SF Tri Run Clinic: Foot Issues

Thanks to everyone from the SF Tri Club who joined us Monday evening for the Run Clinic. This was the second clinic in a series designed by Dino and Katie (our fearless Run Coordinators).

The point of the clinic was to discuss some of the keys to training that might help one avoid injury, particularly those running injuries that can wreck a triathlon season. We talked about running shoe selection, common training errors and barefoot running biomechanics.

There were many great questions from our Peeps. I will be posting those questions here, with answers, for all those who could not make to the Presidio Sports Basement for the clinic.

In fact, here's one now...

Question: What ARE the most common preventable running injuries?

Answer: The most common injuries I see in San Francisco runners and triathletes (that are preventable) are:
1. Stress Fractures
2. Achilles Tendinitis
3. Plantar Plate Injuries
4. Peroneal Tendintis
5. Sesamoiditis

See you out in the water, on the track, or on the road!

Dr. Christopher Segler is an SFTRi Club member, 10-time Ironman Finisher and Sports Medicine Podiatrist. He is Board Certified, American Board of Podiatric Medicine. His practice caters to active runners and triathletes in San Francisco, Berkeley, and Mill Valley. If you have a question about a running injury, you can call him directly at 415-308-0833.

What is The Best Way to Tape a Plantar Plate Sprain In the Ball of the Foot?

The plantar plate is a small ligament that reinforces the bottom of the joint capsule at the ball of the foot. When you sprain this ligament, the ball of the foot can be sore and ache when you walk. One of the best ways to decrease the stress to an injured plantar plate ligament is to tape the foot so that the ligament it stabilized and can heal. This video will show you how to tape the ball of the foot when the plantar plate is sprained or injured.

The first thing you need to do is get the correct type of tape. The very best tape is called Tensoplast (or Elastoplast). It is good because it stretches when you walk. With Tensoplast tape, the toe can flex slightly without getting irritated. You should order one roll of tape that is one inch wide by five yards in length.

Now that you have the right tape, you will cut a piece of tape to the correct length using your hand as a reference. The correct amount will reach from the tip of your finger the base of your palm. Next you will cut that piece of tape into two equal size pieces. Just cut the piece of tape lengthwise splitting it right down the middle. Take one of the two pieces and place it back on the roll to save it for later use. Now you are ready to tape the toe to help the plantar plate heal.

Take the piece of tape and center it on the top of the second toe. You should place the tape between the foot and the last knuckle in the toe. The tape should be right at the base of the toe. Wrap one strand around the toe, pull down slightly to create some tension in the tape and stick the tape across the ball of the foot so that it is in place on the bottom of the foot under the little toe joint.

Now take the other strand and it wrap it around the toe in the opposite direction, pulling down slightly to create some tension in the tape. This strand will cross over the other as you stick the tape across the ball of the foot so that it is in place on the bottom of the foot under the big toe joint.

If placed correctly and looking at the bottom of the foot, the tape will look somewhat like a breast cancer awareness ribbon. With the tape in this position, the pressure on the tape when you walk will keep it secure. There should be just enough tension in the tape that the second toe is pulled downward slightly lower than the third toe. This will decrease the tension on the plantar plate at the bottom of the second toe joint and help it heal.

You should keep the tape on 24 hours a day to protect the plantar plate as the sprain heals. Change the tape if the adhesive wears out and isn’t sticking to the the bottom of the foot. If your skin becomes irritated, discontinue use. Don’t tape the toe if you have an allergy to tape or adhesives. Heal fast, and get back to running!

This instructional video was created by Dr. Christopher Segler who a 10-time Ironman Triathlon finisher. He is also an internationally recognized expert on running injuries and healing foot injuries while running. He is often invited to lecture on the rapid treatment of complicated running injuries to foot surgeons, podiatrists and sports medicine physicians at medical conferences. He practices sports medicine podiatry in San francisco, CA, but also offers remote consultations world-wide. To learn more about the causes and treatment of capsulitis and plantar plate injuries, visit the ball of the foot information page at www.AnkleCenter.com. if you would like to learn about how to get the fastest treatment possible for a plantar plate injury, you can learn more at www.DocOnTheRun.com.

Disclaimer: This video is intended to provide general information about sports medicine injuries and self-teatment options. This of course is not (nor is it meant to be) a sufficient substitute for a medical evaluation by a local physician or medical doctor.

What is this new pain in the ball of the foot? Question from a runner in San Francisco

Today I got a question from a runner in San Francisco. She says...

QUESTION:

"I wanted to get in touch about another issue (!) I'm having with my foot. Honestly, always thought it'd be knees that went...not my feet! Basically here is what happened:

*had been running again, but not heavy mileage...like 3-miles a few times a week along with perhaps some slower jogs (1 - 2 miles).

*but, then I participated in a TRX class where we did TONS of plyo stuff. squat jumps, etc. the next day, I noticed this pain.

*the pain is on the same foot as my tendonitis was. not sure if it's relevant. I decided to take a photo to show you where the pain is! hope that's not creepy ;) I did some research online, briefly, and thought maybe it's a bursitis?? I don't know, but the class was 3 weeks ago and I've been icing it, not running and the pain is not decreasing, if anything it's getting worse. I haven't been running, just doing the elliptical at the gym and cycling. Cycling does not exacerbate it at all, thankfully!

Also, do I need to get x-rays and stuff to rule out a stress fracture, etc.?

Anyway, thanks for your time!

Gretchen
San Francisco


MY RUNNING DOC's ANSWER:

Thanks for sending the pic and providing the description of the pain in the ball of your foot!

Based on your story and the location of the pain, it is most likely predislocation syndrome. Predislocation syndrome is capsulitis (inflammation of the joint capsule) in the ball of the foot, most often at the second metatarsal phalangeal joint (the joint at the base of the second toe). The capsulitis is what causes the pain, but the real issue is a strain or even tear in a reinforcing structure of the joint capsule called the plantar plate.

I actually see this all the time in active people who spending a lot of time on eliptical trainers. At the back stroke of the eliptical trainer, your heel comes up and the toes bend way up stressing the plantar plate. The plantar plate is a small ligament that reinforces the bottom of the metatarsal phalangeal joint capsule (the joint at the base of the toe in the ball of the foot).

To get it to calm down you have to avoid stressing the plantar plate. Avoid anything that causes you to bend the toes up, such as an eliptical trainer, running uphill, etc. You can also tape the toe down to decrease stress on the plantar plate. Ice, contrast baths and compression socks can decrease the inflammation.

This of course all assumes that your pain is caused by predislocation syndrome. The other common possibilities include a Morton's neuroma or a metatarsal stress fracture. It is pretty easy for any sports medicine podiatrist to tell on physical exam.

Given that 1) most stress fractures show nothing on x-ray until it has been at least 6 weeks, and 2) any sports medicine doctor who specializes in running injuries could tell you with relative certainly whether this is predislocation syndrome or not without an x-ray, I think a physician should just do a quick check and get you heading in the right direction.

Thanks for the question!

Dr. Christopher Segler
Doc On The Run
Podiatry House Calls for Runners
San Francisco, Marin, East Bay

If you have a question about foot pain caused by running, you can email a picture (pointing to the painful area) directly to DrSegler@DocOnTheRun. Tell me how it happened and I will post a an explanation so you will know what is most likely ruining you run. Your name will be changed, and you will never be identified by your real name, so as to protect your identity and shield you from any possible accusations of making a preventable marathon training mistake. I will also never, ever share your email address with anyone.