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.

How Custom Cycling Orthotics Decrease Knee Pain Caused by Forefoot Varus

Knee pain is one of the most common complaints among cyclists. If your knee is aching when you finish the climb over Mt. Tam or a long ride out through Marin, it may be because the foot is slightly out of alignment.

In the simplest of terms, your foot is "locked" in place to the pedal by the cleats. if your forefoot is tilted lightly in relation to the rearfoot (a condition called "forefoot varus" or "forefoot valgus") then your leg may tilt slightly when you pedal.

This tilting of the knee can cause the knee cap (or "patella") to track out of alignment. When the knee cap tracks incorrectly, the cartilage on the inside of the knee cap can become irritated and inflamed. This type of knee pain when biking is called "patellofemoral syndrome."

This short video describes bicycle pedaling biomechanics as it relates to knee pain and conditions such as forefoot varus that can be easily corrected with custom cycling orthotics.

Dr. Christopher Segler is a sports medicine podiatrist, cyclists, and 6-time Ironman triathlon finisher. His practice focuses on cyclists, runners, and triathletes in San Francisco, Marin, and the East Bay. He is currently training for Ironman France. If you have a question about pain while cycling, you can call him directly at 415-308-0833. Learn more about house calls for athletes at www.DocOnThRun.com and learn more about foot and ankle pain at www.AnkleCenter.com .

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.

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

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Top 5 Reasons to Avoid the Emergency Room When You Sprain Your Ankle In San Francisco

Ankle sprains are the most common of all sports injuries. Everyday nearly 10,000 people show up with painful, swollen rolled ankles. Although the Emergency Room may seem like a logical choice when you sprain your ankle, there are five reasons that you might want to reconsider.

1. LONG WAIT

The average time a person waits in the emergency room is over six hours. If you have an ankle sprain, the wait could be even longer. The reason is simple. A sprained ankle is not a life-threatening emergency. Every person who shows up in the Emergency Room with a suspected heart attack, stroke, appendicitis, or whomever gets transported to the hospital via ambulance is marked as a higher priority. Its easy to understand when you’re sitting at home reading this, but not so easy if you are sitting in the ER waiting room with a throbbing ankle.

2. COST

Care provided in the ER is expensive. In fact, the ER is the most expensive place for the delivery of health care in the United States. The hospital knows that many uninsured patients show up there with very real emergencies that cost a fortune to treat. If a guy with no insurance gets run over by a car, the ER can’t simply turn him away just because he can’t pay. As a result the Emergency Room fees are priced high enough to recoup some of the costs of indigent care. In a sense, when you go to the ER, you are paying your bill and the bill for the guy next to you who can’t pay. You could expect to pay as much as $1,500 for an ankle sprain work-up in the emergency room. If you sprained an ankle and are searching for the most expensive option, this would be it.

3. ANKLE SPRAINS ARE LOW PRIORITY

The fact is that ER docs are busy saving lives. When your complaint is just a painful swollen ankle, you can’t expect to get the same sort of attention as the patient in the stall next to you who’s going into cardiac arrest. You aren’t going to die today from an ankle sprain. In the ER physician’s mind, an ankle sprain is no big deal and one that can be treated later by a specialist. You can only expect basic first aid and a referral to a specialist. You just cannot expect specialized care in the Emergency Department.

4. MISDIAGNOSIS

ER docs are the most skilled at treated lief-threatening emergencies. But they are not that focused on non-life threatening injuries. You really wouldn’t expect the best treatment for a stroke from an ankle surgeon. By the same token, you can expect an ER Physician to provide the best treatment for your sprained ankle. An award winning-study at the University of Utah found that subtle fractures of the ankle are more than 10 times as common as previously thought. These fractures are frequently misdiagnosed as ankle sprains. Don’t expect an emergency doc to diagnose this type of ankle injury correctly. Without the right diagnosis, you won’t get the best care.

5. INADEQUATE TREATMENT

The number one risk for continued pain, ankle instability and continued ankle problems is inadequate ankle sprain rehabilitation. Because the ER docs don’t focus on ankle injures, they typically give you some basic first aid, a brace and instructions to follow-up with an ankle specialist. The ER doc fully expects you will get the care you need from an ankle specialist later. But many people don’t. The reality is that the final stages of ankle treatment are the most important. You must have an ankle expert guiding you back to strength and health.

If you sprain your ankle, you should know that most ankle sprains will fully recovery...if treated correctly. You need the best treatment to make a full recovery. If you want to see yourself running instead of limping on a weak ankle, you have to start with expert care. Knowing that the ER will send you to a specialist anyway, you can save weeks of recovery, just by starting with an ankle specialist to heal your ankle sprain fast.

Dr. Christopher Segler is a San Francisco based foot surgeon and nationally recognized foot fracture expert. In 2004 he won an award from the American College of Foot & Ankle Surgeons for his research on the accurate diagnosis of difficult to identify fracture patterns in the foot called Lisfranc's injuries (also called tarsometatarsal fracture dislocations). In 2005 he won an award from the American College of Foot & Ankle Surgeons for his research on the accurate diagnosis of difficult to identify fracture patterns in the ankle called Lateral Process Fractures. If you suffered an ankle sprain that needs the very best treatment as fast as possible, he can see you at your home with an emergency house call visit at your home or office. You can also learn more about the typical experience of an ankle sprain patient in San Francisco here. If you have an ankle sprain and just have a question about whether or not it needs to be treated, you can reach him directly at (415) 308-0833.

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.