Can I Run with a Partial Rupture of the Plantar Fascia? Video Lesson

Do we run too much?

How Alcohol Injections Help Runners with Neuroma Pain

Ball of Foot Pain Course Trailer

Will Custom Orthotics Help? How much do custom orthotics cost?

Here is a question from someone considering custom orthotics:

Hi there,

I have high arches and have not been able to find an arch support that works well for me. I don't experience pain but rather weakness/numbness or just the sensation that something is "off".

Hoping to get an evaluation and possibly orthotics.

Wondering, what is your rate for a clinic appointment in San Francisco and general cost for orthotics.

Many thanks,

ML

Hello ML,

Thank you for your inquiry!  I am sorry to hear that you have been having so much trouble finding arch supports that have worked for you, but I will be happy to help.

In many cases, numbness and weakness may be attributable to issues that may not even respond to over-the-counter shoe inserts or custom orthotic therapy. Of course, we would determine that during your evaluation.

I can assure you that I will not make custom orthotics for you unless I am certain I will help. We offer a money back guarantee on custom orthotics and in more than 10 years I've only had one pair returned. Just so happens that the pair was returned from a teenage girl who refused were anything other than flip-flops. 

The guarantee is as follows: you can use the custom orthotics for one full year. If after one year, you don't believe the orthotics have been helpful in alleviating your discomfort, helping you maintain an increased activity level, helping you run faster, or you are unhappy with the custom orthotics for any reason whatsoever you may return them for a full refund of the orthotic fee. The only condition or "fine print" is that you must return them to me within 370 days of delivery. That way you have a full year to try them out.

I do house calls so I will come see you and will cast you for custom orthotics at home during the initial evaluation, if custom orthotics seem appropriate. Seeing you at home can help facilitate evaluation because we can look at all of your shoes to help determine whether or not any of the shoes you are currently wearing may be contributing to the problem.

The rates are as follows: 

New patient evaluation: $500. The appointment is usually about 1 hour to 90 minutes. No additional fees if they you have lots of questions and the appointment runs longer.

Custom orthotics: $487. This includes the a Biomechanical exam, plaster casting to create molds of your feet for the custom orthotics, and the actual production of the custom orthotics.

I will return to your home one week after the casting to deliver the custom orthotics, fit them to your shoes, and discuss the process of break-in. There is no additional charge for the second house call appointment when I deliver the custom orthotics. The cost of the follow-up is included in the orthotic fee.

Please let me know what works best with your schedule so we can find a time that doesn't disrupt your work schedule. 

I look forward to meeting you. 

Sincerely, 

Dr. Christopher Segler

Doc On The Run

www.DocOnTheRun.com

Can I Run with Plantar Fasciitis?

Dear MyRunningDoc,

I am a runner who has been suffering with plantar fasciitis for several months. I tried couple of different things myself to get the heel pain to go away but it still continue to bother me. When I went to see my doctor, she told me that I had to stop running.

Can I run with plantar fasciitis? Will my heel pain get worse if I keep running? Or can I run with plantar fasciitis and still heal.

John H. 
San Jose, CA

Hello John,

Heel pain can be frustrating when you are a runner. It isn't that the heel pain is so debilitating that it stops you from running, but that you are often distracted by it, and concern that the problem will get significantly worse or translate into other overuse injuries.

Plantar fasciitis of course is the most common form of heel pain. But it isn't the only type of heel pain that happens in runners. The short answer is that if it is only plantar fasciitis, you can probably keep running without the problem getting worse. It is also possible to continue running and still heal your heel pain.

This all assumes that you have been correctly diagnosed, and have not been mis-diagnosed. If your doctor mistakenly diagnoses you with plantar fasciitis, when in fact have a calcaneal stress fracture (crack in the heel bone), or a partial rupture of the plantar fascia (a small tear in the plantar fascia), you will have to stop running for some period of time, depending upon the severity of the condition.

It is important to note that stopping running alone will not cure any of the above mentioned causes of heel pain. conditions. Many runners can self-diagnose their heel pain without ever seeing a doctor. But if you have any doubt about the accuracy of your diagnosis, or specifics about how to continue running while you have plantar fasciitis, you should seek a second opinion from a sports medicine podiatrist who specializes in the treatment of runners.

Dr. Christopher Segler is a 14-time ironman triathlon finisher and sports medicine podiatrist who specializes in the rapid treatment of running injuries. He performs remote consultations via Skype for runners and triathletes overseas who do not have access to Western medical doctors and running experts. You can learn more about running with heel pain at DocOnTheRun.com or learn more about plantar fasciitis at AnkleCenter.com

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Can I run a marathon with a metatarsal stress fracture?

Hello Running Doc,

I have been training for my first marathon for the last four months. I have been following an online training plan and my mileage has been increasing steadily. After overcoming all of the initial soreness with the periods of increased distance, I have been doing well. Until recently…

I started having this aching pain in the ball of my foot. At first it was only when I was running. I iced it and kept training. Eventually I started having aching pain and throbbing on the top of my foot as well. I went to see my primary care doctor and I was told that I have a metatarsal stress fracture. My doctor told me I had to stop running for 6 weeks and skip the marathon.

Is it possible for me to still run the marathon, even though I have a metatarsal stress fracture?

Thanks for any advice!
Erin M.
Oakland, CA

👉 Need a complete plan to heal your stress fracture and keep your fitness?
Click here for the full stress fracture guide for runners

Metatarsal stress fractures are one of the most common causes of pain in the ball of the foot in runners. It is also one of the most common reasons that a marathon runner is forced to stop training and skip a race like a marathon.

The short answer is, yes, you could probably still run the marathon. However, that depends on several factors.

The doctor’s job is not to tell whether or not you can run. The actual job of the of a sports medicine podiatrist is to explain all the risks and benefits of a given course of action. It is then of course up to you to decide what is best for you given your circumstances.

Metatarsal stress fractures come in a full range of trouble. In the very early stages it is actually a stress response, that is affecting the metatarsal bone and causing the pain. In many cases of the stress response the metatarsal calms down and heals quickly. If you did not remove the stress that is being applied to the metatarsal (i.e. training) then the metatarsal stress response can get worse and a tiny little crack forms and the bone. This is a metatarsal stress fracture.

If you have a metatarsal stress fracture and you continue to ramp up your training it is possible that the tiny little crack can form a complete break in the bone. This is when the real trouble begins.

The first thing for you determine is whether or not you actually have a true metatarsal stress fracture or just a metatarsal stress response. If it is only a metatarsal stress response, you could substitute running for some other activities that apply less stressed to the metatarsal, maintain your fitness and then resume your training in time to run the marathon.

But if you have a true metatarsal stress fracture and you're not careful about which activities you choose, it is possible that the metatarsal stress fracture could turn into a completely broken bone that requires surgery for repair.

It is indeed possible that you could continue to train, with the appropriate direction, and then run your race. However, it is a dangerous game to play if you're not certain about the exact condition that is causing the pain in the ball of your foot.

You must work with a sports medicine podiatrist who specializes in the treatment of runners to guide you through the alternative activities so you can maintain your running fitness while decreasing the risk of making the stress fracture worse.


Dr. Christopher Segler is a runner,  sports medicine podiatrist and 14-time Ironman triathlon finisher. His practice focuses on the rapid treatment of running injuries, and a rapid return to running for his patients in the San Francisco, Oakland, and San Jose. He also does remote consultations via Skype for runners and triathletes overseas. If you have a question about metatarsal stress fracture that it is affecting your ability to run, you can reach him directly at 415–308-0833. You can also learn more about metatarsal stress fracture surgery for runners at DocOnTheRun.com and learn more about metatarsal stress fractures at AnkleCenter.com 


All content copyright 2015, Dr. Christopher Segler, Doc On The Run.

Should a Runner Have Morton's Neuroma Surgery?

Hello Running Doc!

I am a life-long time runner who has done many marathons. About a year and a half ago I started developing tingling and pain in the ball of my foot about. The pain gradually got worse. I saw a podiatrist and learned that I had a Morton’s neuroma.  I was given some neuroma pads to try to take the pressure off it, but it still continued to bother me after I would run. Eventually I went to the doctor again and I was told that I would have to stop running.

I really don't want to stop running. For this reason I went and got a second opinion from an orthopedic surgeon. He recommended that I have surgery on my foot to remove the Morton's neuroma. I'm still not sure if this is the right approach because I am concerned that surgery can alter my foot in someway that might change my running biomechanics. Is that something I should really be concerned about?

Thanks!
Henry B.
San Jose, CA

A painful Morton's neuroma certainly can disrupt your ability to run. The swollen nerve on the bottom of the foot can cause tingling and burning pain. But in addition this pain can get worse. In the initial stages of the development of then neuroma, many patients will say that they have tingling foot pain that is intermittent and only happens following long runs.

But over time, the continual irritation of the neuroma makes the nerve swell and the pain becomes more frequent. The nerve endings in the painful neuroma become over active. Then you start to have pain when you're simply sitting in a chair, driving your car, or even while relaxing reading a book.

Surgery can be an effective treatment for a Morton's neuroma that is keeping a runner from running. Basically the nerve is removed and you get numbness in the area where you previously had pain. That is the biggest concern is explained by surgeons before you have surgery.

But there are other risks to surgery. The one that is particularly relevant to your concerns is that in order to remove the neuroma the most common surgical approach involves cutting of the intermetatarsal ligament that stabilizes the forefoot. This ligament is not sewn back together once the nerve has been removed.

Because you have essentially removed a ligament in the ball of the foot, you can have a small amount of foot instability that was not present prior to surgery. This is not a “surgical complication” but is just a consequence of the surgery as it is normally performed. The only other alternative is to place a surgical incision on the bottom of the foot. However a painful surgical scar on the bottom of the foot can be even more disruptive to your capacity to run than the Morton’s neuroma.

If you are really considering having surgery in order to surgically remove the Morton’s neuroma, you have to make sure that you discuss your running activity in great detail with your sports medicine surgeon. You have to make sure that your surgeon understands how much you run, which surfaces you prefer to run on and, for what distances. As long as you understand the biomechanical implications of the surgery and you and your surgeon agree that it is the best option for you, it may be appropriate to proceed with surgery to remove the neuroma. If you're not convinced that neuroma surgery is right for you then you should try all of the other alternatives to surgery to make sure that you have tried the less invasive options that can better preserve your ability to run.

Dr. Christopher Segler is a sports medicine surgeon and runner. He is 14-time Ironman triathlon finisher. His practice focuses on the rapid treatment of running injuries, and a rapid return to running for his patients in the San Francisco Bay Area.  If you have a question about a painful neuroma that it is affecting your ability to run, you can reach him directly at 415–308-0833. You can also learn more about Morton’s neuroma at AnkleCenter.com and alternatives to neuroma surgery at DocOnTheRun.com 

What is a Real Runner?

A couple of days ago I had an interesting conversation with a woman. We were talking about exercise, not just for fitness sake, but for enjoyment. About fitness as a lifestyle worth living. I asked her how much she runs, and she explained that she “only runs a few miles several days per week.”

“You seem like a real runner,” she said.

I remember feeling an involuntary wrinkle in my brow and being taken aback for a moment. 

Because even though I started running as a kid and I still run a lot today, I don't actually didn’t think I ever perceived myself to be “a real runner.” 

When I think of a real runner I picture Karen Gaucher, Ryan Hall, Deena Castor and Meb Keflezighi. I tend to conjure mental images of people who have dedicated their lives to running in ways that I never could. In someway, I think I had classified a real runner as somebody who could consistently run 100 miles per week during their training periods or win races.

A real runner, I had always thought, never loses that focus on the future. Keeps her eye on the goal. She visualizes achieving her aim. Always thinks about finishing, and how it will feel.

But as I thought about that, I started to think about my friends who I think of as “real runners.” And I immediately came up with several that don't run outrageous distances. None of them run for paychecks. All of them truly love running.

John Hunt, Anjulee Johnson, Phủỏng Mai N, Sarah Graham, Mimi Jacobson-Kwok, Brynn Ewen, Laura Duplantis. These are my friends, normal people, and they are all “real runners.” In one way or another each one of them has impressed me. I have seen pictures of their runs and have been inspired. The way they have described a specific run, the way they felt, what they get from running has made me smile. 

What I realized is that their stories, their reasons for running and how their descriptions of running touches me is always about being in the moment.

It's about rows of palm trees on the Stanford campus. The smell of running through the redwoods. The beauty of oaks and pine trees passing overhead. It is about sunshine and fog and feeling alive. It's about being grateful to be fit, and able to run. It is about enjoying movement in a beautiful place, right now.

Its not about pace or distance. Its not about how many finisher medals hang on the wall. Its not about being a Kenyan. And its certainly not about how the next marathon finish will feel, tomorrow, next month or next year.

Its about gratitude. An instagram pic of a beautiful setting or a genuine smile in the middle of a long run. Its about now. The way it feels to run 47 blocks in Oakland, one way, today.

And then she asked me what my last run was like.

I didn’t think about how the run fit into my Ironman training plan. I didn’t think about the pace I kept. I described the feeling of warm sun on my shoulders, strength in my legs, 7 deer quietly feeding on the side of the trail, the amazing blue of Crystal Springs set a against a sea of green trees hugged gently by a thin blanket of clouds under a clear blue sky. I though about how that run made me feel so alive, in that moment. 

And I thought, “maybe I am a real runner.”  



Dr. Christopher Segler is a 12-time Ironman Triathlon Finisher, but more importably he is a real runner.  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. 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

Can I play basketball with these blisters?

Question:
Hi MyRunningDoc!

I have a basketball game tomorrow. Can I play basketball with these blisters without causing any problems?   What can put on it while I play?

Thanks!
JM

Answer:
Blisters under the ball of the foot can be painful. In the images above you can see that JM has developed some large blister that cover the entire big toe joint area. The blister may have started draining, or maybe he simply decided to pop and de-roof (meaning cut the blistered skin off) the blister in order to relieve the pressure. With large blisters, it is often necessary to drain blisters ton keep them from getting bigger. Yet doing so can make them more painful and take longer to heal.

In this case the raw pinkish area is going to be painful when running. Suddenly stopping or changing direction will also put a lot of stress on the blistered area and aggravate the raw skin under the big toe joint.

When you run, about 50% of you body weight is transmitted through this area. There are really only two ways to decrease the pressure to the ball of the foot at the big toe joint.

1. Decrease your activity (as in no basketball, walk less, etc.).
2. Move the pressure somewhere else. 

It is a simply rule of physics: you cannot remove pressure, but you can transfer it. It is possible to create a pad that moves the pressure from the big toe joint to the rest of the ball of the foot. By moving much of the pressure and irritation to the little toe joints, it may possible to play with less discomfort.

 

You can purchase pads at any drugstore that are designed for the ball of the foot. The idea is to hold the pad on the foot and identify the painful area. Clear pads obviously make this easier.

 The painful area is outlined on the pad.

The outlined area over the blister is cut away.

The pad now can put more pressure on healthy skin under the ball of the foot. The pad may stay in place well with a sock on. If not it can be taped in place to secure it. If properly placed, there will be less pressure on the blistered area. 

Even if properly offloaded, there is a risk that continuing to play will further erode the skin and cause more discomfort. In the end, if continuing to play on a de-roofed blister, it will take longer to heal. The increased mechanical irritation of running increases the chance of the blistered area becoming infected.

With any de-roofed blister (or other open wound) it is always best to seek an evaluation from your own physician before attempting treatment. You should speak with a sports medicine podiatrist to make sure that the blisters heal properly. You also need to identify the cause so that it doesn't happen again.

Dr. Christopher Segler, DPM is a podiatrist, Board Certified, American Board of Podiatric Medicine. He is also a 12-time Ironman Triathlon finisher. His sports medicine practice caters to athletes He sees patients in person in San Francisco, Houston, and Hawaii. He also offers remote consultations via webcam to athletes living abroad. If you have a sports injury question and are trying to figure out how to keep running, you can reach him directly at 415-308-0833. You can also learn more about blister causes and treatment at AnkleCenter.com and DocOnTheRun.com