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 

What is a Real Runner?

A couple of days ago I had an interesting conversation with a woman. We were talking about exercise, not just for fitness sake, but for enjoyment. About fitness as a lifestyle worth living. I asked her how much she runs, and she explained that she “only runs a few miles several days per week.”

“You seem like a real runner,” she said.

I remember feeling an involuntary wrinkle in my brow and being taken aback for a moment. 

Because even though I started running as a kid and I still run a lot today, I don't actually didn’t think I ever perceived myself to be “a real runner.” 

When I think of a real runner I picture Karen Gaucher, Ryan Hall, Deena Castor and Meb Keflezighi. I tend to conjure mental images of people who have dedicated their lives to running in ways that I never could. In someway, I think I had classified a real runner as somebody who could consistently run 100 miles per week during their training periods or win races.

A real runner, I had always thought, never loses that focus on the future. Keeps her eye on the goal. She visualizes achieving her aim. Always thinks about finishing, and how it will feel.

But as I thought about that, I started to think about my friends who I think of as “real runners.” And I immediately came up with several that don't run outrageous distances. None of them run for paychecks. All of them truly love running.

John Hunt, Anjulee Johnson, Phủỏng Mai N, Sarah Graham, Mimi Jacobson-Kwok, Brynn Ewen, Laura Duplantis. These are my friends, normal people, and they are all “real runners.” In one way or another each one of them has impressed me. I have seen pictures of their runs and have been inspired. The way they have described a specific run, the way they felt, what they get from running has made me smile. 

What I realized is that their stories, their reasons for running and how their descriptions of running touches me is always about being in the moment.

It's about rows of palm trees on the Stanford campus. The smell of running through the redwoods. The beauty of oaks and pine trees passing overhead. It is about sunshine and fog and feeling alive. It's about being grateful to be fit, and able to run. It is about enjoying movement in a beautiful place, right now.

Its not about pace or distance. Its not about how many finisher medals hang on the wall. Its not about being a Kenyan. And its certainly not about how the next marathon finish will feel, tomorrow, next month or next year.

Its about gratitude. An instagram pic of a beautiful setting or a genuine smile in the middle of a long run. Its about now. The way it feels to run 47 blocks in Oakland, one way, today.

And then she asked me what my last run was like.

I didn’t think about how the run fit into my Ironman training plan. I didn’t think about the pace I kept. I described the feeling of warm sun on my shoulders, strength in my legs, 7 deer quietly feeding on the side of the trail, the amazing blue of Crystal Springs set a against a sea of green trees hugged gently by a thin blanket of clouds under a clear blue sky. I though about how that run made me feel so alive, in that moment. 

And I thought, “maybe I am a real runner.”  



Dr. Christopher Segler is a 12-time Ironman Triathlon Finisher, but more importably he is a real runner.  His podiatric sports medicine practice caters to athletes who think that there has to be way to stay fit, keep training, yet still heal an injury. He often lectures at medical conferences on the treatment of complicated running injuries, running biomechanics, and subtle fracture patterns of the foot and ankle. If you have a question about a running injury you can call him directly at 415-308-0833.  You can also learn more about running injuries at www.AnkleCenter.com and www.DocOnTheRun.com

Is this black toenail fungus or a bruised toenail from running?

I have been training for a trail run and have been running on lots of hills in Marin. I recently noticed that I was getting some dark black discoloration of my toenail. I am worried that this might be black toenail fungus infecting the toenail. How can I tell whether the toe is bruised or if I really have a toenail fungus infection? Also, what if anything should I do to treat the black toenail if it is infected?

Thanks,
David, Mill Valley, CA


Black toenails are likely one of the most common injuries I see in runners in Houston and San Francisco. There can be a couple of causes of black toenails from running.

Differences between a bruised toenail and a fungal toenail:
A bruised toenail hurts because 1) there is bruise 2) there is blood under the toenail increasing pressure between the toenail and underlying nail bed. This causes pain in the toenail when you press on it or bump the toenail on the inside of your shoes. Fungal toenails are not usually tender unless the toenail infection has been present long enough to make the fungal nail really thick.  The increased thickness can cause some tenderness, but it doesn't happen quickly.

A bruise comes on quickly, but a toenail fungus infection appears gradually. Bruising will appear within a day or two of your long run, race or whatever injury to the toenail. If you kick a coffee table once with your toe, the toenail may develop a bruise and turn black. If you bump the toe inside your running shoe repeatedly while running down hill (or because the running shoes are too tight) you can also get a bruised black toenail from the cumulative trauma. This can happen overnight.  You wake up and the toenail is black.

The changes in the toenail caused by toenail fungus happen very slowly. The color of the toenail will not change quickly.  The increased thickness, yellow discoloration, white crumbly appearance and dark color of a fungal toenail infection happens so slowly that it is almost hard to notice.

You can learn more about black toenails and toenail fungus treatment here by reading about an example of a black toenail in Houston that actually is just a toenail bruise. You can also read about from runners, blisters and black toenails here.  Learn how a bruised toenail can lead to a toenail fungus infection.

Dr. Christopher Segler, Doctor of Podiatric Medicine is Board Certified, American Board of Podiatric Medicine. He is a 10-time Ironman finisher and marathon runner. He lectures frequently to other podiatrist and foot specialists at medical conferences on the treatment of complicated running injuries and running biomechanics. He is licensed to practice podiatry in Texas, California, and Hawaii. He travels back and forth between Houston and San Francisco to see injured runners who have running injuries that need the fastest treatment based on a runner's goals and running doc perspective. If you live in San Francisco or Marin and have a running injury question call 415-308-0833 to speak to him. If you are in Houston and have a question about a running injury, call him directly at 713-489-7674. 

I have Achilles Tendinitis and it hurts when I run. Can I do Yoga?

Hi Running Doc!

Question:  I have Achilles Tendinitis and it hurts when I run. I stopped running and have been trying to get the Achilles to heal. But I still want to exercise to stay fit and sane. I like Bikram Yoga. So my question is: can I do yoga without risking further injury to my Achilles tendon?
                        Thanks!
                        Aching Achilles in Berkeley.

Answer:  As a runner and sports medicine podiatrist, I firmly believe that injured runners heal fastest when they remain as active as possible.  This true for Achilles injuries as well.


The key with the Achilles tendon is making sure that the tendon is healing and that no further damage is taking place. Continued damage to the Achilles (such as repeated micro-tears) is what leads to tendinosis. Achilles tendinosis always precedes an Achilles tendon rupture.

In most cases of Achilles injury in a runner, there is a period of severely reduced activity. Sometimes a Platelet Rich Plasma (PRP) injection may even be necessary to stimulate healing. In the very worst cases, Achilles tendon surgery may even become necessary.

But once the injury is reversed and healing begins, it is important to get back to activity. If you are at the point where your doctor thinks the tendon is on the mend, it may be OK to add some Yoga to your routine.

With a healing Achilles tendon Yoga is mostly OK. However, there are a few Bikram yoga poses that are concerning, and should be avoided such as:
Garudasana (Eagle Pose)
Dandayamana - JanuShirasana (Standing Head To Knee Pose)
Dandayamana - Dhanurasana (Standing Bow Pulling Pose)
Tuladandasana (Balancing Stick Pose)
Tadasana (Tree Pose)
Padangustasana (Toe Stand Pose)

None of these poses are really likely to rupture the Achilles if done flawlessy. The problem is that if you have your Achilles completely taught (while attempting these poses) and then begin to lose your balance, it may be more than the tendon could take.

If you are doing Hatha Yoga, you should simply keep the risky poses mentioned above in mind and then sit out or modify any Hatha poses that your feel would put your Achilles in a precarious situation.

It is a great question! With any running injury the big trick is not just stopping activity, but being creative in identifying the activities you continue to keep the blood flowing, the mind calm and the healing in progress.

Dr. Christopher Segler, DPM is a sports medicine podiatrist and 10-time Ironman triathlon finisher. He is Board Certified, American Board of Podiatrc Medicine. His sports podiatry practice is limited to runners, triathletes and endurance athletes with complex injuries. He specializes in running injuries that don't heal with the conventional "just stop running" approach. His practice is unique in that he offers remote consultations all over the world via Skype. He travels constantly and is available to treat frustrated injured runners in person in both San Francisco, CA and Houston, TX. If you have an injury that isn't getting better, you can call him directly at 415-308-0833 or 713-489-7674. 

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.

Ironman Texas Race Report

The Woodlands, TX. May 19, 2012

About 12 hours after finishing Ironman St. George (affectionately referred to as “my flogging in the desert”) I was back home in San Francisco staring at the screen on Ironman.com where I kept reading the words again and again...

“General Entry for the 2012 Ironman Texas is SOLD OUT. Ironman Foundation spots are still available! CLICK HERE to register via the Ironman Foundation.”

My sane-self says, “$1300 sure seems like a lot of money for an entry fee.”

My obsessed self counters, “But you know, you ARE going to be in Houston on that day anyway.” The insanity continued, “And it isn’t like you really ran the whole marathon in St. George, so really you are perfectly capable of having a better day in less than two weeks. This would also be the perfect training day for Ironman France.”

My sane-self says, “Perfect training day for France...what...how?!?!?”

My obsessed self interjects. DO IT! DO IT NOW! Quickly...before the sane one intervenes!”

“Click.”

And just like that, I was registered. Hardly time for a recovery ride before I would re-pack the bike and head for Texas.

My friend Henry lives in Houston and we have raced many Ironman events together. I called to let him know I was racing. He was thrilled.

I asked if his friend Josh was racing as well.

Henry said, “No, Josh never signed up. But he just did the New Orleans 70.3. In fact, we did the whole race together, start to finish. It was a blast! It was his first triathlon. But, actually they cancelled the swim, so he stall hasn’t done a big event swim yet. I think he is going to do Texas next year, but not this year.”

I said, “Well great...maybe you and I can do Ironman Texas together. It would be great if we could cross the line at the same time for once.”

Henry said, “I’m in!”

About an hour later Henry called back. He said “So, I told Josh that you said he was a “loser” since he didn’t sign up for Texas. He just got on his computer and signed up for a community fund slot! So I guess the three of us are doing it together!”

I immediately felt terribly guilty.

But I was suddenly really looking forward to a laid back race where the three of us would just spend the day together working up a Texas-sized sweat.

Having just finished Ironman St. George, and with Ironman France 3 weeks away, my race plan and priorities were simple...

1. Don’t get injured.
2. Finish.
3. Have a really fun time.

At 5:00am I quietly sneaked through the front door of my sister’s house and in to the dark humidity that is the early Houston morning. I climbed into Henry’s truck and bid good morning to both Henry and Josh.

Before I knew it we were in transition inflating tires, filling aerodrink bottles and building anxiety.

The sun rose as we walked the mile or so to the swim start. We discussed strategy.

“Ok. Let’s just all stay together through the swim, and then we can head out on the bike course together.”

The water in Lake Woodlands was much warmer than last year, so no wetsuit. The organizers were allowing donning of rubber, but only with the stipulations that they start 10 minutes later than the rest of the field and be disqualified from Kona slots and age-group awards.

About 1-minute before the cannon went off, the three of us kicked our toss-away flip flops in the growing pile at the edge of the boat ramp. We waded in and started treading water near the back of the 2800-or-so strong pack.

“BOOOM!” the canon fired, and thrashing commenced.

Josh almost immediately started to have a bit of an issue. He was sort-of
hyperventilating and a bit panicked. It was after all, his first mass start.

Henry and I both waited. “No problem Josh, we have 2 hours and 20 minutes. We’ll just let everyone go. Take your time.”

We had him hang on to a rescue kayak until the mass splashed ahead. Josh was unnecessarily apologetic. Soon, the crowd was gone and we continued on.

About 20 minutes later, the 10-minute-delayed-wetsuit swimmers caught us. “No problem Josh, we have 2 hours and 20 minutes. Lets just let them pass. Everything’s cool. Take your time.” We again had him hang on to a rescue kayak until the wetsuit group went by.

The rest of the swim was calm and uneventful, albeit slow. Josh was still having some trouble calming down and catching his breath so he kept up a consistent breast stroke. He couldn’t swim freestyle without his heart rate going back up.

While we were drifting along the swim course, I did notice that the water quality was better than last year. Last year I couldn’t even see my elbows when I was swimming. I also ended up with a sinus infection for a month (as did just about everyone else I talked to after that race). So I was hopeful that the slow pace and slightly clearer appearing water would let me escape with an excess intake of water-borne pathogens.

When we exited the water, I had no problem finding my bike. There were only about a dozen bikes racked when we hit T1. I guess there is at last one advantage of a swim that takes 2 hours 8 minutes and 12 seconds.

We had a quick pow-wow in the change tent.

Knowing that this was a new adventure for Josh, I suggested pacing. The plan was for me to lead with Josh and Henry staying far enough apart to avoid drafting. Since I have a power meter, I would lead keeping an even sustainable pace based on wattage.

My typical average power output for a flattish Ironman would be 250 watts. Since Josh was on a road bike I suggested we head out at 225 to see how he felt.

At the first aid station, I looked back and they were gone. In a few minutes they caught up and said I had just dropped them. “No problem, let’s try 200 watts.”

I dropped them again. So we tried 175 watts. I dropped them again. Then 150, and I dropped them again. We then found 135-140 to be sustainable. And on we pressed through the Texas countryside.

The bike course was super-hot, but had some lovely shady sections. The terrain is varied enough to keep the boredom and saddle issues at bay.

At about the 100 mile mark, I rolled through an aid station and noticed Josh and Henry were gone. So I waited. And waited.

About 15 minuted went by before I saw them coming. They stopped at the medical tent about 50 yards behind me and I saw henry take of his helmet and lie down.

“Uh oh.”

I rode back to find out what was going on.

Josh says, “He’s done. Henry has been throwing up on the side of the road for like 10 or 15 minutes.”

I walked under the canopy and Henry simply shook his head and said, “I’m out Bro. Make sure Josh makes it to the finish.”

And then there were two.

Away we rode to finish the last 12 miles before starting the run.

After 7 hours and 23 minutes in the saddle, we were in the change tent and heading out on the run.

As we started the marathon Josh was feeling good and looking great. But as soon as I started to run, or even jog for that matter, my stomach rebelled. It was like a repeat of the last 15 miles of St. George. We only jogged a couple of miles at a 12 min pace, before my stomach just shut down completely. The only pace I could maintain was a fast walk of 4mph.

At that pace we would get in before midnight, but it was going to be a very long day.

And that was exactly what happened...6:45:14 for the run.

But we made it. As Josh and I rounded the last corner before the chaos of the finish chute, I said, “OK Josh, this is it, 100 more yards and you’re an Ironman. Now run...and go get that medal!”

We both started to run, and Josh peeled away like he had been shot out of a cannon. I was just down the straight part of the finish chute when I heard Mike Reily shout “Joshua Johns, YOU ARE AN IRONMAN!”

It was a really great way to finish indeed.

Right after I crossed the line I heard “DADDY!!!” and saw my four year-old son Alex. I handed my finisher medal to him across the fence. He promptly handed it back and said, “Can I have that instead?” pointing to the glow stick necklace.

“Sure! After waiting 16 hours and 37 minutes for me, I guess you can have whatever you want!”

Dr. Christopher Segler is a 9-time Ironman Triathlon Finisher who helps marathon runners and triathletes heal chronic injuries that don’t respond to conventional treatments. He also lectures at medical conferences about the treatment of complicated running injuries. He believes that if your doctor tells you you have to stop running, you should fire your doctor. You can learn more about self-diagnosis of running injuries and cycling injuries at www.AnkleCenter.com and www.DocOnTheRun.com

Houston Marathon Race Report

2011 was a year plagued by urgent sports medicine consults and surgery. With a sports medicine practice structured to provide rapid access to aching athletes, my own training seemed to get buried. So I planned 2012 to begin as a year of racing myself back into shape.

The Chevron Houston Marathon, just two weeks into the new year seemed a great place to start. This was my third year registered for Houston, but would be my first attempt at this event. I was a no-show for both the 2010 and 2011 editions of the marathon, again forced to stay in San Francisco to take care of patients.

Just two days before my departure this year I would have a work matter come up that threatened to thwart my marathon again. I re-booked the flight, so I could fly in at the last minute. Sleep deprived running would be better than no running. A plane with a “broken hose inside the wing” left me anxious and sitting at LAX for an extra 5 hours, but eventually I made it to Houston.

I was excited to run as I would be joining my sister and my brother-in-law. It was his first marathon. My sister Laura however is a veteran.

After a few hours of sleep the three of us were up in the dark and parked in downtown Houston. The temperature was 41 degrees but forecasted to rise to about 60. Perfect!

Because 2011 was so busy with work, I hadn’t actually run more than 13.1 miles since Ironman Texas. That was eight months ago. So the plan for my race was simple. Run steady. Don’t walk. Don’t do anything dumb enough to cause an injury.

I went out for a test run about a week ago to plan my pace for the marathon. I ran 13.1 miles, from the San Francisco zoo, along the Great Highway, up through Golden Gate park and back. I covered the half marathon distance in 1:42. So I figured that a 3:40 marathon would be a reasonable goal.

The Houston Marathon is a huge event, but the organization was great. Runners were separated into corrals based on expected pace. I found the 3:40 pace crowd and waited for the start.

After the mayor spoke and the national anthem was sung, the wheelchair start was off. Ten minutes to gun-time. I took off my warm-up pants and tossed them over the fence into a growing pile of running wear that was to be gathered and donated to the homeless. It was cold, so I kept the sweatshirt on.

The gun went off and anxious shuffling commenced. Thousands of runners trying not to bump into each other, trudging through the shoot, pointed out of town. Like magic, as soon as I hit the start timing mat, running began. Almost instantly the mass was at a seemingly coordinated 8:00 min per mile pace.

As we rounded the overpass, it was a fascinating sight to see. Dawn cast an orange hue on the horizon. There ahead, as far as I could see was a street stuffed with a colorful gyrating mass of bobbing heads flowing through the street.

One mile in and I was finally warm. I bid my sweatshirt goodbye and tossed it into a pile of clothes on the sidewalk. A couple of slow runners suddenly appeared in front of me, creating a challenge to dodge them, without elbowing anyone or stepping on any heels. Time to ignore the crowd and stay on pace.

Before I knew it I was out of downtown and in the Heights. Five miles into the race I passed my sisters house, which happens to be right on the course itself. There on the sidewalk were my twin nephews who offered up a matching pair of enthusiastic high fives.

We kept rolling south through Montrose and towards West University. Bands played. People cheered. A priest stood in the street, waiving a palm frond dipped in holy water, blessing the flowing crowd of runners.

The course continued, flat as a pancake, through historic neighborhoods, under the shady tunnel of trees near Rice University and out through Memorial. As we hit Memorial Park, I had my last energy gel and knew I would make it. All I had to do was keep running and I would be in somewhere close to my goal.

Just then I saw my friends Henry and Josh cheering wildly, a great boost for the final stretch. The last few miles had the only real sequence of hills. But my frequent runs at Lake Merced, Crystal Springs and through Golden Gate Park, made them seem like speed bumps. In the last 4.5 miles I passed 162 runners, but only got passed by 10.

Right turn on Shepherd then left on Allen Parkway. The crowds got bigger, the cheers louder and the buildings of downtown steadily grew into the sky. As I felt the headwind pick-up, I realized it was the wind funneling between the skyscrapers. I was downtown, just blocks from the finish. I felt great and was tempted to turn up the juice, but then the voice of reason rang through me head…”you haven’t run more than 13.1 miles in 8 months. You have Ironman St. George and Ironman France coming up...DON’T DO ANYTHING STUPID!”

And so I stayed on pace. Round the corner and down the longest finish chute I have ever seen. Across the line in 3:41, actually a new PR. Today, I will call that success.

2012 is officially off to a very good start.

Dr. Christopher Segler is a marathon runner, 6-Time Ironman Finisher, and sports medicine podiatrist in San Francisco. He lectures to other foot and ankle surgeons at medical conferences on the topic of complicated running injuries. His practice focuses on runners and triathletes who have complicated injuries and cannot seem to get an accurate diagnosis. You can learn more about foot and ankle injuries at www.AnkleCenter.com and learn more about housecalls for runners in San Francisco at www.DocOnTheRun.com. He performs second opinion consultations for runners and triathletes world-wide through www.RunnerSecondOpinion.com

When is Surgery Needed for a Ganglion Cyst in the Foot by San Francisco Running Foot Surgeon

A runner with a ganglion cyst called from San Francisco and had the simple question. "When should a runner consider ganglion surgery?" Here is the answer....

Whenever a patient has a big squishy lump on the top of the foot, big toe joint or the ankle joint, they want to know what will make it go away. The most common soft tissue mass in the foot is a ganglion cyst. Sometimes ganglion cysts will go away on their own. Sometimes the ganglion cyst needs to be drained. But sometimes a ganglion cyst in the foot needs surgery.

There are really 3 reasons that a ganglion cyst in the foot or ankle will need surgery

1. The ganglion cyst is painful.

2. The ganglion cyst is pushing directly on a nerve and can cause nerve damage.

3. The ganglion cyst is so big that it makes it difficult to wear shoes.

Unfortunately, many times ganglion cyst happen to develop in locations that are positioned close to nerves. This is really the best reason for a runner to think about ganglion surgery.

The tingling and burning pain that is often associated with a ganglion cyst is usually because the soft tissue mass is pushing against a nerve and causing the nerve to become irritated. If this continues for a long period of time, you can develop chronic pain or permanent nerve damage. The skin on the top of the foot is very thin and when a soft tissue mass develops the mass gets squished between the shoe and the bones that are close to the skin. The nerves that are located in that area can then get caught in the middle and cause pain. For this reason midfoot ganglion cysts often have to be removed surgically.

Dr. Christopher Segler is a runner, 6-Time Ironman finisher and a nationally recognized foot surgeon and sports medicine podiatrist who focuses on rapid recovery from running injuries. He is an internationally recognized expert in the treatment soft tissue masses that may appear to be ganglion cysts. His research and theories on PVNS (a dangerous soft tissue mass that is often mis-daignosed as a ganglion in young adults) have been published in the medically journals and were used as the basis for new treatment methods of these soft tissue masses. He practices podiatry, sports medicine and surgery in San Francisco.

You can learn more about the best treatment for ganglion cysts in the foot at www.AnkleCenter.com and www.DocOnTheRun.com. If you live out-of-state or abroad, you can arrange a remote consultation with a true running expert through www.RunnerSecondOpinion.com

Achilles Tendonitis in a Runner...from dropping out to 4th place.

We recently received this inspiring patient testimonial from a runner who had been suffering with chronic Achilles Tendinitis that was so bad it actually forced him to drop out of a race. Dr. Segler saw him and helped him heal the Achilles tendon with some simple treatments..and NO surgery. He didn't even need a PRP injection to heal the Achilles tendon. He went on to run a half marathon, full marathon and compete with his team to win 4th place at the PA/USATF 2011 Cross Country Grand Prix.

"I'm a runner who competes in the PA/USATF. I injured my achilles (tendinitis) last summer and needed to recover before the start of the cross country season (1st week of Sept).

This injury had been bothering me chronically for the last year and a half, impairing my training and in some occasions, forcing me to drop out during races. I called Dr Segler following a drop out from a local race last July. My achilles was very painful and I had difficulty walking. I'm generally a point-scorer for the team (top 5 runners) so my return to competition was much anticipated by my teammates.

Dr Segler came to my house and assessed my injury, explained what type of tendinitis I had and gave me a number of options and treatments (I think 12 in total). Most importantly for me, Dr Segler understood my need to not become totally out of shape before the XC season. Since he is a triathlete himself, he knows what competition means, the efforts you've put into your training, and the satisfaction of a good race. For my type of injury, most doctors would simply recommend to (heavily) use NSAIDs, rest and not run at all for a number of weeks.

Dr Segler gave me additional options to maintain a minimum level of fitness while my tendon was recovering. I followed his advice to the letter and got better in a few weeks, while maintaining some training. I returned to competition on Aug 27th, ran many of this year's XC races, and contributed to my team achieving 4th place at the PA/USATF 2011 XC Grand Prix. More recently I completed a half and full marathon part of the PA/USATF road racing Grand Prix and was part of the "A" scoring team. A great feeling ! I think we will take 3rd place in the Grand Prix this season, the best the club has done in years ... Thanks Doc !"

- Patrick M., San Francisco, CA

Dr. Christopher Segler is a runner, triathlete and 6-time Ironman finisher. His practice focuses on rapid recovery of running injuries. He offers a range of services to help runners get back to running as quickly possible. He provides PRP injections for Achilles tendonitis and ESWT therapy for heel pain in San Francisco, Marin and Palo Alto. He also frequently provides second opinions for runners through remote consultations via web conferencing for complicated injuries world-wide. The best treatment is fast treatment! If you have a question about running injuries, you can reach Dr. Segler directly at 415-308-0833.

Sesamoid injury in a runner?

I recently got from a question from a runner who had been ramping up for the California International Marathon in Sacramento and started having pain in the ball of the foot at the big toe joint...

"Hello Dr. Segler, I have been training for my first marathon and read that hills would be a great way to get super strong. I really wanted to do well and finish in under four hours so I started do hill repeats on Fillmore Street in San Francisco. Things were going great and I really felt like all the training was starting to pay off. Then one morning I got up and noticed this little aching pain in the bottom of my big toe joint every time I stepped on my right foot. It seemed to be worse on the hard tile in the kitchen. I have been really ramping up the miles and I am worried that this may be a stress fracture. Can you tell me the best way to tell if this is a stress fracture or something else? It hurts right in the ball of the foot under the big toe joint. Here is a picture of where it seems to hurt the most. Thanks!"


Great question! And thanks for sending the pic.. Here is your answer...

Pain in the ball of the foot can occur under the big toe joint for several reasons. Based on your description and the location of the tenderness, I would be most worried about the following conditions:

1. Sesamoiditis: inflammation of the sesamoid bones under the big toe joint (first metatarsophalangeal joint). You stand on these two little bones. Because they get stressed more when you run uphill, you may develop sesamoiditis when doing lots of hill repeats. If you push right on the hard little bones, and one hurts more than the other, it is probably sesamoiditis.

2. Flexor Hallucis Longus tendinitis (FHL tendonitis): strain, inflammation and/or micro-tearing of the tendon that pulls the big toe down against the ground allowing you to push off when you run. The sesamoid bones are actually embedded within the FHL tendon. If you push right under the big toe joint and the whole area is tender (and doesn't really hurt more on one specific sesamoid bones) it may be FHL tendonitis. If you pull upward on the big toe (away from the ground) you will stretch the FHL tendon. If this hurts, FHL tendonitis is likely.

3. Sesamoid Stress Fracture: a tiny little crack in one of the sesamoid bones from too many hill repeats and or too much running volume. If this is the cause of your foot pain, it will hurt more on one sesamoid than the other, it will also hurt when you pull the big toe upward, and your foot will most likely be swollen and/or bruised. The best way to diagnose a stress fracture of the sesamoid bone is with an MRI. X-rays don't always show stress fractures right away. X-rays will only show a stress fracture in a sesamoid that has fractured or completely cracked. Based on your story, however, this seems unlikely.

Get better as fast as possible and good luck in your marathon!

Learn more about sesamoiditis, FHL tendonitis and sesamoid stress fractures at www.AnkleCenter.com

Dr. Christopher Segler is a nationally recognized expert on running biomechanics and foot surgery. He has been invited to lecture to foot surgeons, sports medicine doctors, podiatrists, triathletes and runners in training all over the United States, as well as Canada, New Zealand, Portugal and Turkey. If you have foot pain caused by a running injury, you can send a picture of where it hurts and a brief description to him. Your picture and answer to your question will then be posted on our blog so others can learn how to deal with running injuries as quickly as possible and keep running pain free. You can email your pic and question to DrSegler@DocOnTheRun.com If you have a quick question about a running injury and you are not in San Francisco, you can actually call him directly as 415-308-0833. He schedules house calls for runners and triathletes in San Francisco, Marin and the East Bay through DocOnTheRun.com.

PRP Injection vs. Cortisone Injection in a runner with Achilles tendinitis?

Today I received a call from a runner who wants to know whether his painful Achilles tendon would get better faster if he had a cortisone shot or the newer Platelet Rich Plasma (PRP) injection.

Cortisone injections are one of the oldest and most common treatments for tendon pain when inflammation arises due to running and over-training. However it is not always the best treatment.

What you need to understand about cortisone injections (also known as corticosteroid injections) and PRP injections is that they are both very effective at reducing Achilles tendon pain, but for very different reasons. They are essentially opposite ends of the same spectrum.

Corticosteroid injections stop the inflammatory process cold. If you're trying to remove pain, swelling and inflammation, cortisone injections are a great tool. The problem is that if you have a small tear in the tissue that needs to heal, you have essentially stopped the healing process. In addition, the corticosteroids are well know for breaking up collagen bonds. Because your Achilles tendon is really a huge cable made of collagen, corticosteroid injections can weaken the tendon and make it more likely to rupture or completely tear.

PRP injections work in the opposite way. The PRP injection takes all of the growth factors that are present in your blood stream (within the platelets) and concentrates them many times. The powerfully concentrated growth factors are then injected directly into the injured tendon tissue in order to stimulate new blood flow, unlock the body's natural healing response and directly stimulate healing of the injured tendon. If there are small micro-tears in the Achilles tendon, a PRP injection will be much more effective than corticosteroid injection.

One injection turns the inflammation off while the other turns the healing on. Each has its place, just make sure you explain all of your running goals with your sports medicine doctor when considering either of these injections for your aching Achilles tendon.

You can learn more about what happens before your Achilles PRP injection by clicking here and what happens after your Achilles PRP injection by clicking here.

Dr. Christopher Segler is a 6-time Ironman Finisher and an award winning foot and ankle surgeon. He even does house calls for busy runners and triathletes in San Francisco, Marin and the East Bay. If you have a question about foot pain related to running, you can call him directly at 415-308-0833. For more information on Achilles running injuries, visit www.anklecenter.com.

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.

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.

Should I take Calcium if I have a Stress Fracture in my Foot? San Francisco's Running Doc Explains

If you are running and get a stress fracture, you likely want that bone to heal as quickly as possible. When you break a bone in the foot, the bone has to heal just like any other injury. Although calcium is the mineral that makes bones strong and visible on x-rays, it is not the only factor in bone healing. For this reason it is particularly important to make sure that you eat a healthy well-balanced diet when you are healing a stress fracture in the foot.

We know that your body needs many different nutrients to heal a stress fracture. For example, vitamin K is important in the clotting process right after a bone breaks. Vitamin C is essential to collagen formation that is an early step in the formation of soft bone callus that precedes the deposition of calcium where the bone broke. Calcium gets laid down in the repair of the fracture, but supplemental calcium won't be absorbed well without Vitamin D. Lysine is an amino acid that helps you incorporate calcium into the bony matrix as the fracture heals.

The medical literature is conflicting about whether or not supplements help bones heal faster. However there is general agreement that know that adults need about 1000 mg of calcium and 800 I.U. of Vitamin D daily for good bone health. Many nutritionists suggest that you will get all of this in a standard healthy diet. Having said that, there is very little risk and much potential benefit with taking some extra calcium.

Obviously your body will be working harder to repair the fracture by laying down calcium as the bone heals. You could take some Calcium and Vitamin D to help make sure you healing fracture has all the calcium needs. Just be certain that the Calcium supplements you take also have Vitamin D.

Dr. Christopher Segler is a runner, multiple Ironman Finisher and Sports Medicine doctor in San Francisco who focuses on running injuries. If you have a question about a possible stress fracture in your foot from running. you can post a question or call him directly at 415-308-0833. For more info on running injuries see San Francisco's best running injury site.

Do I Need X-Rays if I Sprained my Ankle?

San Francisco's Ankle Expert Explains When You Need X-Rays

If you are out trail running in Marin or Golden Gate Park and roll your ankle, your first thought is going to be whether or not you will be able to run with a sprained ankle. If the ankle is bruised and swollen, you will also probably wonder whether or not you need an ankle x-ray. This video explains how ankle surgeons and emergency room physicians decide whether or not you need to have x-rays after an ankle sprain.



Every single day thousands of people wait in line at the Emergency Room to get x-rays after they roll their ankles. After all that waiting, the ER doc will typically send you to an ankle specialist anyway. By seeing an ankle expert instead of going to the ER, you can be sure to get the best treatment for your ankle sprain. If you sprained your ankle, see an ankle expert today!

Dr. Christopher Segler is a sports medicine podiatrist who specializes in the diagnosis of sprains and fractures of the foot and ankle. Has has won multiple awards from the American College of Foot and Ankle Surgeons for his research on fractures of the foot and ankle that are often misdiagnosed as sprains. As a runner and triathlete himself, he believes that non-surgical treatment is best whenever possible. You can learn more about ankle sprains at the Bay Area's best ankle sprain info site. YOu can also learn more about ankle sprains and x-rays here. You can reach Dr. Segler at 415-308-0833.

How to Tell If You Have a Stress Fracture In the Foot by San Francisco Running Podiatrist

Last year just a few weeks before Ironman Louisville, I got an out-of-state call from a very worried triathlete. He said he had been ramping up his training for the big race. He had slowly been building milage over the past year. But then he started to get an aching foot when he ran. Slowly it turned into throbbing foot pain when he would run. And by the time he called, it was starting to hurt even while he was walking.

He was really distressed.

As a runner and prior Ironman finisher, he had been running long enough to know that a stress fracture in the foot was one of the most likely injuries that could force him to stop running. He was worried he wouldn't even be able to show up on the starting line at Ironman Louisville. The good news is that we were able to manage the stress fracture and he did complete the race without incident.

Training for any distance event (whether a half-matrathon, marathon or Ironman) can lead to a stress fracture in one of the metatarsal bones of the foot. But if your foot aches, there are some simple ways to tell how likely it is that you have a running-related stress fracture. This video explains how you can tell if you might have a stress fracture in the foot.

To learn more about stress fractures, visit the most comprehensive running injury site in San Francisco. All of the running education information has been created by San Francisco's Award-Winning Foot Specialist and Ironman Triathlete Dr. Christopher Segler. He's not just a running specialist who writes about running injuries, but he is a real runner as well.

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

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

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

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

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

NSAIDs SLOW TISSUE HEALING.

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

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

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

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

NSAIDs CAN DAMAGE YOUR KIDNEYS

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

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

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

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

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