Can I Run with Plantar Fasciitis?

Dear MyRunningDoc,

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

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

John H. 
San Jose, CA

Hello John,

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

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

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

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

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

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Can I run a marathon with a metatarsal stress fracture?

Hello Running Doc,

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

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

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

Thanks for any advice!
Erin M.
Oakland, CA

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

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

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

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

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

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

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

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

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

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


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


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

Should a Runner Have Morton's Neuroma Surgery?

Hello Running Doc!

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

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

Thanks!
Henry B.
San Jose, CA

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

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

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

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

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

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

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

Can I play basketball with these blisters?

Question:
Hi MyRunningDoc!

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

Thanks!
JM

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

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

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

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

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

 

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

 The painful area is outlined on the pad.

The outlined area over the blister is cut away.

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

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

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

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



 

Marathon Blister. Should I pop it?

Question:
Hi MyRunningDoc!


I have been reading your site. This blister formed on my heel yesterday. It is huge and painful. I am running in the Avenue of the Giants Marathon on May 5, 2013 and really can't take a break from marathon training. Should I pop it?

Thanks!
W.H., San Francisco CA

Answer:
Thank you for your inquiry! That is certainly a Giant of a marathon blister. I can see how that would hurt and put a damper on your final marathon training.

There is always an advantage and a disadvantage to draining in any blister on the foot that pops up during training.

With a blister that large and a marathon that close, it is unlikely that you would be able to run the marathon without significant pain. In fact the blister is so big it would probably pop during the marathon anyway.

With most small blisters, it is typically better to let them go away on their own. If you do not drain a small blister and can keep it from getting rubbed when you are running, the fluid will gradually recede and the blister will re-adhere. It will eventually peel away revealing healthy skin underneath. It is also the least likely to get infected because you don't open the blister allowing bacteria to get inside the skin.  This actually will heal the fastest and is the safest approach.

Things get tricky when a running blister on the foot gets big.

When you have a big running blister that causes a great deal of discomfort when you run, it actually hurts because the fluid is getting pushed and compressed.  If you step on a water balloon, the balloon will squish outward under your foot. The balloon will push out and stretch as far as it can unless it pops.

So when you run on a blister like this one pictured here, the blister fluid actually pushes and continues to separate the layers of skin at the edge of the blister. This of course causes more irritation and more fluid accumulation, making the blister even bigger as you continue to run.  The only way to stop this process is to stop irritating the blister on the foot. One way to do this of course is to stop running.

If you can pad the blister and keep the pressure off of it you might be able to continue training without the blister getting any bigger.  That would be hard to do given the location of this blister on the inside of the foot and heel. It will be almost impossible to remove all the pressure from the heel inside the running shoe.

If you pop the blister, it will hurt more for the first day or two.  You can decrease the amount of discomfort by using moleskin or another type of blister cover that will stop the friction from rubbing the overlying skin. It may also be helpful to put some padding around the blister in order to decrease irritation.

If you decide to pop your blister, it is always best to drain the blister by making a small hole at the bottom edge of the blister down toward the bottom of the foot so that the fluid will continue to drain downward and out of the blister as it re-accumulates. Typically some more blister fluid will accumulate inside the blister for several days after you pop it.

The skin on the top of the blister is not what is painful. It is the skin underneath. Some people start to drain the blister and realize this and then trim off the entire top of the blister. If you are to do that in this case, it would leave an open sore about the size of a half dollar. This would of course leave an enormous raw spot that would be very painful whenever you run during training. You foot would be killing you during the marathon.

In these types of cases it is often better to simply drain the blister and leave the top of the blister intact to function as a biologic dressing. This will take slightly longer to heal than if you don't drain the blister.  However this assumes that you are of course going to continue to run, train and complete the marathon that you have planned.

It would be best to be evaluated in person or by a podiatrist or arrange a remote consultation with a running injury expert in order to get more detail, before making your final decision.  You can also learn more about blisters from running by clicking here.

Dr. Christopher Segler, DPM a marathon runner, podiatrist and 10-time Ironman Triathlon finisher who is is Board Certified, American Board of Podiatric Medicine.  He believes the best podiatry practice combines cutting edge technology with the old-school convenience of house calls. He makes podiatry house calls for runners in San Francisco, CA and Houston ,TX. He also does remote consults for runners who live outside of the United States. If you have a question, you can reach him directly at 415-308-0833. You can learn more about running injuries at www.DocOnTheRun.com 

Should I drain a liquid nitrogen wart blister?

Question:

I got a blister when I recently tried the liquid nitrogen treatment to freeze a wart on my foot. It is tender and so I stopped running. Should I try to drain the blister so I can run?

Answer:

The idea with treating a wart with liquid nitrogen is in fact to cause a blister. The way this treatment works is that when liquid nitrogen freezes the skin fluid collects between the dermis and the underlying subcutaneous layer of the skin creating the blister. The blister separates the skin layers. Here is how it cures a wart...

The wart is a thick callus covering an encapsulated collection of viral wart particles, which is within then the living layer of skin called the dermis. By creating a blister beneath the dermis (under the wart) the wart essentially gets lifted off of the underlying skin as the blister swells up.

The fluid within the blister will resorb over the next several days. As the blister heals and flattens out, it forms a scab-like structure that doesn’t fully re-adhere to the tissue underneath. Eventually the dried up skin of the blister peels off, and the wart goes with it. If all goes according to plan, you are left with new healthy skin underneath. 

There are many different blistering agents that can be used to cure plantar warts. Here are three of the most common wart treatments that work by blistering:

Liquid Nitrogen - creates a blister with a carefully placed frostbite-type injury. 

Bleomyocin - is a chemical blistering agent injected directly into the wart.

Canthacur - is a topical chemical blistering agent applied to the surface of the wart.

As every runner knows, blisters on the feet can be irritating enough to force one to limit their run mileage or stop running altogether. So it is not surprising that a runner may consider popping a painful blister to lessen the discomfort, promote healing and get back to running. 

This may be a reasonable strategy with friction blisters sustained during a marathon or other long run. But not so with warts treatment blisters.

The problem with warts is that they are caused by a viral infection of the skin. If you poke a needle through the blister (and through the wart containing all of those viral particles) you just might seed the surrounding healthy, non-infected skin with the wart virus. In this way, by attempting to drain the blister under the wart, you may actually infect other areas of the foot and cause a new wart to start growing nearby. 

Then, after the original wart (and its associated treatment blister) have gone away, you may have a brand new nasty little wart rearing its ugly head. Then you have to repeat this process all over again.

Another issue is that the fluid inside the blister is sterile. As soon as you poke a hole the blister fluid can drain out, but bacteria can also get in. So when you pop a blister the risk of bacterial infection goes up. 

If you have a wart that is being treated by a podiatrist, and the blister is large enough to interfere with your activities, you should follow-up with the treating physician. After all the doctor is being paid to treat the wart, so let the doctor finish what he started. Let your podiatrist decide whether or not to drain the blister, and do the draining if needed. That is the safest way to remedy the blister AND make sure that there isn’t any risk of causing a bigger problem long-term.

Heal fast and get back to running! 

Dr. Christopher Segler is a podiatrist who focuses on the rapid treatment of running injuries. He is a runner himself and 10-time Ironman Triathlon finisher. You can learn more about warts, blisters and running injuries at AnkleCenter.com and DocOnTheRun.com  If you have a question about a running injury, you can reach him directly at 415-308-0833.

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.

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

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McGlone's Kona Return after Achilles Injury Today on NBC

A minor ache in the back of the leg down near the heel may just seem like a minor annoyance at first. But if ignored for too long, Achilles tendonitis can keep you from running and cycling for months.

This is precisely what happened to Ironman 70.3 Champion Samantha McGlone. In 2007, the fiercely competitive former Olympian showed up in Kona and finished second in the Ironman World Championships, just minutes behind Chrissie Wellington. But a year later, she found herself sitting on the sidelines recovering from an Achilles tendon injury. Reportedly she spent about 6 months with no running or cycling at all. She struggled with the problem for nearly a year and a half.

Runners and triathletes are particularly susceptible to Achilles tendon problems. In part, this is because they are so determined to set goals and stay on track with training. But whether you are a marathon runner, an age-group triathlete, or someone chasing an Ironman World Championship, it can be hard to back off just because you have a little pain in the back of the heel.

Achilles tendonitis is really nothing more than inflammation within the Achilles tendon. Usually, the pain and swelling is in an area just above the tendon's attachment to the heel bone. This is an area known to be prone to injury due to decrease blood flow to this part of the tendon.

Inflammation in the Achilles' tendon is usually short lived. However, if you continue to run with Achilles pain, the tendonitis turns into tendonosis. This is what happened to McGlone.

Tendonosis is a degenerative condition where chonic inflammation essentially breaks down the collagen in the Achilles fibers. It gets mushy and weak. Many times surgery is required to clean out the tendon. Physical therapy can help speed healing. But, as Maglone learned, it won't just go away on its own. You have to see a sports medicine focused foot and ankle surgeon to get better.

Fortunately Sam is back in action. And today on NBC, we can all watch her chasing an Ironman World Championship in Kona, Hawaii. Although her recovery has been longer than the Queen K Highway on a hot windy day, she will surely show her fire and determination as she takes on the challenge on the Big Island.



Dr. Christopher Segler is a multiple Ironman Finisher and award winning foot and ankle surgeon. He lives and trains in the San Francisco Bay Area. To learn more about Achilles tendonitis, runner’s heel pain, stress fractures, bunions and other common causes of foot pain, visit http://www.MyRunningDoc.com or http://www.AnkleCenter.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 .

Most Painful Running Injuries

The poll results are in! The February 2009 issue of Runner's World Magazine reports on the most painful afflictions and injuies that plague runners.

...and the winner is....SHIN SPLINTS!

Thats right, that aching pain in the front of the leg came out as the most painful running ailment based on 2,263 respondents of the Runner's World poll.

The other top finishers from the complete results were:

Shin Splints 36%
Side Stitches 20%
Chafing 13%
Blisters 12%

We will discuss each of these running injures...and how you can beat them, instead of them beating you over the next few days.


Dr. Christopher Segler is an award winning foot surgeon and Ironman Finisher who treats elite athletes. His podiatry sports medicine practice is at the Doc on the Run Podiatry Sports Medicine House Calls in San Francisco. 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 .

Marathon Strategy Made Simple

Run when you can,
walk when you have to,
crawl if you must.
-Dean Karnazes


Dr. Christopher Segler is an Ironman Triathlon Finisher and award winning foot doctor specializing in elite athletes. His podiatry sports medicine practice is at Doc on the Run Podiatry Sports Medicine House calls in the San Francisco Bay Area. 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 .

Ring in The New Year with a 3 Day Run!

While most settled for watching Dick Clark and waiting for the ball to drop, a Scotsman named William Sichel was taking the ultra-marathon scene by storm. He ran in the new year by winning one of the toughest races on earth, the Across the Years 72-hour event held in Phoenix.

For three days he ran, sleeping little and logging more miles than most Americans would in a year, and more than most well trained marathoners would in a month. During the 72-hour event he saw temperatures ranging from near freezing at night to over 100 degrees during the day. All told he ran 269.36 miles through the Arizona desert. He ran almost continually and finished 34 miles more than the second finisher.

Hard to imagine beating someone by more than a full marathon distance.

Although tis sort of event might be enough any mortal, for him it is a warmup. He will follow-up with a 6-day race aiming to cover 567 miles during the Athens International Ultra Marathon Festival starting on 3 April. The 55 year-old runner will be running on an outdoor cinder circuit used during the 2004 Olympic Games.

With all that pounding, he’ll need more than a soft track and a truck load of Gu. We wish him luck!


Dr. Christopher Segler is Marathon Runner, Ironman, as well as an award-winning podiatrist, and sports medicine foot surgeon practicing at the Doc On The Run: San Francisco Podiatry Sports Medicine House Calls. For more information about heel pain, bunions, ingrown toenails and ankle pain, and other common causes of foot pain, you can order a FREE copy of his book, My Fit Feet, by visiting http://www.MyRunningDoc.com or http://www.AnkleCenter.com.

Young Woman Dies in White Rock Marathon

On December 15, 2008 during the Dallas White rock Marathon, a 29-year-old woman collapsed and was pronounced dead, the race director said.

According to the Dallas morning news, Marcus Grunewald, director of the 39-year-old Dallas White Rock Marathon, said that the young newlywed woman’s death was the first in the event since 1986. In that race a 47-year-old man collapsed after suffering a heart attack and died during the marathon.

Witnesses to the event said the woman appeared to be running fine until mile 21, just a few miles from the finish, when she suddenly stumbled. She was helped to a nearby curb and then lost consciousness. "Her body was cold," one witness said. "She was already gone."

The race director told the Dallas Morning News that due to the marathon's 66-degree weather, higher than the race's average, medical aid and water were readily available along the race route. Although heart attack is suspected, the exact cause of death had not been determined. An autopsy was pending.

This tragic event illustrates the importance of checking with your primary care doctor before training for any endurance event. Undiagnosed heart disease or other underlying medical conditions can lead to disaster.

Even if you have been training for months without any episodes or warnings of trouble, distress of running faster during an organized marathon can lead to enough over-load to cause a heart attack.

After running for many miles particularly at your maximum capacity, dehydration can lead to electrolyte changes that can contribute to a heart attack. It is critical to make sure they don’t have any underlying heart disease before considering when these events.


Dr. Christopher Segler is an Ironman Finisher and award winning foot and ankle surgeon specializing in elite athletes. His podiatry practice is at Don On the Run Podiatry House Calls in San Francisco, Marin and the East Bay. To learn more about Achilles tendonitis, runner’s heel pain, stress fractures, bunions and other common causes of foot pain, you can register for a FREE membership and copy of his monthly newsletter “Finisher’s Circle” by visiting http://www.AnkleCenter.com .

Posterior Tibial Tendonitis: a Pain in the Arch

When you run, your foot hits the ground, you pronate to absorb impact and then you supinate to push off again. All of this is possible because of a muscle in your leg call the tibialis posterior. This muscle deep in the back of your leg forms a tendon call the posterior tibial tendon that attaches to your foot. It attaches to the navicular bone in the instep of your foot, right at the top of your arch.

In the very simplest of terms, this tendon helps to hold up the arch. It is really much more complex than that, but we won’t bore you with the details. All you really need to know about this is that when you get posterior tibial tendinitis it can quickly progress and become a surgical problem.

The good news for runners is that it one of the things that least frequently affect us. It most often affects people who are middle-aged. It also is often associated with high blood pressure, obesity and diabetes. Not exactly the picture of a runner. Interestingly though, one study showed women get it four times more often than men.

This is one thing to watch out for if you have fleet feet. It seems many who get this problem are already flat-footed long before it starts. Excess pronation (common in people with flat feet) puts tremendous stress on the tendon. Running increases the stress and strain several fold. The result is repetitive overuse that can set the condition off.

When too much stress is placed on this tendon, it can become inflamed. Continued inflammation can weaken the tendon and cause it to stretch out. This can lead to a torn or ruptured tendon with a complete collapse of the arch. Not good.

So how do I know if have posterior tibial tendonitis? One clue that you might be getting this problem is pain from the ankle bone to the arch on the inside of your leg. If it is inflamed and you stand up on your toes on that foot, it will likely hurt much worse. If you stand only on one leg and do this, it will be even more painful. You might even have some swelling around the ankle or arch.

If you notice these symptoms you need to get it checked out by an foot and ankle expert. This is not one of the ice-it-and-will-go-away kind of problems. Neglecting it can (and often does) lead to surgery. It is preventable as well as easily treatable in its early stages. Orthotics can limit the force of pronation and help to decrease the risk of injury to the tendon, especially if you over-pronate or have flat feet. And as always, make sure you are wearing the right type of running shoes for your foot type.


Dr. Christopher Segler is an Ironman Finisher and award winning foot and ankle surgeon specializing in elite athletes. His Bay Area based podiatry practice is Doc On The Run Podiatry House Calls. To learn more about Achilles tendonitis, runner’s heel pain, stress fractures, bunions and other common causes of foot pain, you can register for a FREE membership and copy of his monthly newsletter “Finisher’s Circle” 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 .

Os Trigonum Syndrome: A Rare Form of Posterior Ankle Pain

The day that Jessica came into the office she was worried. Not only was she worried, her mother was worried as well. Jessica is a 26-year-old healthy runner with a penchant for training and a high tolerance for pain.

She was in the middle of training for an upcoming marathon. Her mother had noticed her limping about and recommended that she go see somebody. She came in because she was worried about her Achilles’ tendon. She had heard that could be very serious.

I asked her about her training routine. She said that she typically ran 8 miles at a time on a very hilly course area. She felt that this was a good training strategy given that the upcoming marathon would contain a lot of hills. She wanted to make sure that she would be ready. But running up and down all of those hills was aggravating her condition.

She could remember exactly when her pain started. It’d been getting progressively worse. She pointed at the back of her ankle, but it wasn’t right at her Achilles’ tendon where she had the most pain. It was actually deeper in the back of the ankle.

I poked and prodded and couldn’t find any pain or tenderness anywhere around her Achilles’ tendon. However, if I squeeze the back of the ankle, away from the Achilles’ tendon, she had a great deal of pain and tenderness. Next, I put my thumb underneath her big toe. I had her try to push down with her big toe as hard as she could. And when she did, she had the same kind of pain in the back of the ankle.

We took some x-rays and noticed that she had a portion of bone that was not completely fused to the back of her talus bone. This is a condition known as os trigonum syndrome or posterior ankle impingement syndrome.

We got an MRI that reassured us that she had no issues with her Achilles’ tendon or the tendons to go to the big toe area. The flexor hallucis longus (FHL) tendon which pulls the big toe down against the ground when a runner pushes off can sometimes become torn or irritated and have the same type of presentation. But her FHL was fine.

However, not everything was fine. There was a great deal of swelling with in the talus bone (the bone that connects the foot to the ankle), as well as an accessory bone at the back of the talus called the os trigonum. These two pieces of bone in her ankle were connected with some soft tissue attachments which were very irritated.

Os trigonum syndrome is not a common injury. However one study showed that runners who to do a significant amount of downhill running have an 18% chance of acquiring posterior ankle impingement syndrome. And when it does occur, it can be debilitating.

Runners who develop this problem might have no pain at all when walking on level ground. It starts to become painful when they walk on uneven ground. It becomes much worse when they run on hills. This is because the foot needs to point further down (plantarflexion) and the soft tissues can become irritated or even get caught and pinched between the talus and the calcaneus (the heel bone). This causes a great deal of inflammation and pain.

Not only will there be pain, but many will also have swelling and stiffness in the back of the ankle that may extend all the way to the Achilles’ tendon. That is why many patients who think they have Achilles tendinitis might actually have this problem instead.

Although this is not the most common running injury we see, it is important to get it treated. Chronic inflammation can lead to pain that interferes with activities ranging from normal walking to running. Anytime you suspect an Achilles tendon injury, it is important to be evaluated.

Even though Jessica did not have an Achilles’ tendon injury she did have an injury which could be treated effectively. In most cases, immobilization and physical therapy can calm it down. In rare cases, surgery is needed to take out the accessory bone and inflamed tissue. In any event, with this type of problem it is never a good idea to stick your head in the sand and foolishly hope you’ll cross the finish line in record time.


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 based in San Francisco. You can reach him directly at 415-308-0833. 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 .