ray. This video explains how ankle surgeons and emergency room physicians decide whether or not you need to have x-rays after an ankle sprain.



Every single day thousands of people wait in line at the Emergency Room to get x-rays after they roll their ankles. After all that waiting, the ER doc will typically send you to an ankle specialist anyway. By seeing an ankle expert instead of going to the ER, you can be sure to get the best treatment for your ankle sprain. If you sprained your ankle, see an ankle expert today!

Dr. Christopher Segler is a sports medicine podiatrist who specializes in the diagnosis of sprains and fractures of the foot and ankle. Has has won multiple awards from the American College of Foot and Ankle Surgeons for his research on fractures of the foot and ankle that are often misdiagnosed as sprains. As a runner and triathlete himself, he believes that non-surgical treatment is best whenever possible. You can learn more about ankle sprains at the Bay Area's best ankle sprain info site. YOu can also learn more about ankle sprains and x-rays here. You can reach Dr. Segler at 415-308-0833.

How to Tell If You Have a Stress Fracture In the Foot by San Francisco Running Podiatrist

Last year just a few weeks before Ironman Louisville, I got an out-of-state call from a very worried triathlete. He said he had been ramping up his training for the big race. He had slowly been building milage over the past year. But then he started to get an aching foot when he ran. Slowly it turned into throbbing foot pain when he would run. And by the time he called, it was starting to hurt even while he was walking.

He was really distressed.

As a runner and prior Ironman finisher, he had been running long enough to know that a stress fracture in the foot was one of the most likely injuries that could force him to stop running. He was worried he wouldn't even be able to show up on the starting line at Ironman Louisville. The good news is that we were able to manage the stress fracture and he did complete the race without incident.

Training for any distance event (whether a half-matrathon, marathon or Ironman) can lead to a stress fracture in one of the metatarsal bones of the foot. But if your foot aches, there are some simple ways to tell how likely it is that you have a running-related stress fracture. This video explains how you can tell if you might have a stress fracture in the foot.

To learn more about stress fractures, visit the most comprehensive running injury site in San Francisco. All of the running education information has been created by San Francisco's Award-Winning Foot Specialist and Ironman Triathlete Dr. Christopher Segler. He's not just a running specialist who writes about running injuries, but he is a real runner as well.

What If I Have a Stress Fracture and Keep Running on My Sore Aching Foot?

I was heading to Kezar stadium to run intervals when I got a call on my San Francisco Sports Medicine Podiatry practice phone from a runner with a typical question. He explained he was having a mild aching sensation in the foot when walking around, but it has been getting worse when running. He said he thought it was slightly bruised on the top of the foot, but couldn't remember dropping anything on it. He had been trying to figure out whether or not it might be a stress fracture. Because he has ben ramping up his training for a marathon, his main question (of course) was "Well what if it is a stress fracture....what is the worse thing that can happen if I keep running on the foot?"

To help him understand what could happen if he does have a stress fracture and keeps running on it, I told him he could read all about the SF podiatrist point of view on "Can I run with a stress fracture in my foot?"

I also sent him the link for the video on "What If I Run On a Stress Fracture - By San Francisco Sports Medicine Podiatrist."


Dr. Christopher Segler is an award winning foot surgeon and podiatric sports medicine specialists in San Francisco. He developed a house calls based practice to serve active athlete, marathon runners and triathletes who can't waste their free time driving around town or sitting in a doctor's waiting room. If you have a question about a possible stress fracture, you can call him directly at 415-308-0833. You can also learn more at stress fractures at San Francisco's Best Running Related Podiatry Site or MyRunningDoc.com.

What Should I Do If I Sprain My Ankle?

San Francisco Podiatrist Explains How To Stop The Ankle Pain and Swelling When You Twist Your Ankle

Ankle sprains are the most common sports-related musculoskeletal injury. Unfortunately many patients who roll their ankles head to the Emergency Room to treat the pain, swelling and bruising. The reality is, you can often get ankle pain relief much faster if you don't go to the ER. When deciding which doctor is best for your ankle sprain, you should see a specialist: an ankle expert called a podiatrist (not a Jack-of-all-Trades in the ER).

The best ankle sprain treatment right after the sprain is P.R.I.C.E.

P=Protection
You have to prevent any further injury to the sprained ligaments. An ankle brace or fracture walking boot can let most ankle injuries heal without having to worry about hobbling around on crutches.

R=rest
If you get sick and rest, you get well faster. If you tear your ankle ligaments and rest, they heal faster. Try to get some rest and take it easy for the first 48 hours after a bad ankle sprain.

I=ice
Ice is one of the cheapest and most effective home remedies for an acute ankle sprain. Apply ice to your injured ankle for 10 minutes out of every hour during the first 24 hours after you roll your ankle.

C=compression
Use the elastic bandage given to you by Dr. Segler a your House Call visit. By keeping your ankle wrapped the way he showed you, the swelling will stop and go down as fast as possibly. Your ankle ligaments won't start to heal until the swelling goes away.

E=elevation
Use gravity to your advantage! Prop the injured ankle way up on a pile of pillows. It has to be above your heart to really work well. Keep it elevated for the first 24 hours and the throbbing ankle pain will start to go away. Remember, your ankle ligaments won't start to heal until the swelling goes away.

By following the PRICE method, you can help stop all of the inflammation that causes ankle pain and leads to prolonged healing of the ankle sprain.

You can also view the Ankle Sprain First Aid Video here.

Dr. Christopher Segler is a podiatrist and a true ankle expert. He published the largest research study every conducted on subtle ankle fractures that are often misdiagnosed as ankle sprains. The fact is, ankle injuries often don't get the best treatment in the Emergency Room. Dr. Segler won an award from the American College of Foot and Ankle Surgeons for his ankle injury research which showed that lateral process fractures are 10 times more common than previously thought. These ankle fractures often don't heal properly because they are incorrectly diagnosed by busy ER physicians. Dr. Segler now has a podiatry practice in San Francisco that offers same-day house calls for people in the San Francisco Bay Area who have ankle sprains or other sports medicine -related foot and ankle injuries.

If you rolled your ankle and have a question, you can actually call him directly at 415-308-0833. And yes, you will actually get to speak with an award-winning ankle surgeon. No nurses, students or residents... direct access to a true ankle expert.

Learn More about ankle injuries at the best podiatry site in San Francisco: AnkleCenter.com

July is Most Dangerous Time for Surgery: San Francisco Foot Surgeon Explains

Your chances of dying in a hospital are highest in July. A new study published yesterday in the Journal of General Internal Medicine exposes one of medicine’s dirty little secrets. It has long been known that all medical internships, surgery residencies, and fellowships begin on July 1st every year. Because of this, July may be the riskiest month for you to have foot surgery or any other procedure that might be associated with hospitalization.

This is not complicated. After eight years of sitting in college classrooms and medical school lecture halls, the wet-behind-the-ears medical intern is just plain itching to practice all of those skills he or she has read about. The problem is, they have a lot of learning left to do.

You don’t really want to be the first person when a new foot doctor tries to make a surgical incision on your foot. You don’t want to be a new ankle surgeon’s very first ankle ligament repair surgery. You also don’t want to that new, nervous, over-worked and sleep deprived intern fumbling through a Pharmacy handbook while writing your medication orders at 4:00 a.m.

It is this combination of pressure and inexperience on new doctors in training that produces the “July Effect.” This new study conducted at large teaching hospitals in California (but not in the San Francisco Bay Area) found that fatal medication errors spiked by 10% during the month of July in counties that had teaching hospitals. By contrast there was no increase in medication errors in counties that did not have doctor’s in training. The study concluded that the spike in hospital deaths was in large part associated with the influx of new medical resident doctors in the month of July.

Whether you are considering bunion surgery or back surgery, there are some simple steps you can take to avoid the risks associated with new medical residents.

1) Have surgery in June or August instead of July. The most change in staff happens in July. This is when the medical residents are newest and more likely to make errors. They are also more likely to get in over their heads in surgery.

2) Avoid the teaching hospitals in July. If you have an elective procedure (such as bunion surgery, ankle stabilization surgery, or heel spur surgery) request that the procedure be performed at an outpatient ambulatory surgery center. There will be fewer residents and less chance of a newbie bungling your case.

3) Ask questions! You have a right to understand all of the procedures that will be done, and by whom. Ask if a resident will scrub in your foot surgery. You do have the right to refuse to have doctors-in-training involved in your care. By asking questions about your surgery, postoperative care, rehabilitation and medications, you will force the attending doctor to stop and think. This may decrease your risk of an error that could occur if the doc is hurried.

4) Have an advocate on your side. If you have a concierge type physician caring for you and overseeing your care, it is far more likely that any mistakes will be caught in time. Docs that report to other docs will be more focused and paying closer attention. If you don’t have a concierge-type physician, at least bring a family member who can ask lots of questions and take notes.

5) Choose an “Out-of-Network” Surgeon. Don’t expect concierge care if you have Medicare. This is just math. On June 1, 2010 doctor’s who accept Medicare got a 21% pay cut. They will be moving faster and working harder to pay the light bill. This will quickly trickle down to all “In-Network” Insurance Policies. Most insurance contracts with “In-Network” doctors are based on a percentage of Medicare pay rates. By choosing a doctor who is “Out-of-Network” you will get a doctor who has more time to spend with you, answer your questions, and guard against resident-associated errors.

The more you know about the dangers of medication errors and inexperience associated with the annual medical trainee change-over in July, the more empowered you will be to enter the hospital or operating room and have a successful surgery. But if you have to check into a University Teaching Hospital in July, stay low and keep moving!

Dr. Christopher Segler is a San Francisco based foot surgeon and an award-winning podiatrist. His new patient appointments with foot surgery patients generally take 1-2 hours. He thinks the best medical care is personalized convenient care. He makes house calls and does not allow residents to perform surgery for him. He also takes his patients to reputable outpatient surgery centers. If you have a question about foot surgery, you can call him directly at 415-308-0833. Learn more at San Francisco's Foot Surgery Info Site.