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.

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.

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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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

Ironman Florida 2009 Race Report and Story November 7, 2009 by MyRunningDoc

2 DAYS to RACE DAY
When the rising sun finally cast enough glow on the sand for me to see, I walked out onto our balcony. I looked toward the Gulf of Mexico and saw water as smooth glass. A gentle breeze stirred only the slightest rustle in the palms between our hotel and the beach. It was Thursday morning, and time for a practice swim.

We had already been up for a couple of hours. I could lie and say that it is because I am a dedicated triathlete, but the reality is more about life with a two year-old. I made some coffee in our french press before gathering my wetsuit, goggles and earplugs to head to the beach.

Alex was already enjoying his Ironman cowbell while I put on my wetsuit at the Gatorade practice swim area. I headed down and waded into the water to blend in with the other hundreds of triathletes making their way out along the big yellow and orange pyramid shaped buoys.

The water was incredibly smooth and crystal clear. The visibility was much better than my local pool. I swam about halfway out along the course and could see the bottom the entire time. As I would rotate and look to the side to breath I would catch a fantastical underwater view of herds of googled folks in wetsuits stroking in unison. Everyone looks the same out there.

I made it back in, rinsed off and went to check in. Time for play with Alex and Paige in the pool and waterpark.

1 DAY BEFORE RACE DAY
In the interests of time (and convenience) I decided to swim from the beach right behind our hotel. I headed out alone into the gulf. As I waded out I saw a stingray just in time to miss stepping on him as he flew along the sandy bottom. I started to swim instead of wade. A moment later I saw a second stingray. I realized how nice it is to swim in clear open water as opposed to other venues where the water is usually closed to swimmers. This was the first triathlon where I could easily see more than a few feet in any direction.

While swimming, I felt more like I was snorkeling. Watching clams hop along the ocean floor, noticing sand dollars resting peacefully, small fish darting about. Then I saw a jelly fish. I was glad I was wearing a wetsuit. Then I saw another, and another. Next thing I knew I was in a school of dozens of jelly fish. I figured I had gone far enough so I turned around and swam back in.

My wife was building sandcastles with Alex when I got back on shore. I rinsed off, put on my bike gear and headed out for a quick ride. It was slightly windier than the day before, but still perfect. I rode about 15 miles at an easy pace. As soon as I got back, I swapped my bike for a pair of running shoes and off I went on a short run.

After my final tune-up workout, I showered and we ate breakfast, I took my bike and transition bags down to the transition area. With everything turned in, nothing left to do but, eat sleep and wait.

RACE DAY!
The alarm only buzzed twice at 4:30 a.m. and I was wide awake. I made coffee and a peanut butter and jelly sandwich. Shower, shave, bodyglide (in all the important places), band-aids on the nipples, dressed and I was ready.

I made a quick post on Facebook to let my friends know that I felt good and would go for a new PR. We got Alex in his stroller, handed him his cowbell and clapper and we were off the the start.

In the hotel lobby, athletes with bike pumps and goggles in hand were heading out into the dark. I saw several that had a familiar expression and look in their eyes. I had seen this expression before on the faces of climbers at the base of El Capitan. Its fear.

They were probably first timers. I bet I had that look when I showed up in Arizona to see if I could go 140.6 miles in one day. I do know that until my first Ironman was over, I wasn’t really sure.

We drove down in the dark predawn chill to the start. Paige went to find parking while I went in to air my tires and fill my Aerodrink bottle with fluid. With the bike ready, I went find to a porto-potty. Hint...its always at the end of the longest line. But I had plenty of time.

While I waited, I watched the palms waiving in the wind thanks to Tropical Storm Ida brewing way off in the Gulf. I knew that the winds would be out of the East at about 10 mph, but not too gusty. The flat water would be gone today.

With the sun finally up, I put on my wetsuit and gave all of morning clothes to Paige. I tucked my timing chip way up under my pant leg, to protect it from getting pulled off by thrashing swimmers. The professional’s start was my signal to head down and find a place to line up. I kissed Alex and Paige goodbye and headed onto the sand.

SWIM 2.4 MILES
The start of any Ironman is intimidating. But Florida is really spectacular. You get a running start from the sand in a crowd of 2,400 over-hyped type-A’s. And they are all aiming for the same line of buoys.

I knew that the best place to start would be to the left, directly in line with the buoys stretching out to sea. This would be the shortest distance. This of course, would also be the most crowded, and hence, most dangerous place to be. I was weighing this, recalling that a father of two young children was killed in the swim here a couple of years ago.

A lot of other people must have been thinking about this too, because they were very spread out. It seemed like some people were so intent of staying out of the crowd that they were going to start from the Alabama state line. I just figured I would start on the left, but start slow enough to let the speed demons get ahead and not clobber me.

The cannon fired and... run, paddle, dog-paddle, bump, gasp, swim, swim, bump, swim. It was a lot like swimming with drunk hockey players. But I was ready. I learned my lesson in Louisville where I got hit in the head, sending my ear plug to the deep recesses of my ear canal. I felt safe and secure in the malay, having tied dental floss around them as insurance this time.

The whole first lap was just plain chaos. I never went more than a few strokes without either hitting or getting hit by someone. At the first turn buoy I swam right over someone as someone else swam right over me.

I then saw something waving in the water and flapping on my wrist. I realized that in the tussle someone had caught my ID band and pulled it apart. This was not good. You are required to keep it on until the event is over. I wadded it up and stuffed it up my wetsuit sleeve, so I could try to get it back together once I got out of the water.

After rounding the second turn buoy, I saw some jelly fish. Most were comb jellys like the ones I had seen the day before (that don’t sting as I found out with a little internet research). However there were a bunch of moon jelly fish too. It seemed like they stayed about 10 feet down under us, which was just fine with me.

With 1.2 miles down we all ran up on shore like a bunch of seals escaping a trolling great white in some National Geographic special. Aim for the timing mat and back into the water for the second lap. The second lap was much calmer than the first. In no time I was back on shore, wiggling out of my wetsuit. 1 hour 17 minutes… 3 minutes ahead of schedule!

T1 - SWIM to BIKE TRANSITION
I had some trouble with locating my transition bag, but found it pretty quickly. The volunteers really do a great job helping all of the frantic athletes. Knowing the changing tent would be packed, I started to get dressed outside. I also got my wristband back on. Luckily it had just come unsnapped and wasn’t broken. I tried to get my Garmin started and began putting on my heart rate monitor, sock, etc, while the GPS searched for beacons in the sky.

By the time the Garmin was online, I was ready to go. But I still had to make the required hike through the change tent. It was like getting through the Bay Bridge Toll Both at rush hour. It took minutes that seemed like hours to wade through the jammed crowd.

Clip-ity-clop, clip-ity-clop, out of the change tent through transition and onto the bike. I grabbed my bike and jogged to the mount line. A painfully long 11 minute transition. On the bike and away I go.

BIKE 112 MILES
I was really ready to go. I was moving at 22-23 mph, eating my first pack of powergel and taking in some fluid. I was still wet and felt a little chilled moving through the 50 degree air but knew it would warm up soon. Realizing I had a slight tailwind out of transition, I picked up the pace.

The ride was mostly flat with some long half-mile hills that are just enough reason to stand up and get out of the torturous saddle, but not enough to wear you out. There was some wind, but not too bad. There was however a huge crowd.

For almost the whole first half of the bike leg I was passing people, continuously. The crowds would get clogged up at the aid stations and it was distracting. I did see some people who were obviously deliberately drafting, but not too many. More than anything else, it was just congested. Often it was hard to get through these packs. A couple of times I was over the center-line as I passed some 3 or 4 rider wide packs.

Somewhere around mile 20 or 30 I was getting ready for my aid station routine. I popped a salt cap in my mouth and took a sip of water. Next I sat up, pulled the cap of my the aero water bottle nestled in my aerobars and got ready to grab water, gatorade and powergel as I cruised by.

I slowed down to about 18 or 19 mph and snathced a water bottle from a jogging volunteer. I immediately squeezed about 16oz. into my bottle and tossed it aside just in time to grab some gatorade and pour it in. Then I yelled “gel” and a kid started running down the course ready to hand it off. As I flew by I clenched the foil packet tight and reached for aerobar to upshift and start accelerating again.

It was then that I felt a thick sticky ooze running through my fingers and down the back of my hand. The kid had even gone the extra mile and opened the packet for me. By the time I realized this, my shifter was coated in thick sugary goo and my hand was basically glued to the aerobar.

At the next aid station I grabbed two bottles of water. After thirty minutes of dribbling water on my hand, bar, and shifter, I was free from the energy-gel-fly-trap.

About this same time time, I realized my right pedal cleat was loose and shifting about. I couldn’t believe I hadn’t checked them in months. I just hoped it was hold up through the final 50 or 60 miles.

At about mile 75 a yellow jacket flew straight into the front vent on my aero-helmet and stung me on my poor defenseless bald head. I was frantically trying to get my hand under the helmet to squash him, but didn’t want to risk a DQ from a chinstrap violation. So we buzzed along together for about 7 miles. Twenty minutes of a bee-in-my-bonnet-later, I pulled over at an aid station, dismounted, took of my helmet, and the assailant flew away into the pines.

As I pedaled back toward town, it felt great riding with a tailwind at 26-30 mph. But then the last 10 miles are right into the wind. I tried to relax and slow down on this stretch to make sure I could run off the bike.

Once I slowed, a guy pulled up along side of me and said he noticed I was shifting a lot. I was trying to explain that I was just trying to find a rhythm, but was having trouble with my cleat. Then a woman screamed and we both turned our attention back to the road. The two of us swerved away as she turned sideways, went skinny, and squealed as we narrowly missed her. Hard to imagine walking in the bike lane as a couple of thousand triathletes head your way.

T2 - BIKE to RUN TRANSITION
When I dismounted, I checked the time. 5 hours and 18 minutes. Pretty close to the 5:15 I had planned. My second transition went smoothly. Start the other Garmin, helmet off, hat and Newtons on. Out on the run course in just over three minutes.

RUN 26.2 MILES
I set off on the two-loop run course at an easy pace. I did the math and realized that to finish under 11 hours I needed pretty close to a 4 hour marathon. I aimed to hold a 9:00 per mile pace for the first 10 mile warm-up. I had the idea that I should also shoot for a sub-4 hour marathon, but didn’t want to risk overdoing it and missing my goal finish time.

Several times during the run I would suddenly hear a high-pitched “CHRIS!!!!” and see Paige and Alex waiting and waiving on the side of the road. I paused just long enough to kiss Alex on the forehead. As I ran off, I could hear the drifting away of his clanging cowbell and “godaddygo…”

The second 10 miles were a little harder and somewhere I lost some minutes. Overindulging on the pretzels at the aid station, I guess. With only about 10K to go, I realized my 11 hour goal was within reach, as long as I didn’t waste any time.

As I rounded the turn at the park to head back on my second and final lap, I walked through an aid station to drink some gatorade and water. A guy started talking to me, saying he was just on his first lap.

He had been rear-ended on the bike. He had some dizziness and they almost didn’t let him continue. He started telling me the whole story. While I was interested, I really didn’t have time to listen. But I felt bad for him and didn’t want to be rude and add to an already tough day for him.

But the second he came to stopping point, I said, “Well... good luck buddy... you’ll do great!” and launched into a run. Three miles to go I came to the sobering realization that I was in trouble. These would have to be my fastest miles of the entire day if my 11 hour goal was going to materialize.

I saw an aid station just a couple of blocks ahead. I figured that when I got there I would sip some chicken broth, do some more math and re-assess. My body was aching, my neck was stiff, my back hurt and my quads were vibrating. I realized that even if I finished in 11 hours and 5 minutes, that would be respectable. It would still be a personal record by almost an hour. I also knew no one would really care.

But then I thought about about looking at the time of 10:59:59 I had posted on my refrigerator and as a bookmark in whatever book I was currently reading. I thought about the “21.33” taped on my bike stem to remind (every time I rode) of exactly how many miles per hour I needed to ride to reach my goal. I suddenly remembered that on 7 different days in past 9 weeks I had run mile repeats on the track in the rain and thunder so I would be able to RUN today. And suddenly 11:anything just wouldn’t do.

And so I RAN.

I ran right past the aid station and said “hold chicken broth.”

I ran that mile. And the next, staying wide of the aid stations to fly by the crowds reaching for water and bananas. And when I saw the lights of the finish chute and began to hear the finish line announcer, I ran like hell.

Every muscle fiber in my legs were screaming in pain. Most of the last mile my eyes were closed. I kept them clinched shut and told myself it was just the final lap of my last mile repeat on a track day. And it ended up being my fastest mile of the day.

When I rounded the last corner, out of the dark and into the bright lights, the clamor of cow bells and the screaming crowd lining the finish chute drowned out the noise from my quads, and I ran.

Just before I hit the timing mat, I opened my eyes and looked up at the clock.

10:59:07

Some guy grabbed me, wrapped a mylar blanket around my shoulders and a voice boomed over the loudspeakers…

“CHRISTOPHER SEGLER……...YOU... ARE…...AN IROMAN!!!!!!!!!!!!!!!”

What a way to end the day!

APMA Creates New Patient Education Brochure on Heel Pain

Did you know that plantar fasciitis is the number one condition treated by foot doctors? In fact, plantar fascitis (the most common form of heel pain) accounts for about 40% of all visits to podiatrists. In response, the American Podiatric Medical Association has recently created a 12-page "patient eductaion" brochure on heel pain. It has been released to member podiatrists as a marketing tool to lure lucrative heel pain patients into their podiatry practices.

The bottom line is that many people can treat plantar fasciitis themselves using simple at-home treatments that are non-painful. No shots. No surgery. No expensive shoe inserts. Very few patients with plantar fasciitis every need surgery. If you have heel pain that has been bothering you for a short time and a podiatrist tells you that you need heel spur surgery...RUN!

Dr. Christopher Segler is an Ironman Triathlete and award winning foot and ankle surgeon who specializes in providing self-treatment for heel pain caused by plantar fasciitis. You can learn more about heel pain (especially morning heel pain) as well as request a FREE copy of his book on heel pain at http:www.NoMoreHeelPain.com.

Can Runners Heal Heel Pain?

What could be worse than a runner with heel pain? Answer: a runner who has heel pain and can't run. In this excerpt from a video interview with Ironman finisher and award winning podiatrist, Dr Christopher Segler discusses heel pain.





Dr. Christopher Segler is an Ironman Triathlon Finisher and award winning foot doctor specializing in elite athletes. His podiatry sports medicine house calls practice is located in San Francisco, Marin, Oakland and Berkeley. You can register for a FREE membership and will receive the monthly newsletter “Finisher’s Circle,” which provides expert advice on increasing your running efficiency and preventing injuries and foot pain by visiting http://www.AnkleCenter.com .

Marthon Champion Dies at Age 41

On Monday it was announced that Australia's double Commonwealth Games marathon gold medallist Kerryn McCann has died from cancer at age 41. She has long been regarded as one of Australia's best female long-distance runners. She was first diagnosed with breast cancer in 2007. Apparently the cancer spread to her liver four months ago.

It is reported that she died in peace at her home south of Sydney with her husband and three children by her side. "On behalf of the entire athletics community, I would like to pass on my sincere condolences to the McCann family," Athletics Australia President Rob Fildes said in a statement. "Kerryn will fondly be remembered for being an extremely popular team member who represented her country on 14 occasions, across an athletics career that spanned 22 years."

In 1996 at Atlanta and 2000 at the Sydney Olympics McCann competed in the marathon but saved her best performances for the Commonwealth Games.

She won the gold medal in Manchester in 2002 and later defended her title in Melbourne Australia four years later with an incredible last-lap effort against Kenyan Hellen Cherono. At that time she was 38.

She will be missed by the running community throughout the world.


Dr. Christopher Segler is an award winning foot surgeon and Ironman Finisher who treats elite athletes. His podiatry sports medicine practice is Doc On The Run: San Francisco Podiatry Sports Medicine House Calls. To learn more about increasing your speed and avoiding running injuries like tendonitis, shin splints and stress fractures, you can register for a FREE membership and copy of his monthly newsletter “Finisher’s Circle” by visiting http://www.AnkleCenter.com .

Dean Karnazes in Second at Sahara

Last month Dean Karnazes finished in 2nd place at the Sarah Race in Egypt. The Saharah Race is a 250K race across the largest non-polar desert on Earth. His time was 30 hours 13 minutes and 9 seconds. He was only about 3 hours behind Ryan Sandes; a South African who is 20 years younger. 

Paul Liebenberg (another South African) and Karnazes are competing to be the first to finish all 4 legs of the series in one year.  The series a part of a 4 race desert series including events in Chile, China, Egypt and Antarctica.

The final leg called  "The Last Desert" will be a 250K race across the Antarctic peninsula. It starts on November 24, 2008, just about a month after the event in Egypt.

I am guessing that it will seem cold compared to the Sahara.  

Go Dean, Go... And don't forget your mittens!

No Show for Ironman Florida

As I write this, I should be covered in salt, draped in mylar and wearing a finisher medal for Ironman Florida. I should be eating pizza and watching other's dreams realized, crossing the line, a year of effort paid off. 

Instead, I blog. 

Due to a remarkable culmination of commitments (both business and family) I decided at the last minute to skip the event. As soon as I had decided to do that, my wife pointed out that "MyRunningDoc" would not have approved of anyone showing up for that race given the preponderance of stress and massive shortage of expendable energy available. So I find some small consolation in the knowledge that I made a difficult but healthy decision; one which I would have supported any patient in making.  I am already registered for Ironman Louisville 2009, and if the stars align just right, I just might find a spot for Ironman Florida 2009 as well. 

For all of you who did participate today...I hope it was all you dreamed of!  See you next year.

How Does the Foot Cause Knee Pain in Runners?

Iliotibial Band Friction Syndrome is the second most common overuse injury among endurance athletes. Also know as Iliotibial Band Syndrome, IT Band Syndrome, and ITBS, it is a common cause of knee pain in runners and cyclists. In fact, ITBS has been reported in up to 12% of distance runners.

The most frequent complaint of ITBS sufferers is pain at the outside of the knee. They will typically report that the pain will come on at a predictable distance and then worsen throughout the remainder of the run. This pain usually goes away at rest. In its later stages, the same pain may begin with other, less stressful activities, such as stair climbing or even walking. 

So what exactly is ITBS?  The Iliotibial band is a thick reinforcing band of tissue that stabilizes the outside of the thigh and upper leg. When the knee is bent at about 30 degrees, the IT band changes position and moves backward behind a prominence (the lateral femoral condyle) at the outside of the knee. In short, ITBS is inflammation of the outside of the knee from repeated friction as the knee bends and the IT band snaps back and forth across this bony prominence, becoming irritated. 

There are many reported causes and contributing factors to ITBS. Those who are bow-legged, have high arches, a tight iliotibial band, or a limb-length discrepancy are more at risk.  All of these conditions can increase the amount of shock transmitted through the leg to the knee. The knee then has to absorb all of this extra force by bending more and more friction from the IT band results.

So how do you make sure you don’t become the one out of ten runners that will develop ITBS? As with most overuse injuries…avoid overtraining. One study actually found 42% of all ITBS cases to be associated with training errors such as increasing miles too quickly. Nearly half of those cases caused by training errors could be attributed to a single excessive harmful training session.

Other ways to prevent ITBS include the use of custom orthotics to correct for deficits in pronation.  If you are bowlegged, have high arches, or a limb length discrepancy, orthotics can correct the biomechanical shortcomings you were born with, increase running efficiency, and help prevent injury. If you have any of the aforementioned conditions, also avoid shoes that decrease pronation such as “stability” or “pronation control” shoes.

Stretching is a mainstay of prevention of the initial injury or re-injury. To stretch the IT band, stand with your hand out in front of you, holding onto a surface such as a counter for balance. Cross your right leg behind the left leg. Now lean to the left and you will feel an increasing stretch at the right hip. Hold this stretch for 15 seconds. Perform the stretch three times for each side. 

If you do develop IT band syndrome, icing and anti-inflamatories are the usual treatments. The most successful treatments have included immobilization, icing, stretching and a quick return to activity. Interestingly, running at faster pace has been correlated with a lower incidence of ITBS.  This is because the higher cadence requires the knee to remain flexed at a higher degree and decreases the amount of friction to the IT band.  This being the case, you should shorten your stride and pick up the cadence. 

Including IT band stretches in your routine can help to prevent the knee pain common with ITBS. If you have high arches or are bow-legged, use your orthotics and avoid motion control shoes. Avoid running along on a down-sloping road (such as always facing traffic). Train sensibly and stick to your training program. Do all this and the one out of ten runners who get knee pain from ITBS…won’t be you!

Christopher Segler, DPM, AACFAS

Award Winning Foot and Ankle Specialist

MyRunningDoc.com 

Stay Fit. Go Long. Run Fast. Be Strong.