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.

Do I Have Gout in the Big Toe Joint

Gout is one of the most painful conditions I see as a Podiatrist in San Francisco. Usually gout attacks the big toe joint. The question is, how do you tell if you are having an attack of gout in the foot?

When gout happens the first thing you will notice is pain, swelling and redness around the joint. In the foot this is most often the base of the big toe in the joint podiatrists call the "metatarsaophalangeal joint." Gout can happen in any of the joints in the foot, but usually it the big toe joint.

When gout develops, you get uric acid crystals forming and being deposited in the joint itself. If untreated, the crystals may continue to form and lead to the buildup of a chalky paste-like substance called tophi. You can see the huge lump on the bottom of the big toe joint in the picture above. All of that is uric acid crystals in the joint.

Because these sharp needle-shaped crystals end up in the joint, it can be incredibly painful to move the joint. Every time you move the big toe, it is like having a thousand little needles poking the inside of the joint. This of course hurts.

In response, your body reacts with inflammation. That is where the classic pain swelling and redness comes in. The foot will be warm to the touch, red and very painful. Many gout sufferers will say they can't even have a bed sheet touching the foot because it is so painful.

The biggest problem with trying to tell if you actually have gout is that gout mimics two other conditions: infectious arthritis and Charcot. Charcot arthropathy is an emergency that can look like gout, but is actually more serious. It is most common in people with diabetes. Infectious arthritis is where bacteria (instead of uric acid) is invading the joint. Both of these are emergencies. With either, it is important to start treatment right away to prevent further damage and the potential for losing the foot to an amputation.

Many people who have had multiple attacks of gout can seem to tell when it is coming on. However, if you have never been diagnosed with gout, it is important to see a foot specialists who can make sure you don't have a more serious condition.

The most accurate way for your podiatrist to diagnose gout is through a small procedure called joint aspiration. In this way, the uric acid crystals in the joint can easily be identified. More importantly, your foot doctor can rule out a bacterial infection. Blood tests and x-rays may give clues that you have had gout, but can be unreliable if used alone to diagnose gout.

Once you have been diagnosed with gout, your podiatrist will likely make recommendations on modifying your diet to prevent it from happening again. You can view our recommendations on a Gout Diet here. If you are given a prescription to treat the gout, you will be given written instructions that you should follow closely.

Dr. Christopher Segler was selected in 2010 as one of "America's Top Podiatrists." He has a podiatry house calls practice in the San Francisco Bay Area. To learn more about gout, visit the Gout page on our website. If you have gout and need pain relief right away, he makes podiatry emergency house calls 24/7. If you think you might have gout and would like to speak directly with him to ask a question, you can call him (415) 308 0833.

NSAIDs: Why Runners Should Think Twice - by San Francisco Running Podiatrist

Ibuprofen is often referred to as "vitamin I" by marathon runners and triathletes. I have spotted ibuprofen tablets in the road on nearly every marathon or Ironman triathlon I have entered. Usually the tablets have been dropped and sprinkled on the asphalt just before an aid station, presumably by some miserably sore athlete hoping to kill the pain and keep on running. But just because its popular, doesn't mean its a good idea.

Non-steroidal anti-inflammatory drugs (NSAID's) are the most commonly consumed over-the-counter medication. The anti-inflammatory drugs includes aspirin, Motrin (ibuprofen), Aleve (naproxen) and others. Because these seemingly harmless drugs can relieve minor aches and pains while also decreasing inflammation they are very popular among endurance athletes.

But there are actually two very good reasons why you might want to think twice before popping those pills.
1. NSAIDs slow tissue healing.
2. NSAIDs can damage your kidneys.

I have had dozens of running buddies tell me that they routinely take 600-800mg of ibuprofen after long runs or intervals. This is a common tactic to decrease inflammation and attempt to prevent delayed-onset muscle soreness. There is no doubt that this can work, but at a price.

NSAIDs SLOW TISSUE HEALING.

The very first phase of any wounded tissue healing is the "inflammatory phase." By taking a medication that interferes with inflammation you can actually decrease the tissue healing that takes place after your workouts. This really seems counterproductive.

If you think about how hard you work to stay on pace that last couple of miles during your hard workouts, it would seem you would want the maximum recovery benefit as well. There are a number of studies that show NSAIDs can decrease the effectiveness of the recovery process, and in effect, your workouts.

As long ago as 1986 a study showed that NSAIDs appeared to interfere with recovery from muscle strains. Your hard run workouts (particularly intervals, mile repeats and progression runs) are nothing more than controlled induction of muscles strains. Of course, when your muscles respond to these workouts, they heal and increase your muscular strength and fitness. Interfere with this process and you don't get the maximum bang for your workout buck.

Twenty years later, another study showed that NSAIDs also impaired strength and interfered with tendon-to-bone healing. This is important for any runner or triathlete with tendonitis. Achilles tendon injuries, peroneal tenditis, and posterior tibial tendonitis all have the potential to completely halt your marathon training. If you have any tendon pain, you definitely need to heal as quickly as possible. You have to treat the problem by seeing a running specialized podiatrist and not just covering up the pain.

NSAIDs CAN DAMAGE YOUR KIDNEYS

Your kidneys are metabolic waste-removal machines. They filter the blood and help you get rid of any waste by-products. They also clear NSAIDs.

When you exercise hard, your blood flow is diverted from your internal organs to your hard working muscle groups. Runners know this best in terms of the limited capacity to eat while running. Because of the reduced blood flow to your digestive track, you might get a gastric revolt if you eat too much during a strenuous run. The same sort of decreased organ blood flow happens in the kidneys, but you don't get any warning such as nausea when you tax your stomach.

Studies from New Zealand and England have shown that during sustained exercise NSAIDs can decrease renal (kidney) function and increase the risk of developing acute renal failure. To make matters worse, consider that many marathon runners and aching triathletes will take OTC pills (which are 200 mg each) at a prescription strength (600-800 mg). Taking big doses when your you are exercising further increases the risk of kidney overload and kidney damage.

While NSAIDs are great drugs for the right circumstances, they should be respected. As hard as marathon training and speed workouts are, you want to make certain that you get the best recovery and the most strength gain possible from those workouts. During the race, you must realize that running at your limit is going to hurt. Fight the temptation to relieve the pain with ibuprofen during the race. Otherwise you might find yourself wearing a hospital gown under that finisher medal.

Dr. Christopher Segler is a multiple Ironman finisher and marathon runner. When not busy seeing athletes in his podiatry house call practice, you can find him riding through Nicasio Valley, running in Golden Gate Park, or doing mile repeats at Kezar Stadium. If you think you have tendonitis or any running related foot pain, he will come right to your Bay Area home or San Francisco office to help get you back on the road to recovery as quickly as possible. (415) 308-0833. www.AnkleCenter.com

To Pop or Not To Pop: Blister treatment for runners explained by San Francisco's Running Podiatrist

Dr. Oz recently ran a segment on his television show instructing his audience to pop blisters whenever they occur on the feet. He went on to explain that if you successfully get all of the fluid out, the top layer of the blister will form a adhere down to the tissue underneath and create a "biologic dressing."

While this may be sound advice for a typical healthy woman who gets a blister from a new pair of high heels, the real question for Bay Area runners is: "Should I drain a blister" if I am a runner training for a race such as a marathon or triathlon?

The best answer is "sometimes you should, and sometimes you shouldn't."

The medical term for the type of blisters on the feet when running are "friction blisters." Blisters on the feet occur from a combination of skin friction and pressure. When your foot slides around inside the running shoe, you get friction. Rubbing the skin over and over in one spot (such as the back of the heel or ball of the foot) causes the layers of the skin to begin to separate. Fluid then seeps into this newly created space between the layers forming the blister.

Keep irritating the area and the blister continues to get bigger. Even if you simply continue to apply pressure to the blister (like pressing it against the heel counter inside the running shoe) it will continue to get bigger. This is because the fluid will try to spread outward and keep separating the skin layers. Then even more fluid seeps in to make the blister bigger.

If you keep rubbing the blister long enough, the skin on the top of the blister will tear effectively popping on its own. The blister then starts to ooze relieving the pressure as the fluid leaks out. So should you take charge and drain it yourself?

What sports medicine podiatrists know about blisters in runners is:

1) small non-painful blisters heal quickly
2) large painful blisters hurt less if drained and not irritated, but hurt more and have a slightly higher risk of getting infected if they are drained and the activity (such as running) is continued
3) blisters with the overlying blister roof removed will heal, but hurt more initially

So If you are runner with a small blister on a toe and it doesn't hurt don't drain it. It will heal quickly and has a very low risk of infection. If the fluid can't drain out, bacteria can't get in. If you have a blister that is small, put a felt pad around the blister. You need a donut shaped or U-shaped pad for this to work. You need to put the pressure around the blister and not on the blister. This will stop all of the rubbing that could make the blister get bigger. It will also stop the blister from hurting.

If you running a marathon or competing in an Ironman triathlon and get a huge blister that makes it hard to walk after the race, drain it. You can do this by poking a small hole at the edge of the blister. Heat the needle or soak it in rubbing alcohol. This will sterilize the needle so that you don't introduce any infection causing bacteria when you puncture the blister.

Cover the blister with a bandage that will soak up the fluid as it continues to leak out. If the fluid starts to build up again, then repeat this process and drain the fluid again. Marathon runners with big blisters may have to do this a couple of times. The blister can be quite irritated after running 26.2 miles.

So what are the "exceptions to the rule" about popping or draining blisters in runners?

1. If you notice the blister at mile 13.1 and still have another half-marathon to go, don't pop the blister. This is where the advice from Dr. Oz doesn't fit with runners. If you drain the blister on your heel then continue to run, more fluid will seep under that skin. The skin will slide back and forth. If the drained blister skin slides around, it can't work as a "biologic dressing" because it never has a chance to stick to the underlying raw area. The roof of the blister may also tear. That is what happened in the blister pictured above. All of the rubbing of the heal inside the running shoe caused the blister to rip open. If the roof of the blister tears, it needs to be removed (called "de-roofing" by podiatrists).

If the blister is drained, you need to secure the overlying skin in place with a dressing. Wait until the race is over. If you drain it mid-race it will hurt like hell, there is a higher risk of infection and it will take longer to heal. You also need to wear a pair of shoes that won't rub on the raw blister after it has popped. So once you drain the blister, apply a dressing that will hold the skin securely in place. Change the dressing daily. Studies show that hydrocolloid dressings works best to bake blisters heal fastest. But there is NO evidence than antibiotic ointment helps blisters heal any faster.

2. All blisters should be drained, completely de-roofed and treated by a podiatrist if you are diabetic. The risk of infection is much higher in diabetics. A blister anywhere on the foot in a diabetic runner is a medical emergency. I have personally performed many amputation on diabetics where a blister became hugely infected and spread to the underlying bone. Seek immediate medical attention if you have diabetes and a blister anywhere on the foot, heel or toes.

Although it is easy to prevent blisters, they still often occur in runners. In fact research shows that blisters on the feet are by far the most common running injury reported among marathon finishers. If you get a blister on the feet, treat it right and it will heal quickly so you won't have to miss much training at all.

Dr. Christopher Segler is a sports medicine podiatrist in San Francisco with a focus on runners. He is also a marathon runner and Ironman triathlete himslef. He makes house calls all over the Bay Area to treat running injuries like blisters, stress fractures and Achilles tendonitis. If you have a question about a running injury you can email him or call (415)-308-0833 to reach him directly. For the best source of running injury prevention information in the San Francisco Bay Area, visit MyRunningDoc.com or AnkleCenter.com.

Ironman 70.3 California Race Report by San Francisco Sports Medicine Podiatrist

On Saturday March 27, 2010 I officially started the triathlon season with my first half Ironman.

The Rohto Ironman 70.3 California in Oceanside, CA is one of the most popular events on the 70.3 circuit and this weekend I got to find out why.

Given that I have competed in many full Ironman distance triathlons (but no half-Ironman events) I really only had three main goals for this race:

1. Finish injury-free! (bad form for a podiatrist to get injured while running)
2. Finish in 5 hours 30 minutes or less.
3. Test the engine and see what I need to do to prepare for the 2010 Ironman season.

PRE-RACE DAY:
Early that morning I went out for the obligatory short ride and transition run. It felt great to loosen up all of the 8-hour car ride stiffness sustained from the drive down from the San Francisco Bay Area. The weather was perfect! I picked up my registration packet and went back to the room to meet Paige and Alex and go for a swim with my favorite 2 year-old.

Because the swim portion takes place in the Oceanside Harbor, athletes are not allowed to swim at the site before race day. No big deal as swimming is swimming and it all looks pretty much the same on race day… arms, legs, and churning confusing.


Because the bulk of the bike leg winds through Camp Pendelton, competitors are not allowed to ride on the bike course. This would be the first race where I would have basically know clue of what to expect on the bike.

I just figured I would treat it like one of my group rides in Marin with my biking buddies in the Bay Area. I usually don’t really know the routes I am being led on when we head somewhere new, so this should feel similar. I’d try to just take it as it comes and pay attention to my heart rate and perceived exertion.

RACE DAY:
We rented a condo right by the harbor which made race morning stress-free as can be. Up at 4:00 a.m., peanut butter and jelly sandwich down, make coffee, shower, get dressed, pump up bike tires, fill aerodrink bottle, gather gear, etc.

It seems like every race lead to some item forgotten in transit to transition, and this was no exception. I had everything meticulously organized. But just as I was headed out of the door I realized it was cold and decided to put on a fleece jacket. In doing so I forgot to put my backpack on again.

So I headed out into the dark and streamed in line with the other 2300 or so athletes heading to transition. I found my spot and racked the bike. When I got ready to lay out my running gear, I realized the conspicuous absence of the back pack.

No big deal as the condo was only about ¼ mile away. I did a warm-up jog back to the condo and grabbed the back pack. Paige, Alex and I then headed back to transition so I could add my towel, running shoes, hat and number belt to the #589 pile in transition.

With everything in place, just had to wait for the start.


SWIM 1.2 MILES:
The goal for the swim was simple. Relax and swim 1.2 mile in 40 minutes without getting worn out or beaten up.

My swim wave was relatively early and I got to start right at 7:00 am. The cannon went off and away we went. The water was clean, clear and way warmer than San Francisco Bay! It seemed like no time before I was rounding the red turn buoy at the mouth of the harbor. I drafted a little, but mainly tried to stay clear or the flailing arms and kicking feet that surrounded me.

When I got back to the boat ramp, I checked my watch and saw success! Swim time of 39:33, no black eyes, and no one kicked me in the head. I felt great knowing I could get out on the bike without having to extract an impacted earplug (at least this time).

Transition 1:
After the 600 foot long run in a wetsuit, I made it to the bike. Stripped the wetsuit, put on my socks, helmet, Garmin, sunglasses and away I went!

BIKE 56 MILES:
The bike course was great! Lots of gentle rollers, some big long climbs interspersed with plenty of flat stuff where I could get on the gas. I can say with confidence that the course is beautiful as it wind through the Marine Corps base. Big green mountains, wildflowers and blue ocean dominate. There is also the occasional “Tank X-ing” and “Live Fire Zone” signs just to remind you where you are. The soldiers volunteering on the base provided (no surprise) perfect order and execution at the aid stations.

I kept a constant low-stress level on the bike course. I went hard, but easy enough that I knew I could still run the half marathon. After 2 hours 45 minutes and 9 seconds (20.35 mph average) I was back in Oceanside and ready to run.

RUN 13.1 MILES:
The run course is a mostly flat out-and-back two-loop affair. The best part was that it runs along the ocean and passes directly in front of the condo where I could see Paige and Alex waiving and cheering from the balcony.

I really wanted to make sure I finished in under 5:30 total. So after some quick math I knew I could coast in as long as I maintained an average pace of 9:00 per mile for the entire half marathon. I went about 9:30 min/mile pace for the first mile to try get moving and loosen up my legs. Then I started to gradually increase the pace.

About two miles from transition I saw my old motorcycle road-racing partner Fred Provis cheering for me out on the course. Fred is one of those guys who can make anyone feel like a champion. He definitely put a spring in my step. The next few miles felt much better. By the first turn around I knew I would make the finish on target.

By the second lap I was in a comfortable groove. I fought the urge to push the pace knowing that I might invite injury, or blow it and end it walking. Given that I had a goal of getting a qualifying slot for Ironman Arizona (as well as doing Ironman Canada five months from now) I knew I should be sensible and just keep the pace steady.

About a quarter mile from the finish I realized I was still slowly creeping up on another guy in my age group. I had been behind him for about 5 miles. For some reason passing him suddenly seemed important.

Right after I crossed the bridge to the harbor, I kicked it in high gear and shot past him. Confident that I was far ahead, I slowed down. Next thing I knew he flew by on my right as we entered the last 50 feet of the finish shoot. I started chasing him as he peered back at me over his right shoulder.

I was picking up speed as we approached the finish line. Then the poor guy suddenly stood bolt upright, grabbed he right hamstring and started limp-running to the line just ahead of me. When I crossed the line he was holding onto a volunteer with one hand his his hamstring with the other. I patted him on the back and said “You reeeeeeally earned that one!”

My total time was 5:29:42. I made my goal with 18 seconds to spare. And most importantly (unlike the guy in front of me), I was injury free. Best of all, I went to watch the roll down... and secured my Ironman Arizona slot. See you in Tempe in November!

Let the training begin...


Dr. Christopher Segler is an Ironman triathete, marathoner, and an award-winning Sports Medicine Podiatrist in San Francisco. He has written extensively on the subject of podiatric sports medicine and running injury prevention. His San Francisco Podiatry practice focuses on house call appointments for busy professionals and athletes who want to prevent or recover from running injuries. He offers the convenience of podiatry house calls at Bay Area homes and offices so that his clients don’t have to lose time going to the doctor or getting custom orthotics. You can learn more about common running injuries at AnkleCenter.com and Doc On The Run.com.

What Happens If I Keep Running on a Stress Fracture in the Foot - San Francisco Sports Medicine Podiatrist Explains

Stress fractures in the foot are one of the most common injuries in runners. Although runners often endure many different aches and pains while training for a marathon or half marathon, an ache in the foot that is a stress fracture is one pain that shouldn't be ignored. One of the questions I get from runners on a regular basis is "what happens if I keep running and it is stress fracture."

The short answer is that if you continue to run, the stress fracture will likely get worse and lead to a complete break in the bone.

I have seen this happen more than once. One runner was actually a triathlete. He had been rapidly increasing his milage while training for an olympic distance triathlon. He started to notice a vague aching sensation in foot one day during a run. The next day the foot was sore. By the end of that day at work it was throbbing. He took off a couple of days from running and rode his bike instead. He resumed running a couple of days later. Then he noticed the dull ache in his foot with every step during his run. When he took his shoe off he noticed some bruising of the foot as well. He kept running anyway.

When I finally saw him, he had been running on this painful, aching foot for about 5 weeks. The foot was swollen, tender and bruised. As soon as we took an x-ray of the foot, it was obvious that he had fractured the fifth metatarsal bone. He had to have foot surgery to repair the fractured bone and allow it to heal. Obviously, foot surgery is not a good start to any running or triathlon training season.

A stress fracture is a tiny (virtually invisible) crack in the bone. If you continue to apply stress to it (such as running) the tiny crack gets bigger. Continue running and the crack can lead to a complete break in the bone. Once the bone breaks, the ground essentially pushes the bone up out of the way. At that point the stress that was being applied to that bone get transfered to the bone next to it.




That is what has happened in this xray image. The pain from the 5th metatarsal stress fracture was ignored by the patient. Once the stress fracture turned into a completely broken bone, a stress fracture started to develop in the next bone over (the 4th metatarsal bone).

Generally a sore foot while running warrants attention from a sports medicine podiatrist. Particularly if you want to keep running. With early treatment, you can get it to calm down and avoid disaster. Make sure you find a podiatrist in your area who runs and understands runners. That will give you the best chance of making to the starting line and finish line of your next big race.


Dr. Christopher Segler is a Podiatrist in San Francisco. He is also an Ironman triathlete and marathon runner. He authored a chapter in the Handbook on Podiatric Sports Medicine. He has also won multiple awards from the American College of Foot and Ankle Surgeons for his research on diagnosing subtle foot fractures. He offers podiatry house call appointments for busy professionals and athletes who prefer the convenience of a house call at their home or office, instead of waiting half a day to go to the doctor. You can learn more about stress fractures in the foot at AnkleCenter.com and Doc On Th Run.com.

San Francisco Podiatrist on Difference Between Heel Pain and a Heel Spur

Heel pain is the most common form of foot pain that causes people in San Francisco to make an appointment with a podiatry clinic. In fact, nationwide, about 40% of all visits to podiatrists are due to heel pain diagnosed as plantar fasciitis. As a podiatrist in San Francisco myself, the thing that I find interesting is that most people with plantar fascitis think they must have a heel spur to have heel pain. But that’s not always true.

So what is the difference between plantar fasciitis and a heel spur?

To begin with, let’s explain how to tell if you have plantar fasciitis. Anyone with plantar fasciits will have pain in the bottom of the heel or in the arch. In most cases this pain is worse when you get up and step out of bed in the morning. The heel may also hurt when you get up from your desk after working at a computer for a couple of hours.

As you start to walk, the first step is usually a sharp pain or sudden ache in the bottom of the heel. After a few steps, the heel pain starts to subside and feels better. In many cases, it may not even hurt at all while you are walking around or even running. But when you sit still and get back up again to start walking, that’s when the heel pain returns.

If you have this kind of morning heel pain and simply push on the bottom of the heel (and it hurts) you most likely have plantar fasciitis.

Many people in the San Francisco Bay Area seem to believe that heel pain is due to a sharp heel spur poking down and causing pain. But in fact about half of all people who have this kind of heel pain don’t have a heel spur at all. And about half of people with no heel pain, happen to have a heel spur that will show up on x-ray. So the two problems aren’t necessarily related.

The most common cause of heel pain is plantar fasciitis, which is simply inflammation of the plantar fascia. The plantar fascia is a big ligament attaching to the bottom of the heel and extending out to the toes. If you put too much stress on the plantar fascia, it can become inflamed where it attached to the heel bone.



With improper biomechanics, such as excessive pronation (flat feet that roll inward as the arch collapses) the plantar fascia ligament may tug away at the heel bone. With tension applied to the plantar fascia, the attachment may cause the heel spur to form.

The way this happens is that the ligament pulls the covering (called the periosteum) of the heel bone away. A small blood clot forms and then becomes calcified as it heals. If this happens again and again, the heel spur gradually grows. Because the heel spur is caused by the pulling on this big ligament, you can understand why a heel spur points out toward the toes and not down toward the ground.




Any podiatrist in San Francisco can simply take an x-ray of your heel to tell whether or not you have a heel spur. But the reality is, it doesn’t matter.

In the last 7 years, I have only surgically removed 2 heel spurs. Both of them were broken and wouldn’t heal. One was an young ironworker in San Francisco who fell off some scaffolding while working on the Golden Gate Bridge retrofit project. The other was a woman in her sixties who has some osteoporosis and broke the heel spur while doing high impact aerobics.

But most people with plantar fasciitis can get better on their own, even if they have a heel spur. In the vast majority of cases, spending a few minutes doing our San Francisco Podiatry Heel Pain Recovery Stretches will make the heel pain go away. The spur just simply doesn’t usually need to be removed in surgery.

Dr. Christopher Segler is a nationally recognized expert on conditions affecting the heel bone. In 2006 he was awarded 1st Place at the National Meeting of the American Podiatric Medical Association for his research on diagnosing heel bone infections with magnetic resonance imaging (MRI). He offers podiatry house calls in San Francisco for busy athletes and people who just think it is ridiculous to take half a day off work just to see a foot doctor. You can reach him through Doc On The Run: San Francisco Bay Area Podiatry House Calls.You can also learn more about the causes and available treatments for heel pain at AnkleCenter.com.

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Can Your Sports Drink Cause Diabetes? San Francisco Running Podiatrist Explains New Study

San Francisco, CA - March 11, 2010: A new study conducted at the University of California San Francisco (UCSF) was just released that blames sports drinks commonly used in marathon training and other endurance sports for the rising epidemic of obesity and diabetes.

The question is.. Do you need to find another way of getting your calories and nutrition during your next long run, marathon, or triathlon?

About the Study
At UCSF, researches used a form of computer modeling called the "Coronary Heart Disease (CHD) Policy Model" to predict effects of sugar-added sports drinks on adults over age 35. One of the lead authors of the study is an internal medicine resident at UCSF. The finding from the study were presented at the "50th Annual Conference on Cardiovascular Disease Epidemiology and Prevention" in San Francisco from March 2-5, 2010.

The main conclusion from the study were:

• sugary drinks are now contributing to the increased incidence of obesity in America.

• sugary drinks are costing the U.S. Health Care System $300 to $550 million per year.

• increased use of sugary drinks have led to 130,000 new cases of diabetes between 1990 and 2000.

Doctors and podiatrists in are aware and concerned about the growing midsection of America and the associated rise in diabetes. Diabetic foot amputation are more or less preventable, but are still on the rise. Mostly because more people have diabetes in America than ever before. In fact, one study showed that in the next 25 years 1 out of 3 Americans will become diabetic. That's a lot of diabetic feet. So all podiatrists (whether in San Francisco or rural America) are concerned.

So then back to the question. "Is the consumption of sports drinks by runners, triathlete, etc likely to lead to diabetes?"

The answer is... probably not.

The people who are sitting around (on their rapidly growing behinds) playing video games chugging 32 oz. bottles of Powerade are certainly more at risk of developing diabetes that someone drinking a sports drink out on a run.

Here's an example:
On my last 10 mile run along Ocean Beach and through Golden Gate Park, I burned 2,357 calories. During that run I wore a Fuel Belt with diluted Gatorade. In all, I drank four 6 oz. bottles of 1/2 Gatorade and 1/2 water. That's a total of 12 ounces of sports drink. Grand total 310 calories found in 78 grams of carbohydrate (of which 42 grams is sugar). That leaves me with a 2000 calories deficit after my run.

So not only will this sort of athletic activity leave you with a caloric shortage, but we also know that exercise in and of itself is protective (in fact some studies suggest curative) of diabetes.

We know that someone who is "pre-diabetic" can lower their average blood sugar readings, just by exercising 30 minutes per day, 5 days per week. Diabetics using insulin shots have gone from using insulin, to only taking pills just by adding aerobic exercise. This is key to controlling your diabetes and preventing complications like poor circulation in the legs and diabetic foot problems.

So the bottom line is that I will still drink my Gatorade on my next long run. And when I roll through the aid station at Ironman Canada I will grab that gatorade and that Gu. I won't start taping dried dates on my top tube just yet.

Now having said all of that, I will say that I never, ever drink sports drinks... if I'm not wearing a heart rate monitor.


Dr. Christopher Segler is a Podiatrist in San Francisco. He is also an Ironman triathlete and runner. On most days, you will find him riding through Marin, running along Ocean Beach or making house calls for busy athletes who would rather get casted for orthotics at home instead of missing a track session. You can reach him at Doc On The Run. Learn more about common foot problems at AnkleCenter.com.

San Francisco Marathon Runner and Bunion Surgeon Posts Video Explaining "What is a Bunion?"

Educational Video by San Francisco Bunion Surgeon "What is a Bunion?"

One day after a marathon, a runner came up to me and explained that he had stopped running because he had so much bunion pain. This guy was no novice runner. And no wimp. He was a multiple Ironman finisher, who had even qualified for the Ironman World Championships in Kona. He said he just wanted to know if he would be able to run again.

As a runner currently training to earn my own Kona slot, I know first hand the level of pain tolerance that has to exerceised to finish an Ironman in a respectable time. So when he told me that "pain" was what was stopping him from running, I knew he really had to be suffering from some serious bunions.

And he was. So after evaluating his feet, looking at the x-rays, etc., we decided to surgically correct his painful bunion. Interestingly to me, he still didn't really seem to understand how a bunion forms. In fact, I have had many bunion surgery patients who came to see me with bunions who have tried to research bunions on the internet, but still didn't fully understand how a bunion happens.

To help people understand what a bunion is, how a bunion forms, why it gets bigger, why bunions become more painful, etc, I created a short video and posted it. Click on the link above if you want to understand how a bunion develops.


Dr. Christopher Segler is a 4-time Ironman Finisher and foot surgeon in San Francisco. He is also the inventor of the Tarsal Joint Distractor, a surgical instrument designed to help bunion surgeons perform bunion correction surgery faster with a lower complication rate. You can learn more about bunion surgery at San Francisco's Best Foot Info Site. If you are a busy athlete who would rather have a doctor come to you for your evaluation see San Francisco's Podiatry House Call Site.

San Francisco Podiatrist Posts Video on 1 Hour Ingrown Toenail Relief in San Francisco

Ingrown toenails are easily the most common reason that a podiatrist will see a doctor for pain in the toe. Ingrown toenails can be prevented with some simple tips:

1. Cut normal nails straight across.
2. Keep your nails just shorter than the end of the toe.
3. Avoid shoes that cramp the toes.

The most common way people cause ingrown nails is by cutting them too short. This is often in an attempt to relieve a painful ingrown nail before it becomes infected. Unfortunately, this usually backfires. But even if you try to take it out and make the ingrown toenail worse, you can still get relief. This video explains how you can get ingrown toenail relief in San Francisco in only about an hour, even without going to a podiatry office.





Dr. Christopher Segler is a San Francisco Podiatrist and toenail surgeon. He treats podiatry emergencies (such as ingrown toenails) like they really need treatment now. He drives around San Francisco seeing patients at home, in their offices or even tourists on vacation in their hotel rooms. No one needs to suffer with a painful infected ingrown toenail. If you need immediate relief from an ingrown toenail in only an hour, you can reach him directly at (415) 308-0833. You can learn more about ingrown toenails at San Francisco's Podiatry House Call Site and San Francisco's Best Podiatry Patient Information Site

San Francisco Podiatrist Explains Why Athlete's Foot is Common in Bay Area Runners and Cyclists

Athlete's foot is a fungus infection of the skin that often occurs in runners, cyclists and other athletes. It just so happens that the San Francisco Bay Area has a climate that can make it easier for you do develop a case of itching, burning, peeling feet that characterizes the condition.

In order for any fungus to grow best, it needs a habitat that is dark, warm and moist. As it turns out, shoes are perfect for this. You put on your running shoes and head out for a run through Golden Gate Park. Your feet sweat (even if it is fifty degrees), and the heat from your feet turns the shoe into a little incubator for the nasty stuff to grow. If it is like many days in San Francisco, you may even get some rain or light drizzle further soaking your shoes. Then you get home and toss your shoes in the closet until you get ready to go for a run the next day.

The problem is that very few closets have heat or air conditioning vents in them. For this reason, the shoes just won't dry out. They stay damp. And damp running shoes equals fungus.

Cyclists have a similar problem. Head out on the road to Nicassio or anywhere else in Marin county on the weekend and you will see hundreds of cyclist out for a ride. Most of them are wearing shoe covers to help keep their feet warm and dry. But these shoe covers don't breathe very well. As a result, all of that moisture gets trapped inside the cycling shoes. Once the ride is over, many cyclists will toss there shoes in the garage right next to their bike. Sitting in a cool and damp garage keeps the inside of those cycling shoes damp as well.

Sooner or later, the fungal spores in the shoes will cause an athlete's foot infection. Often this is just nothing more than mild peeling of the skin on the bottoms of the feet (see picture above). But some people get severe itching, redness and burning of the feet. Once in a while a secondary infection (caused by bacteria) can start an even bigger problem.

So what to do?

First off, it is very easy to prevent athlete's foot by simply drying your running shoes and cycling shoes out. Bring them inside. I usually leave mine near of a heating vent for a couple of hours after I go running or biking. This ensures that the insides of the shoes will stay dry. Dry shoes don't support fungus very well. If you wear cycling shoe covers, take them off after every bike ride to help them dry out.

If you do get athlete's foot, over-the-counter (OTC) anti-fungal treatment creams will usually cure the problem in about 4 weeks. All you have to do is follow the directions on the tube. Make sure you use the cream for about a week after the problem seems to have gone away. Otherwise you might still have some fungus in the skin that can flare back up in only a couple of weeks after you stop applying the anti-fungal medicine.

Keep in mind that if you get athlete's foot, you will have been shedding fungal spores in your shoes. You need to decontaminate them by spraying lysol in your shoes and letting them dry out thoroughly afterward. If the athlete's foot doesn't improve after you treat it yourself with OTC medications, see the best podiatrist you can find.

Dr. Christopher Segler is a runner and Ironman triathlete who practices Podiatry in San Francisco. He offers house calls to busy athlete's through www.DocOnTheRun.com. You can learn more about common causes of foot pain at www. AnkleCenter.com, San Francisco's best podiatry treatment information site.

San Francisco Podiatrist: Out-Run Your Fat Cells!

An article in the San Francisco Chronice discusses some alarming statistics.

Ten years from now, 80% of men and 70% of women will be obese. In addition, there will be a 98% increase in obesity related diabetes. The problem of couse isn't just that all those fat people will have a tough time fitting in an airplane seat when getting on the plane in San Franciso heading to Hawaii.

The problem is that essentially preventable conditions like heart disease, stroke and diabetic foot amputations will follow those plump Americans like the dust cloud following Pigpen in the Charlie Brown cartoons.

The truth of course is that the bigger the waist size, the shorter the life. Many of the ultimately fatal complications of obesity and diabetes are lifestyle related. A little prevention can go a long way.

Given that I am a podiatrist and runner, I of course am biased toward exercise and preventing the complications that lead to foot amputations. Not just because I like to run, but because people who have diabetic amputations don't live very long.

We know that a "pre-diabetic" (sometimes also referred to as a "borderline diabetic") can often reduce their blood sugar and reduce the chances of developing diabetes just through regular exercise. A diabetic who is taking insuling who begins a walking or moderate running routine can go from taking insulin shots, to just taking some pills to keep the blood sugar under control.

And we all know that exercise is a more reliable way to fight obesity than diets.

So maybe just by adding a 30 minute running routine in Golden Gate Park, along the Embarcadero, or through Marin, San Francisco Bay Area residents could actually outrun the ability of their fat cells to pack on the pounds. San Francisco is easily one of the most scenic and runner friendly cities in the world.

As a Podiatrist who has done lots of diabetic foot sugery, I can honestly say that I would rather meet you on a Saturday morning run in San Francisco than see in the hospital because you need me to amputate a part of your diabetic foot. Every run in San Francisco I go on feels like a success. Every diabetic foot amputation feels like a failure.


Christopher Segler is a Foot Doctor in San Francisco who practices Podiatry. He is also a multiple Ironman Finisher. For more info about foot pain or running injuries see www.DocOnTheRun.com or www.AnkleCenter.com

Runner's Pedicure???

Question: "What in the world is a runners pedicure!!! What I am looking for is someone who knows what happens sometimes when you run a half or full marathon. Yes the dreaded black toenail. My toes have mostly recovered but my girlfreind is insisting I get them in shape or keep my shoes on!" - Rick J.




Answer:As a Bay Area podiatrist and active runner (marathons and Ironman) I can tell you that you don't necessarily have a fungal infection just because the toenail is getting thicker and uglier. There is a very common condition among distance runners and triathletes. It is often referred to as "Runners Toenail." Podatriss call it "traumatic onychauxis." If you run a marathon or half marathon and get the black toenail, you have caused enough trauma to the nail bed (under the nail) to bleed. It is basically a bruise or bllod blister under the nail. Repeatedly beating up your toes in this way leads to the root of the nail getting smashed, deformed and becoming missahpen. Then the toenail grows out thicker. It may be greyish, or yellowis in color and often looks like a fungal nail, but it may not have any fungal infection. A pedicure can often thin the nail and return more of a normal appearance to it. Podiatrists can also prescribe topical solutions that decrease the buildup of keratin on the nail that makes it look like a fungal toenial. The bad news is that there is no "cure" for runners toenail. But you can keep your toenail looking presentable with a pedicure. If it gets worse over time (and you haven't had any more episodes of black toneails) it might be a fungal toenail infection. The only way to know for sure is to see a podiatrist. Your foot doctor with then take a sample of the toenail and send it off to a lab for anlaysis. A test called a PAS reaction will determine whether or not there is any fungus living within the nail plate. If there is no fungus, then you have "traumatic onychauxis" (runner's toenail, in plain English. You can also visit http://www.MyRunningDo... for more info. Best of luck! - Dr. Christopher Segler, San Franciso Podiatry House Calls

Can I Run After Ankle Ligament Surgery?

Question from Mike in Corte Madera:
For years I had unstable ankles and repeated ankle sprains. It seemed like every time I would walk on any sort of uneven ground, my ankle would roll under. Although it wasn't always painful, it was bothersome. My doctor said this unstable ankle (continually giving way) was porbably caused by a bad ankle sprain I had back when I was playing high school basketball. I had surgery about a year ago to repair the torn ankle ligaments. The ankle ligament surgery was called a Brostrum repair. Now the ankle seems fine, but I want to know if I can run in a marathon. Ultimately I would like to participate in a triathlon this year as well. Is this possible?

Answer from My Running Doc:
Ankle sprains are very common. Some estimates show that there are nearly 25,000 ankle injuries in the U.S. every day. The vast majority of these ankle injuries (about 85%) are ankle sprains. Many people try to treat ankle sprains at home with ice, rest, elevation, and maybe an over-the-counter brace or ACE wrap to keep the swelling down. But many more will seek treatment at the Emergency Room or from an ankle expert like a podiatrist.

When doctors try to determine how severe the sprain is, they base it on a grading system from 1 to 3. A grade 1 ankle sprain means that you have sort of stretched the ligaments a little. A grade 2 ankle sprain means that you have partially torn one of the ligaments supporting the ankle. Although this is more severe, the ankle ligaments are still mostly intact. A grade 3 ankle sprain means that you have completely torn at least one of the ankle ligaments.

It is often difficult for a patient to tell the severity of the ankle sprain, but there are some indicators that it might be severe and needs to be treated by an ankle specialist. Bruising and swelling are clues that you have had some level of tissue damage. With severe bruising, your ankle doctor should also be suspicious of a fracture. But even if there is no fracture and the ankle isn't broken, that doesn't mean you don't still need serious treatment.

In your case it sounds like you had one of the classic ankle sprains that resulted in Grade 3 ankle injury. Because the ankle ligaments never healed, you were left with an unstable, wobbly ankle. By performing a Brostrum ankle ligament repair, your ankle surgeon has attempted to rebuild and repair the torn ankle ligaments. If the ankle surgery has been successful, you should gain full mobility and use of the ankle. If I were to have performed your ankle surgery, the goal would be to have a much stronger ankle after the surgery than before. This of course means that you should be better able to run and bike once the ankle surgery is all healed.

In short, anyone who has ankle surgery to repair the torn ligaments should be able to run or ride a bicycle without any trouble. Marathon training and triathlon training are reasonable goals, once you have healed. Having said all of that, you should check with your current treating ankle surgeon and make sure your ankle surgery has healed before you start running, cycling or any new training routine.

Best of luck in your 2010 season!

My Running Doc - Dr. Chistopher Segler is a San Francisco based foot & ankle surgeon with a unique perspective on foot and ankle injuries.  He is a rock climber, skier, marathon runner, and Ironman triathlete.  Because of this, he understands when someone has an injury, they want to get better, just to get back to activity.  He understands that the common doctor's notion of "just stop running" or "find another hobby," or "take up Scrabble" are all unacceptable to the athletically minded.  He believes that any active athlete can suffer an injury yet return to sport stronger than ever.