Do I Have Gout in the Big Toe Joint

Gout is one of the most painful conditions I see as a Podiatrist in San Francisco. Usually gout attacks the big toe joint. The question is, how do you tell if you are having an attack of gout in the foot?

When gout happens the first thing you will notice is pain, swelling and redness around the joint. In the foot this is most often the base of the big toe in the joint podiatrists call the "metatarsaophalangeal joint." Gout can happen in any of the joints in the foot, but usually it the big toe joint.

When gout develops, you get uric acid crystals forming and being deposited in the joint itself. If untreated, the crystals may continue to form and lead to the buildup of a chalky paste-like substance called tophi. You can see the huge lump on the bottom of the big toe joint in the picture above. All of that is uric acid crystals in the joint.

Because these sharp needle-shaped crystals end up in the joint, it can be incredibly painful to move the joint. Every time you move the big toe, it is like having a thousand little needles poking the inside of the joint. This of course hurts.

In response, your body reacts with inflammation. That is where the classic pain swelling and redness comes in. The foot will be warm to the touch, red and very painful. Many gout sufferers will say they can't even have a bed sheet touching the foot because it is so painful.

The biggest problem with trying to tell if you actually have gout is that gout mimics two other conditions: infectious arthritis and Charcot. Charcot arthropathy is an emergency that can look like gout, but is actually more serious. It is most common in people with diabetes. Infectious arthritis is where bacteria (instead of uric acid) is invading the joint. Both of these are emergencies. With either, it is important to start treatment right away to prevent further damage and the potential for losing the foot to an amputation.

Many people who have had multiple attacks of gout can seem to tell when it is coming on. However, if you have never been diagnosed with gout, it is important to see a foot specialists who can make sure you don't have a more serious condition.

The most accurate way for your podiatrist to diagnose gout is through a small procedure called joint aspiration. In this way, the uric acid crystals in the joint can easily be identified. More importantly, your foot doctor can rule out a bacterial infection. Blood tests and x-rays may give clues that you have had gout, but can be unreliable if used alone to diagnose gout.

Once you have been diagnosed with gout, your podiatrist will likely make recommendations on modifying your diet to prevent it from happening again. You can view our recommendations on a Gout Diet here. If you are given a prescription to treat the gout, you will be given written instructions that you should follow closely.

Dr. Christopher Segler was selected in 2010 as one of "America's Top Podiatrists." He has a podiatry house calls practice in the San Francisco Bay Area. To learn more about gout, visit the Gout page on our website. If you have gout and need pain relief right away, he makes podiatry emergency house calls 24/7. If you think you might have gout and would like to speak directly with him to ask a question, you can call him (415) 308 0833.

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

To Pop or Not To Pop: Blister treatment for runners explained by San Francisco's Running Podiatrist

Dr. Oz recently ran a segment on his television show instructing his audience to pop blisters whenever they occur on the feet. He went on to explain that if you successfully get all of the fluid out, the top layer of the blister will form a adhere down to the tissue underneath and create a "biologic dressing."

While this may be sound advice for a typical healthy woman who gets a blister from a new pair of high heels, the real question for Bay Area runners is: "Should I drain a blister" if I am a runner training for a race such as a marathon or triathlon?

The best answer is "sometimes you should, and sometimes you shouldn't."

The medical term for the type of blisters on the feet when running are "friction blisters." Blisters on the feet occur from a combination of skin friction and pressure. When your foot slides around inside the running shoe, you get friction. Rubbing the skin over and over in one spot (such as the back of the heel or ball of the foot) causes the layers of the skin to begin to separate. Fluid then seeps into this newly created space between the layers forming the blister.

Keep irritating the area and the blister continues to get bigger. Even if you simply continue to apply pressure to the blister (like pressing it against the heel counter inside the running shoe) it will continue to get bigger. This is because the fluid will try to spread outward and keep separating the skin layers. Then even more fluid seeps in to make the blister bigger.

If you keep rubbing the blister long enough, the skin on the top of the blister will tear effectively popping on its own. The blister then starts to ooze relieving the pressure as the fluid leaks out. So should you take charge and drain it yourself?

What sports medicine podiatrists know about blisters in runners is:

1) small non-painful blisters heal quickly
2) large painful blisters hurt less if drained and not irritated, but hurt more and have a slightly higher risk of getting infected if they are drained and the activity (such as running) is continued
3) blisters with the overlying blister roof removed will heal, but hurt more initially

So If you are runner with a small blister on a toe and it doesn't hurt don't drain it. It will heal quickly and has a very low risk of infection. If the fluid can't drain out, bacteria can't get in. If you have a blister that is small, put a felt pad around the blister. You need a donut shaped or U-shaped pad for this to work. You need to put the pressure around the blister and not on the blister. This will stop all of the rubbing that could make the blister get bigger. It will also stop the blister from hurting.

If you running a marathon or competing in an Ironman triathlon and get a huge blister that makes it hard to walk after the race, drain it. You can do this by poking a small hole at the edge of the blister. Heat the needle or soak it in rubbing alcohol. This will sterilize the needle so that you don't introduce any infection causing bacteria when you puncture the blister.

Cover the blister with a bandage that will soak up the fluid as it continues to leak out. If the fluid starts to build up again, then repeat this process and drain the fluid again. Marathon runners with big blisters may have to do this a couple of times. The blister can be quite irritated after running 26.2 miles.

So what are the "exceptions to the rule" about popping or draining blisters in runners?

1. If you notice the blister at mile 13.1 and still have another half-marathon to go, don't pop the blister. This is where the advice from Dr. Oz doesn't fit with runners. If you drain the blister on your heel then continue to run, more fluid will seep under that skin. The skin will slide back and forth. If the drained blister skin slides around, it can't work as a "biologic dressing" because it never has a chance to stick to the underlying raw area. The roof of the blister may also tear. That is what happened in the blister pictured above. All of the rubbing of the heal inside the running shoe caused the blister to rip open. If the roof of the blister tears, it needs to be removed (called "de-roofing" by podiatrists).

If the blister is drained, you need to secure the overlying skin in place with a dressing. Wait until the race is over. If you drain it mid-race it will hurt like hell, there is a higher risk of infection and it will take longer to heal. You also need to wear a pair of shoes that won't rub on the raw blister after it has popped. So once you drain the blister, apply a dressing that will hold the skin securely in place. Change the dressing daily. Studies show that hydrocolloid dressings works best to bake blisters heal fastest. But there is NO evidence than antibiotic ointment helps blisters heal any faster.

2. All blisters should be drained, completely de-roofed and treated by a podiatrist if you are diabetic. The risk of infection is much higher in diabetics. A blister anywhere on the foot in a diabetic runner is a medical emergency. I have personally performed many amputation on diabetics where a blister became hugely infected and spread to the underlying bone. Seek immediate medical attention if you have diabetes and a blister anywhere on the foot, heel or toes.

Although it is easy to prevent blisters, they still often occur in runners. In fact research shows that blisters on the feet are by far the most common running injury reported among marathon finishers. If you get a blister on the feet, treat it right and it will heal quickly so you won't have to miss much training at all.

Dr. Christopher Segler is a sports medicine podiatrist in San Francisco with a focus on runners. He is also a marathon runner and Ironman triathlete himslef. He makes house calls all over the Bay Area to treat running injuries like blisters, stress fractures and Achilles tendonitis. If you have a question about a running injury you can email him or call (415)-308-0833 to reach him directly. For the best source of running injury prevention information in the San Francisco Bay Area, visit MyRunningDoc.com or AnkleCenter.com.

Ironman 70.3 California Race Report by San Francisco Sports Medicine Podiatrist

On Saturday March 27, 2010 I officially started the triathlon season with my first half Ironman.

The Rohto Ironman 70.3 California in Oceanside, CA is one of the most popular events on the 70.3 circuit and this weekend I got to find out why.

Given that I have competed in many full Ironman distance triathlons (but no half-Ironman events) I really only had three main goals for this race:

1. Finish injury-free! (bad form for a podiatrist to get injured while running)
2. Finish in 5 hours 30 minutes or less.
3. Test the engine and see what I need to do to prepare for the 2010 Ironman season.

PRE-RACE DAY:
Early that morning I went out for the obligatory short ride and transition run. It felt great to loosen up all of the 8-hour car ride stiffness sustained from the drive down from the San Francisco Bay Area. The weather was perfect! I picked up my registration packet and went back to the room to meet Paige and Alex and go for a swim with my favorite 2 year-old.

Because the swim portion takes place in the Oceanside Harbor, athletes are not allowed to swim at the site before race day. No big deal as swimming is swimming and it all looks pretty much the same on race day… arms, legs, and churning confusing.


Because the bulk of the bike leg winds through Camp Pendelton, competitors are not allowed to ride on the bike course. This would be the first race where I would have basically know clue of what to expect on the bike.

I just figured I would treat it like one of my group rides in Marin with my biking buddies in the Bay Area. I usually don’t really know the routes I am being led on when we head somewhere new, so this should feel similar. I’d try to just take it as it comes and pay attention to my heart rate and perceived exertion.

RACE DAY:
We rented a condo right by the harbor which made race morning stress-free as can be. Up at 4:00 a.m., peanut butter and jelly sandwich down, make coffee, shower, get dressed, pump up bike tires, fill aerodrink bottle, gather gear, etc.

It seems like every race lead to some item forgotten in transit to transition, and this was no exception. I had everything meticulously organized. But just as I was headed out of the door I realized it was cold and decided to put on a fleece jacket. In doing so I forgot to put my backpack on again.

So I headed out into the dark and streamed in line with the other 2300 or so athletes heading to transition. I found my spot and racked the bike. When I got ready to lay out my running gear, I realized the conspicuous absence of the back pack.

No big deal as the condo was only about ¼ mile away. I did a warm-up jog back to the condo and grabbed the back pack. Paige, Alex and I then headed back to transition so I could add my towel, running shoes, hat and number belt to the #589 pile in transition.

With everything in place, just had to wait for the start.


SWIM 1.2 MILES:
The goal for the swim was simple. Relax and swim 1.2 mile in 40 minutes without getting worn out or beaten up.

My swim wave was relatively early and I got to start right at 7:00 am. The cannon went off and away we went. The water was clean, clear and way warmer than San Francisco Bay! It seemed like no time before I was rounding the red turn buoy at the mouth of the harbor. I drafted a little, but mainly tried to stay clear or the flailing arms and kicking feet that surrounded me.

When I got back to the boat ramp, I checked my watch and saw success! Swim time of 39:33, no black eyes, and no one kicked me in the head. I felt great knowing I could get out on the bike without having to extract an impacted earplug (at least this time).

Transition 1:
After the 600 foot long run in a wetsuit, I made it to the bike. Stripped the wetsuit, put on my socks, helmet, Garmin, sunglasses and away I went!

BIKE 56 MILES:
The bike course was great! Lots of gentle rollers, some big long climbs interspersed with plenty of flat stuff where I could get on the gas. I can say with confidence that the course is beautiful as it wind through the Marine Corps base. Big green mountains, wildflowers and blue ocean dominate. There is also the occasional “Tank X-ing” and “Live Fire Zone” signs just to remind you where you are. The soldiers volunteering on the base provided (no surprise) perfect order and execution at the aid stations.

I kept a constant low-stress level on the bike course. I went hard, but easy enough that I knew I could still run the half marathon. After 2 hours 45 minutes and 9 seconds (20.35 mph average) I was back in Oceanside and ready to run.

RUN 13.1 MILES:
The run course is a mostly flat out-and-back two-loop affair. The best part was that it runs along the ocean and passes directly in front of the condo where I could see Paige and Alex waiving and cheering from the balcony.

I really wanted to make sure I finished in under 5:30 total. So after some quick math I knew I could coast in as long as I maintained an average pace of 9:00 per mile for the entire half marathon. I went about 9:30 min/mile pace for the first mile to try get moving and loosen up my legs. Then I started to gradually increase the pace.

About two miles from transition I saw my old motorcycle road-racing partner Fred Provis cheering for me out on the course. Fred is one of those guys who can make anyone feel like a champion. He definitely put a spring in my step. The next few miles felt much better. By the first turn around I knew I would make the finish on target.

By the second lap I was in a comfortable groove. I fought the urge to push the pace knowing that I might invite injury, or blow it and end it walking. Given that I had a goal of getting a qualifying slot for Ironman Arizona (as well as doing Ironman Canada five months from now) I knew I should be sensible and just keep the pace steady.

About a quarter mile from the finish I realized I was still slowly creeping up on another guy in my age group. I had been behind him for about 5 miles. For some reason passing him suddenly seemed important.

Right after I crossed the bridge to the harbor, I kicked it in high gear and shot past him. Confident that I was far ahead, I slowed down. Next thing I knew he flew by on my right as we entered the last 50 feet of the finish shoot. I started chasing him as he peered back at me over his right shoulder.

I was picking up speed as we approached the finish line. Then the poor guy suddenly stood bolt upright, grabbed he right hamstring and started limp-running to the line just ahead of me. When I crossed the line he was holding onto a volunteer with one hand his his hamstring with the other. I patted him on the back and said “You reeeeeeally earned that one!”

My total time was 5:29:42. I made my goal with 18 seconds to spare. And most importantly (unlike the guy in front of me), I was injury free. Best of all, I went to watch the roll down... and secured my Ironman Arizona slot. See you in Tempe in November!

Let the training begin...


Dr. Christopher Segler is an Ironman triathete, marathoner, and an award-winning Sports Medicine Podiatrist in San Francisco. He has written extensively on the subject of podiatric sports medicine and running injury prevention. His San Francisco Podiatry practice focuses on house call appointments for busy professionals and athletes who want to prevent or recover from running injuries. He offers the convenience of podiatry house calls at Bay Area homes and offices so that his clients don’t have to lose time going to the doctor or getting custom orthotics. You can learn more about common running injuries at AnkleCenter.com and Doc On The Run.com.

What Happens If I Keep Running on a Stress Fracture in the Foot - San Francisco Sports Medicine Podiatrist Explains

Stress fractures in the foot are one of the most common injuries in runners. Although runners often endure many different aches and pains while training for a marathon or half marathon, an ache in the foot that is a stress fracture is one pain that shouldn't be ignored. One of the questions I get from runners on a regular basis is "what happens if I keep running and it is stress fracture."

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The short answer is that if you continue to run, the stress fracture will likely get worse and lead to a complete break in the bone.

I have seen this happen more than once. One runner was actually a triathlete. He had been rapidly increasing his milage while training for an olympic distance triathlon. He started to notice a vague aching sensation in foot one day during a run. The next day the foot was sore. By the end of that day at work it was throbbing. He took off a couple of days from running and rode his bike instead. He resumed running a couple of days later. Then he noticed the dull ache in his foot with every step during his run. When he took his shoe off he noticed some bruising of the foot as well. He kept running anyway.

When I finally saw him, he had been running on this painful, aching foot for about 5 weeks. The foot was swollen, tender and bruised. As soon as we took an x-ray of the foot, it was obvious that he had fractured the fifth metatarsal bone. He had to have foot surgery to repair the fractured bone and allow it to heal. Obviously, foot surgery is not a good start to any running or triathlon training season.

A stress fracture is a tiny (virtually invisible) crack in the bone. If you continue to apply stress to it (such as running) the tiny crack gets bigger. Continue running and the crack can lead to a complete break in the bone. Once the bone breaks, the ground essentially pushes the bone up out of the way. At that point the stress that was being applied to that bone get transfered to the bone next to it.




That is what has happened in this xray image. The pain from the 5th metatarsal stress fracture was ignored by the patient. Once the stress fracture turned into a completely broken bone, a stress fracture started to develop in the next bone over (the 4th metatarsal bone).

Generally a sore foot while running warrants attention from a sports medicine podiatrist. Particularly if you want to keep running. With early treatment, you can get it to calm down and avoid disaster. Make sure you find a podiatrist in your area who runs and understands runners. That will give you the best chance of making to the starting line and finish line of your next big race.


Dr. Christopher Segler is a Podiatrist in San Francisco. He is also an Ironman triathlete and marathon runner. He authored a chapter in the Handbook on Podiatric Sports Medicine. He has also won multiple awards from the American College of Foot and Ankle Surgeons for his research on diagnosing subtle foot fractures. He offers podiatry house call appointments for busy professionals and athletes who prefer the convenience of a house call at their home or office, instead of waiting half a day to go to the doctor. You can learn more about stress fractures in the foot at AnkleCenter.com and Doc On Th Run.com.

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.