Seasonal Transitions in Athletic Activity

As winter turns to spring, many people transition from indoor to outdoor training and athletics. These transitions are a common period for foot and ankle specialists to see an increase in acute injuries that many times could have been prevented. Consider the following tips when making any transition in athletics or conditioning:
1) Indoor terrain is different from outdoor terrain. Running a 7 minute mile for 30 minutes on a treadmill subjects the body to stresses and strains that are different from this same workout on concrete or an uneven woodland trail. Consider reducing the duration, intensity or both of a routine workout by as much as 50% with any tranistion and gradualy increase your workout back to 100% over the course of several weeks to avoid acute injuries that could potentially limit your performance for the entire season.
2)Not all conditioning translates well into athletic performance. Being able to run a 7 minute mile for 10 miles on a treadmill does not directly translate into being conditioned to play 1 hour of competive soccer after not playing in the offseason. Cardiovascular conditioning is different from the unique musculoskeletal conditioning required for many sports. The message again. Transition slowly when resuming competitive sports.

Charcot Foot

Charcot Foot

Charcot arthropathy is a destructive condition of the bones where the bones begin to crumble and change shape. The condition is associated with nerve damage and repetitive injury to the bones. The condition is most commonly experienced as a late complication of nerve damage from diabetes and can result in a foot deformity known as a rocker bottom foot. (see attached picture). Although diabetes is one of the most common cause of Charcot related injury that I see in clinical practice, other conditions associated with nerve damage to the lower extremities can also result in Charcot such as alcohol induced neuropathy. Treatment of Charcot feet can be controversial and includes bracing, complex surgery and amputation in some circumstances when a patient may not be a candidate for surgical reconstruction or bracing. Undoubtably the best treatment is early detection of the condition before advanced deformity of the foot or ankle can occur. The condition can be difficult to identify at times and individuals should seek treatment by a foot and ankle specialist trained in treatment of these complex deformities. For more information and patient testimonials of how Charcot can affect one's life, go to

CHARCOT EDUCATION VIDEO AND PATIENT TESTIMONIAL:

http://www.youtube.com/watch?v=UgkxtzEWGUI

Avoiding Foot Pain With Pregnancy

Of all things, foot pain is usually one of the least expected problems of expecting mothers. Foot pain however affects a large number of "expecting mothers" and is commonly one of the top 5 discomforts of pregnancy. Most expecting mothers begin experiencing foot pain during the end of the second and throughout the third trimester. Pregnancy related foot pain occurs in part because of the hormone, postural and anatomic changes that occur during pregnancy. Pregnancy results in hormone changes that cause ligamentous laxity in the pelvis to allow the child to pass through the birth canal. The hormone changes also result in ligament laxity in the foot that can promote foot strain and pain, particularly in the heel along a ligament called the plantar fascia. This type of foot pain is commonly refered to as plantar fascitis. Foot strain also occurs as one's body mechanics and center of gravity change with the baby's size and position in utero. The change in body mechanics alters the way one's feet distribute the pressures of walking and standing. Pressure of the baby on the pelvis and venous system of the lower extremity can also cause swelling in the legs and feet that further add to the discomfort.
One of the greatest challenges for mothers with foot pain during pregnancy is that most medications typically prescribed to treat inflammation in the foot should not be taken while pregnant. This can leave many expecting mothers with the false expectation that they have to suffer with foot pains associated with pregnancy. This is not necessarily the case. Custom orthotics, devices molded to the foot to support foot function, can be used to support the foot and improve foot mechanics during pregnancy. Orthotics can help reduce foot strain and provide support during this period when ligamentous laxity and postural mechanics are less favorable for foot function and comfort.

Preventing Fall Injuries in the Winter, Consider the "Urban Crampon"

Ice, snow, sleet and rain are common winter challenges that are made more challenging when your shoes or boots are made for fashion and not traction. The lack of traction of many casual shoes and boots increases one's fall risk in inclement weather and can result in injury. This can be even more treacherous if you are someone with a pre-existing condition or injury that makes you generally unstable on your feet. Tips for reducing your risk of fall injury in snow and ice conditions include wearing a shoe with a wide heavy lug sole with deep treads. Boots with a “high heel” should be avoided because they place your ankle in a generally more unstable position that is at risk for twisting injuries. High heel shoes also tend to have a narrow heel that is less stable on slick surfaces than wide or flared heel shoes. Mountaineers and ice climbers use crampons to gain footing on ice surfaces but what do you do if you are an urban mountaineer type and your ice climbing consists of scaling the front steps of your house or a store parking lot? Yak Trax, by Implus Footwear ( http://beginnertriathlete.com/cms/Article-detail.asp?Articleid=1080&vote=10 )(pictures above) might help improve traction in winter weather. Yak Trax are a metal coil system that slips over conventional shoes to improve traction on slick surfaces. Yak Trax consist of metal coils that are wrapped around a stretchable rubber slipper that fits over the bottom of a shoe. They are about as easy to apply to your shoes as galoshes, are light weight and compact. They can easily fit in a small bag, oversized pocket or the glove compartment of a car. They are sized according to shoe size and price is approximately $30. They are even used by some runners during icy weather conditions to improve traction. Although they are no crampons, they might just give you the additional traction you’re looking for during inclement weather.

Flip Flops: How Bad Can they Really be for Your Feet

Flip Flops, sandals, mules, and other kinds of open foot wear have long been chastised by podiatrists and orthopedists alike as being unsupportive for feet and a risk for foot injuries such as heel pain, ankle sprains and stress fractures. Despite these risks and warnings, their popularity continues to escalate as fashion rather than function guide footwear use and selection. Dr. Robert Joseph PhD, DPM relates that he typically sees an increase in open foot wear related injuries in the spring time and throughout the summer as people commonly transition from boots and shoes to open shoe wear. Flip flops are the least supportive of open foot wear and are intended for limited use to protect the bottom of the foot when walking short distances such as through a public shower room or parking lot at a beach. They should not be worn for extended periods of time and never during athletic activities. According to Dr. Joseph, “open foot wear does not provide enough functional foot support or cushioning with activity. The lack of heel and arch support can promote over-pronation of the foot, a leading contributor to foot and leg pain.”
The risks from flip flop use are greater for individuals with flat feet and high arched feet as these feet require the most support from shoe gear. Be aware of your foot-type and whether you are at greater risk of foot injury from flip flops than the average person. Consider having your feet and shoe gear professionally examined by a podiatrist if you have questions or concerns regarding a connection between your current shoe gear, foot pains, and foot type.
Individuals with flatfeet are more prone to shin splints, knee strain, and tendonitis than the average person when they wear flip flops. People with high arched feet are at exceptional risk for fasciitis, Achilles tendonitis and fasciitis, back pain when wearing flip flops. If you are an individual who regularly wears a device such as an orthotic in your shoe, you may also be at risk for injury since most open shoe wear can not accommodate an orthotic. Traditionally, open shoe wear lack a heel counter that would customarily hold an orthotic in place within a shoe. Advances in sandal design have changed however and select flip flops and sandals can now be used with custom orthotics. Several manufacturers now offer open shoe wear with a removable midsole that can be replaced with a custom orthotic. Replacement of the removable midsole with a custom orthotic can help improve foot support and function to help reduce the risk of injury. (Example style noted in the above picture) Specialty shoe stores often carry a variety of open footwear that are able to accept orthotics.

The Fall Risks of Diabetes

Diabetes, It Affects Your Sugar but Did You Know It Can Increase Your Risk of Falling ?


Each year, 30 percent of persons aged greater than or equal to 65 years suffer a fall and 13,700 of those individuals died from that injury in 2003. Between 1993 and 2003, the rate of fatal falls among this age group had increased. Did you know that the incidence of diabetes is also increasing in this age group and diabetes is now one of the top 5 chronic medical conditions affecting Americans? As diabetes progresses, many individuals suffer from nerve damage as a result of increased levels of sugar in their blood. Nerve damage, also known as neuropathy, can decrease ones ability to feel their feet and legs. The lack of feeling makes it difficult for a person to sense where their feet are with respect to the ground. This loss of feeling is called a loss of proprioception and increases the risk of falling. Some medications prescribed for diabetic nerve pain can also cause drowsiness, dizziness or weakness that further increases the risk of falling. Consider these steps towards reducing you or someone you care about risk of falling when they have diabetes:

· Use night lights along the path to the bathroom and hallways at night. Our sense of balance depends on our nerves to our feet as well as sight. Vision becomes even more important for balance when there is nerve damage to the feet so make sure walking areas are well lit.
· Beware of the side affects of medications such as drowsiness, dizziness or weakness that may increase your risk of falling. Consult your physician about changing medications if this occurs.
· Avoid use of house slippers and flip flops. This type of footwear is loose on the foot and a lack of feeling in the feet makes them more likely to slide or twist off the foot and cause a fall
· Avoid uneven terrain, especially in dimly light areas. Gravel surfaces, hills and inclines are more challenging and require more balance.

Turf Toe

Turf Toe, Tough Turf, or Tough Luck

Now that football season has kicked off again, players on the professional, college and high school level are at risk for a numbers of foot injuries that can not only end their season, but leave them with lasting injuries. Turf Toe is one of those injuries that affects athletes and sports enthusiasts at all competitive levels.

Picture of Carbon FootPlate with Morton Extension Above

Dr. Robert Joseph D.P.M., Ph.D. relates that turf toe is caused by injury to the ligaments of the great toe joint when the joint is overstretched. Although it is most commonly associated with football injuries, it can occur with any sport prone to rapid changes in direction of running such as soccer or tennis. Once thought to be related to the unforgiving properties of artificial turf, greater understanding of foot and shoe gear mechanics show improper shoe selection and foot mechanics may also be risk factors for injury.

According to Dr. Joseph, the great toe is associated with several types of sports related injuries than can be difficult for the layman or physician to distinguish. These injuries include fractures of the two small bones of the great toe joint called the sesamoids, rupture of ligaments, or injury to the cartilage of the joint’s surface. Evaluation by a foot specialist is not only an integral part in determining the type of injury and treatment but also guides rehabilitation and proper shoe selection. Use of a proper shoe gear can reduce the risk of injury and at times, a carbon fiber foot plate with a mortons extension can be used to reduce joint strain as an athlete returns to sports after a turf toe injury. Dr. Joseph relates that proper shoe gear selection is not as easy for patients as it once was given the variety of shoe types, styles and technologies available. Choosing a knowledgeable and reputable shoe store can also make a significant difference helping one get the right type of shoe recommended by your foot and ankle specialist.


Robert Joseph D.P.M., PH.D., is a podiatric clinician and researcher in private practice in Dayton, Ohio. He is adjunct faculty of the University of Dayton, Dayton Ohio and Clinical Research Associate of the Tissue Regeneration and Engineering Center of the University of Dayton and Providence Center For Clinical Research. For more information, visit robertjosephpodiatry.mobi. or call (937) 479-1793