San Francisco Podiatrist on Difference Between Heel Pain and a Heel Spur

Heel pain is the most common form of foot pain that causes people in San Francisco to make an appointment with a podiatry clinic. In fact, nationwide, about 40% of all visits to podiatrists are due to heel pain diagnosed as plantar fasciitis. As a podiatrist in San Francisco myself, the thing that I find interesting is that most people with plantar fascitis think they must have a heel spur to have heel pain. But that’s not always true.

So what is the difference between plantar fasciitis and a heel spur?

To begin with, let’s explain how to tell if you have plantar fasciitis. Anyone with plantar fasciits will have pain in the bottom of the heel or in the arch. In most cases this pain is worse when you get up and step out of bed in the morning. The heel may also hurt when you get up from your desk after working at a computer for a couple of hours.

As you start to walk, the first step is usually a sharp pain or sudden ache in the bottom of the heel. After a few steps, the heel pain starts to subside and feels better. In many cases, it may not even hurt at all while you are walking around or even running. But when you sit still and get back up again to start walking, that’s when the heel pain returns.

If you have this kind of morning heel pain and simply push on the bottom of the heel (and it hurts) you most likely have plantar fasciitis.

Many people in the San Francisco Bay Area seem to believe that heel pain is due to a sharp heel spur poking down and causing pain. But in fact about half of all people who have this kind of heel pain don’t have a heel spur at all. And about half of people with no heel pain, happen to have a heel spur that will show up on x-ray. So the two problems aren’t necessarily related.

The most common cause of heel pain is plantar fasciitis, which is simply inflammation of the plantar fascia. The plantar fascia is a big ligament attaching to the bottom of the heel and extending out to the toes. If you put too much stress on the plantar fascia, it can become inflamed where it attached to the heel bone.



With improper biomechanics, such as excessive pronation (flat feet that roll inward as the arch collapses) the plantar fascia ligament may tug away at the heel bone. With tension applied to the plantar fascia, the attachment may cause the heel spur to form.

The way this happens is that the ligament pulls the covering (called the periosteum) of the heel bone away. A small blood clot forms and then becomes calcified as it heals. If this happens again and again, the heel spur gradually grows. Because the heel spur is caused by the pulling on this big ligament, you can understand why a heel spur points out toward the toes and not down toward the ground.




Any podiatrist in San Francisco can simply take an x-ray of your heel to tell whether or not you have a heel spur. But the reality is, it doesn’t matter.

In the last 7 years, I have only surgically removed 2 heel spurs. Both of them were broken and wouldn’t heal. One was an young ironworker in San Francisco who fell off some scaffolding while working on the Golden Gate Bridge retrofit project. The other was a woman in her sixties who has some osteoporosis and broke the heel spur while doing high impact aerobics.

But most people with plantar fasciitis can get better on their own, even if they have a heel spur. In the vast majority of cases, spending a few minutes doing our San Francisco Podiatry Heel Pain Recovery Stretches will make the heel pain go away. The spur just simply doesn’t usually need to be removed in surgery.

Dr. Christopher Segler is a nationally recognized expert on conditions affecting the heel bone. In 2006 he was awarded 1st Place at the National Meeting of the American Podiatric Medical Association for his research on diagnosing heel bone infections with magnetic resonance imaging (MRI). He offers podiatry house calls in San Francisco for busy athletes and people who just think it is ridiculous to take half a day off work just to see a foot doctor. You can reach him through Doc On The Run: San Francisco Bay Area Podiatry House Calls.You can also learn more about the causes and available treatments for heel pain at AnkleCenter.com.

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Can Your Sports Drink Cause Diabetes? San Francisco Running Podiatrist Explains New Study

San Francisco, CA - March 11, 2010: A new study conducted at the University of California San Francisco (UCSF) was just released that blames sports drinks commonly used in marathon training and other endurance sports for the rising epidemic of obesity and diabetes.

The question is.. Do you need to find another way of getting your calories and nutrition during your next long run, marathon, or triathlon?

About the Study
At UCSF, researches used a form of computer modeling called the "Coronary Heart Disease (CHD) Policy Model" to predict effects of sugar-added sports drinks on adults over age 35. One of the lead authors of the study is an internal medicine resident at UCSF. The finding from the study were presented at the "50th Annual Conference on Cardiovascular Disease Epidemiology and Prevention" in San Francisco from March 2-5, 2010.

The main conclusion from the study were:

• sugary drinks are now contributing to the increased incidence of obesity in America.

• sugary drinks are costing the U.S. Health Care System $300 to $550 million per year.

• increased use of sugary drinks have led to 130,000 new cases of diabetes between 1990 and 2000.

Doctors and podiatrists in are aware and concerned about the growing midsection of America and the associated rise in diabetes. Diabetic foot amputation are more or less preventable, but are still on the rise. Mostly because more people have diabetes in America than ever before. In fact, one study showed that in the next 25 years 1 out of 3 Americans will become diabetic. That's a lot of diabetic feet. So all podiatrists (whether in San Francisco or rural America) are concerned.

So then back to the question. "Is the consumption of sports drinks by runners, triathlete, etc likely to lead to diabetes?"

The answer is... probably not.

The people who are sitting around (on their rapidly growing behinds) playing video games chugging 32 oz. bottles of Powerade are certainly more at risk of developing diabetes that someone drinking a sports drink out on a run.

Here's an example:
On my last 10 mile run along Ocean Beach and through Golden Gate Park, I burned 2,357 calories. During that run I wore a Fuel Belt with diluted Gatorade. In all, I drank four 6 oz. bottles of 1/2 Gatorade and 1/2 water. That's a total of 12 ounces of sports drink. Grand total 310 calories found in 78 grams of carbohydrate (of which 42 grams is sugar). That leaves me with a 2000 calories deficit after my run.

So not only will this sort of athletic activity leave you with a caloric shortage, but we also know that exercise in and of itself is protective (in fact some studies suggest curative) of diabetes.

We know that someone who is "pre-diabetic" can lower their average blood sugar readings, just by exercising 30 minutes per day, 5 days per week. Diabetics using insulin shots have gone from using insulin, to only taking pills just by adding aerobic exercise. This is key to controlling your diabetes and preventing complications like poor circulation in the legs and diabetic foot problems.

So the bottom line is that I will still drink my Gatorade on my next long run. And when I roll through the aid station at Ironman Canada I will grab that gatorade and that Gu. I won't start taping dried dates on my top tube just yet.

Now having said all of that, I will say that I never, ever drink sports drinks... if I'm not wearing a heart rate monitor.


Dr. Christopher Segler is a Podiatrist in San Francisco. He is also an Ironman triathlete and runner. On most days, you will find him riding through Marin, running along Ocean Beach or making house calls for busy athletes who would rather get casted for orthotics at home instead of missing a track session. You can reach him at Doc On The Run. Learn more about common foot problems at AnkleCenter.com.

San Francisco Marathon Runner and Bunion Surgeon Posts Video Explaining "What is a Bunion?"

Educational Video by San Francisco Bunion Surgeon "What is a Bunion?"

One day after a marathon, a runner came up to me and explained that he had stopped running because he had so much bunion pain. This guy was no novice runner. And no wimp. He was a multiple Ironman finisher, who had even qualified for the Ironman World Championships in Kona. He said he just wanted to know if he would be able to run again.

As a runner currently training to earn my own Kona slot, I know first hand the level of pain tolerance that has to exerceised to finish an Ironman in a respectable time. So when he told me that "pain" was what was stopping him from running, I knew he really had to be suffering from some serious bunions.

And he was. So after evaluating his feet, looking at the x-rays, etc., we decided to surgically correct his painful bunion. Interestingly to me, he still didn't really seem to understand how a bunion forms. In fact, I have had many bunion surgery patients who came to see me with bunions who have tried to research bunions on the internet, but still didn't fully understand how a bunion happens.

To help people understand what a bunion is, how a bunion forms, why it gets bigger, why bunions become more painful, etc, I created a short video and posted it. Click on the link above if you want to understand how a bunion develops.


Dr. Christopher Segler is a 4-time Ironman Finisher and foot surgeon in San Francisco. He is also the inventor of the Tarsal Joint Distractor, a surgical instrument designed to help bunion surgeons perform bunion correction surgery faster with a lower complication rate. You can learn more about bunion surgery at San Francisco's Best Foot Info Site. If you are a busy athlete who would rather have a doctor come to you for your evaluation see San Francisco's Podiatry House Call Site.

San Francisco Podiatrist Posts Video on 1 Hour Ingrown Toenail Relief in San Francisco

Ingrown toenails are easily the most common reason that a podiatrist will see a doctor for pain in the toe. Ingrown toenails can be prevented with some simple tips:

1. Cut normal nails straight across.
2. Keep your nails just shorter than the end of the toe.
3. Avoid shoes that cramp the toes.

The most common way people cause ingrown nails is by cutting them too short. This is often in an attempt to relieve a painful ingrown nail before it becomes infected. Unfortunately, this usually backfires. But even if you try to take it out and make the ingrown toenail worse, you can still get relief. This video explains how you can get ingrown toenail relief in San Francisco in only about an hour, even without going to a podiatry office.





Dr. Christopher Segler is a San Francisco Podiatrist and toenail surgeon. He treats podiatry emergencies (such as ingrown toenails) like they really need treatment now. He drives around San Francisco seeing patients at home, in their offices or even tourists on vacation in their hotel rooms. No one needs to suffer with a painful infected ingrown toenail. If you need immediate relief from an ingrown toenail in only an hour, you can reach him directly at (415) 308-0833. You can learn more about ingrown toenails at San Francisco's Podiatry House Call Site and San Francisco's Best Podiatry Patient Information Site

San Francisco Podiatrist Explains Why Athlete's Foot is Common in Bay Area Runners and Cyclists

Athlete's foot is a fungus infection of the skin that often occurs in runners, cyclists and other athletes. It just so happens that the San Francisco Bay Area has a climate that can make it easier for you do develop a case of itching, burning, peeling feet that characterizes the condition.

In order for any fungus to grow best, it needs a habitat that is dark, warm and moist. As it turns out, shoes are perfect for this. You put on your running shoes and head out for a run through Golden Gate Park. Your feet sweat (even if it is fifty degrees), and the heat from your feet turns the shoe into a little incubator for the nasty stuff to grow. If it is like many days in San Francisco, you may even get some rain or light drizzle further soaking your shoes. Then you get home and toss your shoes in the closet until you get ready to go for a run the next day.

The problem is that very few closets have heat or air conditioning vents in them. For this reason, the shoes just won't dry out. They stay damp. And damp running shoes equals fungus.

Cyclists have a similar problem. Head out on the road to Nicassio or anywhere else in Marin county on the weekend and you will see hundreds of cyclist out for a ride. Most of them are wearing shoe covers to help keep their feet warm and dry. But these shoe covers don't breathe very well. As a result, all of that moisture gets trapped inside the cycling shoes. Once the ride is over, many cyclists will toss there shoes in the garage right next to their bike. Sitting in a cool and damp garage keeps the inside of those cycling shoes damp as well.

Sooner or later, the fungal spores in the shoes will cause an athlete's foot infection. Often this is just nothing more than mild peeling of the skin on the bottoms of the feet (see picture above). But some people get severe itching, redness and burning of the feet. Once in a while a secondary infection (caused by bacteria) can start an even bigger problem.

So what to do?

First off, it is very easy to prevent athlete's foot by simply drying your running shoes and cycling shoes out. Bring them inside. I usually leave mine near of a heating vent for a couple of hours after I go running or biking. This ensures that the insides of the shoes will stay dry. Dry shoes don't support fungus very well. If you wear cycling shoe covers, take them off after every bike ride to help them dry out.

If you do get athlete's foot, over-the-counter (OTC) anti-fungal treatment creams will usually cure the problem in about 4 weeks. All you have to do is follow the directions on the tube. Make sure you use the cream for about a week after the problem seems to have gone away. Otherwise you might still have some fungus in the skin that can flare back up in only a couple of weeks after you stop applying the anti-fungal medicine.

Keep in mind that if you get athlete's foot, you will have been shedding fungal spores in your shoes. You need to decontaminate them by spraying lysol in your shoes and letting them dry out thoroughly afterward. If the athlete's foot doesn't improve after you treat it yourself with OTC medications, see the best podiatrist you can find.

Dr. Christopher Segler is a runner and Ironman triathlete who practices Podiatry in San Francisco. He offers house calls to busy athlete's through www.DocOnTheRun.com. You can learn more about common causes of foot pain at www. AnkleCenter.com, San Francisco's best podiatry treatment information site.

San Francisco Podiatrist: Out-Run Your Fat Cells!

An article in the San Francisco Chronice discusses some alarming statistics.

Ten years from now, 80% of men and 70% of women will be obese. In addition, there will be a 98% increase in obesity related diabetes. The problem of couse isn't just that all those fat people will have a tough time fitting in an airplane seat when getting on the plane in San Franciso heading to Hawaii.

The problem is that essentially preventable conditions like heart disease, stroke and diabetic foot amputations will follow those plump Americans like the dust cloud following Pigpen in the Charlie Brown cartoons.

The truth of course is that the bigger the waist size, the shorter the life. Many of the ultimately fatal complications of obesity and diabetes are lifestyle related. A little prevention can go a long way.

Given that I am a podiatrist and runner, I of course am biased toward exercise and preventing the complications that lead to foot amputations. Not just because I like to run, but because people who have diabetic amputations don't live very long.

We know that a "pre-diabetic" (sometimes also referred to as a "borderline diabetic") can often reduce their blood sugar and reduce the chances of developing diabetes just through regular exercise. A diabetic who is taking insuling who begins a walking or moderate running routine can go from taking insulin shots, to just taking some pills to keep the blood sugar under control.

And we all know that exercise is a more reliable way to fight obesity than diets.

So maybe just by adding a 30 minute running routine in Golden Gate Park, along the Embarcadero, or through Marin, San Francisco Bay Area residents could actually outrun the ability of their fat cells to pack on the pounds. San Francisco is easily one of the most scenic and runner friendly cities in the world.

As a Podiatrist who has done lots of diabetic foot sugery, I can honestly say that I would rather meet you on a Saturday morning run in San Francisco than see in the hospital because you need me to amputate a part of your diabetic foot. Every run in San Francisco I go on feels like a success. Every diabetic foot amputation feels like a failure.


Christopher Segler is a Foot Doctor in San Francisco who practices Podiatry. He is also a multiple Ironman Finisher. For more info about foot pain or running injuries see www.DocOnTheRun.com or www.AnkleCenter.com

Runner's Pedicure???

Question: "What in the world is a runners pedicure!!! What I am looking for is someone who knows what happens sometimes when you run a half or full marathon. Yes the dreaded black toenail. My toes have mostly recovered but my girlfreind is insisting I get them in shape or keep my shoes on!" - Rick J.




Answer:As a Bay Area podiatrist and active runner (marathons and Ironman) I can tell you that you don't necessarily have a fungal infection just because the toenail is getting thicker and uglier. There is a very common condition among distance runners and triathletes. It is often referred to as "Runners Toenail." Podatriss call it "traumatic onychauxis." If you run a marathon or half marathon and get the black toenail, you have caused enough trauma to the nail bed (under the nail) to bleed. It is basically a bruise or bllod blister under the nail. Repeatedly beating up your toes in this way leads to the root of the nail getting smashed, deformed and becoming missahpen. Then the toenail grows out thicker. It may be greyish, or yellowis in color and often looks like a fungal nail, but it may not have any fungal infection. A pedicure can often thin the nail and return more of a normal appearance to it. Podiatrists can also prescribe topical solutions that decrease the buildup of keratin on the nail that makes it look like a fungal toenial. The bad news is that there is no "cure" for runners toenail. But you can keep your toenail looking presentable with a pedicure. If it gets worse over time (and you haven't had any more episodes of black toneails) it might be a fungal toenail infection. The only way to know for sure is to see a podiatrist. Your foot doctor with then take a sample of the toenail and send it off to a lab for anlaysis. A test called a PAS reaction will determine whether or not there is any fungus living within the nail plate. If there is no fungus, then you have "traumatic onychauxis" (runner's toenail, in plain English. You can also visit http://www.MyRunningDo... for more info. Best of luck! - Dr. Christopher Segler, San Franciso Podiatry House Calls

Can I Run After Ankle Ligament Surgery?

Question from Mike in Corte Madera:
For years I had unstable ankles and repeated ankle sprains. It seemed like every time I would walk on any sort of uneven ground, my ankle would roll under. Although it wasn't always painful, it was bothersome. My doctor said this unstable ankle (continually giving way) was porbably caused by a bad ankle sprain I had back when I was playing high school basketball. I had surgery about a year ago to repair the torn ankle ligaments. The ankle ligament surgery was called a Brostrum repair. Now the ankle seems fine, but I want to know if I can run in a marathon. Ultimately I would like to participate in a triathlon this year as well. Is this possible?

Answer from My Running Doc:
Ankle sprains are very common. Some estimates show that there are nearly 25,000 ankle injuries in the U.S. every day. The vast majority of these ankle injuries (about 85%) are ankle sprains. Many people try to treat ankle sprains at home with ice, rest, elevation, and maybe an over-the-counter brace or ACE wrap to keep the swelling down. But many more will seek treatment at the Emergency Room or from an ankle expert like a podiatrist.

When doctors try to determine how severe the sprain is, they base it on a grading system from 1 to 3. A grade 1 ankle sprain means that you have sort of stretched the ligaments a little. A grade 2 ankle sprain means that you have partially torn one of the ligaments supporting the ankle. Although this is more severe, the ankle ligaments are still mostly intact. A grade 3 ankle sprain means that you have completely torn at least one of the ankle ligaments.

It is often difficult for a patient to tell the severity of the ankle sprain, but there are some indicators that it might be severe and needs to be treated by an ankle specialist. Bruising and swelling are clues that you have had some level of tissue damage. With severe bruising, your ankle doctor should also be suspicious of a fracture. But even if there is no fracture and the ankle isn't broken, that doesn't mean you don't still need serious treatment.

In your case it sounds like you had one of the classic ankle sprains that resulted in Grade 3 ankle injury. Because the ankle ligaments never healed, you were left with an unstable, wobbly ankle. By performing a Brostrum ankle ligament repair, your ankle surgeon has attempted to rebuild and repair the torn ankle ligaments. If the ankle surgery has been successful, you should gain full mobility and use of the ankle. If I were to have performed your ankle surgery, the goal would be to have a much stronger ankle after the surgery than before. This of course means that you should be better able to run and bike once the ankle surgery is all healed.

In short, anyone who has ankle surgery to repair the torn ligaments should be able to run or ride a bicycle without any trouble. Marathon training and triathlon training are reasonable goals, once you have healed. Having said all of that, you should check with your current treating ankle surgeon and make sure your ankle surgery has healed before you start running, cycling or any new training routine.

Best of luck in your 2010 season!

My Running Doc - Dr. Chistopher Segler is a San Francisco based foot & ankle surgeon with a unique perspective on foot and ankle injuries.  He is a rock climber, skier, marathon runner, and Ironman triathlete.  Because of this, he understands when someone has an injury, they want to get better, just to get back to activity.  He understands that the common doctor's notion of "just stop running" or "find another hobby," or "take up Scrabble" are all unacceptable to the athletically minded.  He believes that any active athlete can suffer an injury yet return to sport stronger than ever.

Videotaping your gait to improve running stride

Question:
I've been reading alot about heel-striking lately, and the effort to improve your stride. Now focusing on 70.3's and IM's, I'm beginning to question if I should review my stride and look for ways to improve it (if there is one).
Thanks!
Robert


Answer:
Running stride alterations to improve efficiency can help improve your marathon and Ironman triathalon time considerably. In these endurance events it is all about conserving energy and being efficient. Its not really about how fast you go, but how little you slow down.

I am a podiatric surgeon with an area of expertise in running biomechanics. I am also a 4-time Ironman finisher. I am not particularly fast (P.R. of 10:59:57), but have been improving considerably over the past year by simply modifying my stride. I now run more upright/forward, at a much higher cadence and with a shorter stride. I also have much less heel strike.

You may simply be able to evaluate your stride by looking at the wear pattern on the soles of your shoes. That is why I always examine my patient's running shoes during their evaluation. Most podiatrists specializing in running injuries will do this.

Having an expert watch you run is helpful. Your local podiatrist, triathlon coach, running coach, etc. can help. Short of this, you should capture some video (from the rear and from the side) so you can see what you foot strike is currently, and how it improves over time.


Dr. Christopher Segler is an Ironman triathlete and award winning foot doctor specializing in endurance athletes. He lives and trains in the San Francisco Bay Area.

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 .