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

Here is a question from someone considering custom orthotics:

Hi there,

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

Hoping to get an evaluation and possibly orthotics.

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

Many thanks,

ML

Hello ML,

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

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

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

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

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

The rates are as follows: 

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

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

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

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

I look forward to meeting you. 

Sincerely, 

Dr. Christopher Segler

Doc On The Run

www.DocOnTheRun.com

How Custom Cycling Orthotics Decrease Knee Pain Caused by Forefoot Varus

Knee pain is one of the most common complaints among cyclists. If your knee is aching when you finish the climb over Mt. Tam or a long ride out through Marin, it may be because the foot is slightly out of alignment.

In the simplest of terms, your foot is "locked" in place to the pedal by the cleats. if your forefoot is tilted lightly in relation to the rearfoot (a condition called "forefoot varus" or "forefoot valgus") then your leg may tilt slightly when you pedal.

This tilting of the knee can cause the knee cap (or "patella") to track out of alignment. When the knee cap tracks incorrectly, the cartilage on the inside of the knee cap can become irritated and inflamed. This type of knee pain when biking is called "patellofemoral syndrome."

This short video describes bicycle pedaling biomechanics as it relates to knee pain and conditions such as forefoot varus that can be easily corrected with custom cycling orthotics.

Dr. Christopher Segler is a sports medicine podiatrist, cyclists, and 6-time Ironman triathlon finisher. His practice focuses on cyclists, runners, and triathletes in San Francisco, Marin, and the East Bay. He is currently training for Ironman France. If you have a question about pain while cycling, you can call him directly at 415-308-0833. Learn more about house calls for athletes at www.DocOnThRun.com and learn more about foot and ankle pain at www.AnkleCenter.com .

Will orthotics help heel pain when running?

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

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

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

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

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

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

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

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


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

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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.

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.

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.

Top 10 Ways to Ruin a Marathon

1. Buy New Running Shoes

Question...What could be better than sporting shiny new shoes for your finish picture? Answer...Sporting a finisher medal without limping.  By now, you should know better than to wear new shoes or socks on race day.

2. Try on A New Outfit

Equipment is essential for a successful event.  This mean shoes, socks, shorts, top, number belt, watch or GPS.  All of it should follow the No-New-Gear-on-Raceday rule. Not even a new top.  Not even a more aerodynamic hat.  Comfort above all else will spell success.

3. Change Your Plan

If you trained for the race, you have been likely training for many months.  That means you have planned for months. Do not be tempted to switch gears or change plans on race day.  If you are planning for a 4:00:00 marathon it is O.K. to shoot for 3:55.  But do not follow the 3:40 pace group thinking you will “gain an extra time cushion.” This is a recipe for disaster. Stick to the plan, Stan!

4. Keep Up With the Joneses

The folks around you might be faster than you.  Then again, they just might be dumber. Do not attempt to keep up with someone simply because he or she “looks like” someone you “should” be able to beat.  Let them disappear on the horizon. You just might pass them on the side of the road in the final few miles.

5. Go Out In a Blaze of Glory

No matter what you do, you will be on fire when the gun goes off. Most will blast off the line. You will be tempted to follow.  If you have a GPS, watch it closely and stay on pace. It is worth noting that most world class distance runners produce negative splits when they compete. Follow the experts.  Start slow and finish strong.

6. Don’t Drink and Run

You can go for a long, long time without food before you starve.  Water is not the same.  You must stay hydrated. Hopefully you experimented on you long runs. Drink too much and you will be hurling on the side of the road.  Drink too little and you will be sapped. You will be walking before you know it. Drink responsibly.

7. Forget to Fuel the Machine

The “wall” that most marathon runners describe occurs between 18 and 22 miles. The reason for this physiologic barrier is that that is when most people run out of calories. They just plain run out of gas. You must eat on the run. Not Krystal, but GU, Cliff Blocks, Powerbars, or what ever magical but nasty form of energy intake you prefer. Just don’t try a new one on race day.  Wear a number belt with elastic loops that holds your gels and they will be in the holster, at your side and ready to keep you fed.  I eat GU every 40-45 minutes. Keep track of when it is your time to eat, and eat as you approach the water stop so you can discard the wrapper and wash it down at the aid station.  

8. Just One More Long Run

Every endurance athlete struggles with the idea that one more workout or one more long run will somehow make you more “ready.”  Hope that your competition does this, but don’t do it yourself. The taper you have been prescribed by your training plan must be followed.  It is not optional if you want optimum performance. Trust that you are prepared.  Save it for race day.

9. Stay up Late 

No matter what you do, you will have trouble sleeping on the eve of the race.  This is normal. Just don’t make it worse by watching television until you are “tired enough” to fall asleep. Counts sheep or mile markers, or whatever you do.  Get all the rest you can.

10. Forget the Point

On the morning of the your big event, try to remember why you got out of bed every morning to go on long runs. Remember why you ran in the heat, the rain, the dark and the cold. Try to remember why you registered for a marathon in the first place. Keep in mind that it wasn’t just to finish at a certain pace.  Don’t forget to have a good time. Take the time (but not too much) to thank the volunteers at the water stations, the lone sentry standing there all day just so you will not have to think about where to turn, and the folks at the finish cheering and screaming your name. 

Take time to enjoy all of the event and your big day. Just keep in mind that you are ready.  Best of luck of luck from MyRunningDoc.com and all of us at the Ankle and Foot Center of Chattanooga!

Christopher Segler, DPM, AACFAS

Award Winning Foot and Ankle Surgeon

MyRunningDoc.com 

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

Doc On The Run: San Francisco Podiatry Sports Medicine House Calls

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.