Toe Jams March Madness Bracketology

Even runners are watching March Madness right now. College basketball will have the nation riveted to their TV and discussing this year's Cinderella stories. The biggest health story of the tournament so far is the jammed big toe of North Carolina's Ty Lawson.

Wayne Ellington had 25 points for the Tar Heels (29-4), who led the entire way and had no trouble beating the 16th-seeded Highlanders in their opening game of the tourney, even with point guard Ty Lawson, who missed his third straight game with this toe injury.

Ellington’s day more than offset the loss of Lawson, who has been slow to recover from a jammed right big toe suffered in practice two days before the regular-season finale against Duke. Lawson played 36 minutes in that game, but the toe swelled unexpectedly the day after and forced him to miss both of the Tar Heels' ACC tournament games.

Lawson has said he is feeling better and battling more stiffness than pain, adding he thinks he'll play Saturday. Is this too soon? Will he be able to play up to his normal potential?

And more important to most readers at home, what does this do to the bracketology? Even President Obama has picked the Tarheels to win the national championships, but if Lawson is not 100%, can they win?? Many athletes who have suffered a jammed big toe (a.k.a. turf toe) will tell you it takes months to get over that kind of injury. Many a season has been tarnished by turf toe. The latest was the San Diego Charger’s LaDainian Tomlinson whose entire season was a disaster due to turf toe. Ask him, he will tell you what a pain in the toe!

What is turf toe?

Turf toe is a condition of pain in the base of the big toe. This usually caused from either traumatically jamming the toe, or pushing off repeatedly when running or jumping. The most common complaints are pain, stiffness and swelling. The pain can be so severe that pushing off in football is virtually impossible.This injury is especially common among athletes who play on artificial turf, hence the name “turf toe”. The hard surface combined with running, jumping and cutting in football and soccer, make turf toe a frequent injury. Some also blame the choice of athletic footwear. The more flexible shoes, especially used in competition, provide less support to the forefoot joints, possibly contributing to the incidence of turf toe.

How does turf toe occur?

When a player sustains a turf toe injury they are actually tearing the capsule that surrounds the joint at the base of the big toe. Tearing this joint capsule can be extremely painful. Furthermore, tear of the joint capsule can lead to significant instability and even dislocation of the joint at the base of the toe. This may lead to accelerated cartilage wear and arthritis of the big toe known as Hallux limitis or rigidus. This wear-and-tear arthritis can end a promising career prematurely.

How is turf toe diagnosed?

Turf toe is diagnosed based primarily on the physical examination of the patient. X-rays may be taken to ensure there is no fracture or evidence of arthritis. Occasionally an MRI is needed to evaluate the surrounding tendons or to rule out an occult stress fracture.

What is the treatment of turf toe?

Treatment of turf toe consists of trying to control the inflammation of the joint capsule. Treatment protocol can include:
1. Rest
2. Ice
3. Elevation
4. Taping or padding to off-weight the toe joint
5. Anti-inflammatories
6. And in chronic cases steroid injections to the joint may be helpful
7. Long term use of a functional foot orthotic to balance the forefoot in the athletic shoe is quite helpful.

Athletes diagnosed with turf toe should avoid stress to the joint for about three weeks to allow the joint capsule to heal. Once returning to activities, functional orthotics can be used to limit the motion of the big toe and prevent further damage to the joint capsule.

Will turf toe return?

Unfortunately, turf toe can return, often more severe than the initial injury, and rehabilitation may be very slow. Most athletes have trouble when they try to come back to sports too soon after sustaining a turf toe injury. Surgery is rarely needed for treatment of turf toe unless this has been a chronic injury and spurs are present in the joint limiting motion. If a bone spur has formed, and severely limits the motion of the toe joint, surgery to remove the spur may be helpful.

Prevention and early treatment is really the key! Unfortunately for the North Carolina men’s basketball team, recovery may be too late for a national championship; but you never know…..they call it Mrach Madness for a reason...anything can happen!

Girls on The Run Changes Lives and Relationships!

Girls on the Run in Southlake, TX

My 11-yr-old daughter, Alex, and I have been participating in “Girls on the Run” at her school, Durham Intermediate, in Southlake. The program has given us the opportunity to run together and share a moment in time that has been very special. She is learning more about her body and having open discussion about it with me! I encourage all women who run to share their love of exercise with their daughters. Fourth, Fifth and Sixth grade level is ideal.

Studies show that girls between the ages of eight and twelve are still receptive to adult influence, while beginning to feel peer pressure. It's an age psychologists call the latency period of development when girls begin to confront important life and relationship issues. As a prevention program, Girls on the Run initiates healthy decision making about difficult issues and really talking to their parents/caretakers before it's too late.

In addition, learning healthy exercise habits early in life increases the chances that participants will value their own physical fitness as adults. Recent studies show that only those who develop exercise habits in their teen years or earlier are likely to maintain those habits for life. It's well documented that regular, moderate exercise improves cardiovascular functioning, and reduces the risk of developing breast cancer, osteoporosis (brittle bones), and obesity. In addition, girls of this age are more open to the positive peer influences, positive adult role models and the confidence enhancing which are all parts of the GOTR experience.

Many moms have posed the question, “Is it safe for my young daughter to run that far?”

"Children's bodies are well suited for endurance exercise, and numerous studies have shown that children show many positive physiological adaptation to endurance exercise training. The keys are gradual progression and common-sense adult supervision. If those conditions are met, running 3 miles is a reasonable goal for most young people."

from Russell R. Pate, Ph.D. with the Department of Exercise Science at the University of South Carolina

If you are interested in the program, contact Girls on the Run. If you want to join us for the local race this year you can register on-line:

GOTR of DFW Metroplex
4/25/09 @ 8:00a.m. – New Balance Girls on the Run 5K
Address of Event:Andrew Brown Park W 360 N Denton Tapp Road Coppell, TX

Share your love of running with your child….it may make the difference of their lifetime!

Off-The-Shelf Arch Supports vs. Custom Orthotics: The Debate Continues

They are at it again. The debate that has been going on since the late 1970’s when custom orhtotics became the mainstay of treatment for plantar fasciitis. “Millions in Potential Health Care Savings: Prefab Orthotics Found More Effective” was a press release today from a company that...guess what?…makes an off-the-shelf arch support! Are you kidding me???

Now don’t get me wrong, I think there is a place for prefabricated arch supports in our treatment plans and not everyone needs a custom orthotic; but to say that prefab is BETTER than custom is ludicrous! Let's use common sense! They sited a poor study done in California on patients with plantar fasciitis and then backed it up with a totally flawed study from 1996! That’s all they have??? What about the millions of patients that have been helped by custom orthotics across the country? Several thousands right here in the Dallas/Fort Worth area!

Just another ploy to get patients to potentially waste their money on off-the-shelf inserts prior to visiting their podiatrist! A copay is much cheaper and I am so sick and tired of seeing peolpe waste hundreds of dollars on things they find on-line. Then spend months in physical therapy or even need surgery to try to conquer their plantar fasciitis; when they could have gotten better much faster IF the first thing they did was call the podiatrist!

I’m done venting, but for more information on why custom orthotics work check out my patient information pages.

Cowtown Marathon Teaches RunDoc to respect the Distance!

Cowtown Marathon kicked my butt! I'll admit it. I have again been humbled. It happens to all of us from time to time. I thought I was in good enough shape even though I had been lazy in my training lately. Too many things to do, not enough time. I was taught again to respect the distance. Yesterday's Cowtown Marathon in Fort Worth, TX was typical of the marathons I have run in the last two years: Freezing (25 degree wind chill factor), 30 mph wind in your face half the time, and added killer, rolling hills to the mix. I have not had good race karma. I thought White Rock Marathon in December was bad, but this was much worse and very hilly. For the record, I HATE COWTOWN! The last time I had run this race was in 1999. My peeps talked me into running it again because the Austin Marathon weekend timing didn't fit the schedule and this was closer to home. Never again....But truly it was not all the race's fault. It was poorly organized with random water stops and almost no spectators, but that's not why I had a bad day. I've been traveling too much, hadn't run enough (only one 20) and was mentally and physically tired. My absolutely wonderful running peep, Dr Steve Buksh, ran the whole way with me and should get a huge reward for not killing me when I started whining then ultimately crying (yes, that bad of a day). My hamstrings went into a seizure at about mile 16 from all the hills and we walked a good 2 or 3 miles. By 23 miles, I could barely run and looked like an epileptic. Definately not my day...but the lesson learned is to respect the distance. No matter how many times you have run 26.2 miles, it is still a formidable task and not for the weak or unprepared. The marathon humbled me yesterday and I learned my lesson....always respect the distance.

Now we can talk about delayed onset muscle soreness tomorrow when I can barely walk :)

Run Happy ....and respect the marathon or she will beat you into submission!

Funky Toenails? New Laser Treatment Kills Fungus!

My nails are thick, yellow and seem to have something growing underneath them. I’m not a dirty person, how did this happen? Many of my running friends have the same nasty toenails but say the treatment can be worse than the problem! Is this true? What about the new laser I have heard about?

Toe nail fungus strikes across class, ethnic, age and hygiene lines. In fact, one study showed that almost 50% of people over the age of 40 have experienced some type of toenail fungus. Fungal infections are incredibly common, but are more prevalent in athletes (due to toenail trauma) and the infirmed (due to a decreased immune response).

The typical athlete’s foot fungus, called a dermatophyte, is the same fungus that infects your toenails. Fungus loves a moist, dark environment like in your shoes, between your toes. The affected toenails can have a whitish superficial infection or a yellow to brown discoloration under the toenails that seems to destroy the nail as it grows. Long standing fungal toenail look like thick, brownish-yellow mountains growing on the end of your toes. The thickness makes them painful and susceptible to a secondary bacterial infection (paronychia). This infection can be quite dangerous and has been linked to gangrene in diabetics.

How is toenail fungus diagnosed? Diagnosis of onychomycosis can only be made by a toenail biopsy. Your podiatrist can take a small piece of the leading nail and send it for a special stain that shows the fungus. A PAS stain is usually faster and more accurate than a fungal culture, because often the fungus does not grow in the laboratory. Do not assume you have onychomycosis. Psoriasis and other skin disorders as well as chronic trauma can look like fungus. Also, a melanoma under the nails can mimic fungus, but can be deadly if there is a delay in diagnosis. If you suspect you have toenail fungus, don’t delay, see your podiatrist today!

How can I prevent toenail fungus? 1. If you get regular pedicures, bring your own instruments or go to a spa that sterilizes their instruments in an autoclave (like our spa, Health Steps).
2. Clean your toenail clippers with alcohol before you use them if you do your own toenails and make sure to replace Emory boards and orange sticks regularly.
3. We also recommend you regularly clean your shoes with either antibacterial spray like Lysol or even better an antibacterial with an antifungal like Mycomist at least once a month and dry them with a hairdryer.
4. Changing socks regularly (even a few times a day if you have sweaty feet) and keeping your feet clean and dry is also helpful.
5. Keep your athletic shoes dry and also change them regularly. If you exercise regularly, buy your athletic shoes a half size larger than your street shoes so you won’t bash your toenails as your feet swell with exercise.

How is toenail fungus treated? There is a lot of misinformation out there about toenail fungus. I have never told my patients to use white iodine, Vic’s Vaporub or organic cornmeal soaks on their toes. There is no evidence that it works.

Topical therapy should have some penetration of the nail plate like Formula 3 (my favorite), organic tetre oil, Nailstat or prescription (now generic Penlac) ciclopirox nail lacquer. This should be coupled with a nail treatment plan from your podiatrist.

If this doesn’t work after several months, oral medication, like terbinafine (generic Lamisil) or itraconazole (generic Sporonox) may be needed, but these have serious side effects.

There is now a new option for treatment that includes a painless laser procedure to kill the fungus in the toenail with usually one treatment! Think about it, one 30 minute treatment by a painless laser and 6 to 9 months later, the toenails have grown out normal! Too bad we can’t figure out how to make them grow faster! The new PinPointe FootLaser has given us a much better treatment option for eradicating toenail fungus. Unfortunately most insurance companies deem it cosmetic so they don’t cover it, but if you think about all the hassles, copays and the risk of side effects; the toenail laser looks like the best option for most patients.

Remember, no matter how you treat fungal toenails, it takes at least 6 to 12 months for the toenails to grow out completely. Relapse is also common, so it’s important to play offense (treat the fungus) and defense (try to prevent the fungus) at the same time.

Inspiration From New Runners!

Inspiration From Newbies!

This morning I got to spend a few minutes with a new group of hopeful marathon runners who had joined the local Team-in-Training Program raising money to fight Leukemia and Lymphoma. It was 35 degrees and I had to drag my 2 year old with me because of life's bad timing :) I was not in the greatest of moods when I got there, to say the least.

My bad mood cloud almost instantaneously lifted and my mood changes 180 degrees! What amazed me is that you could almost palpate the hope and joy in this group. A cold Saturday morning at 7am and they are laughing, joking and supporting each other in this endevour. These types of moments always reinforce the realization that it is the journey, the miles on the pavement, the friends and peeps we run with who support us, laugh and cry with us, that make marathoning such an uplifting pursuit....a growth experience for all...not the race itself, but the journey to get there.

I applaud everyone who got up this morning, laced their running shoes and headed out the door to run with their peeps.....

Happy Valentine's Day! Here's to the love of the run.......

Painful Blisters on The Run

Painful blisters often plague distance runners. Blisters, as we all know, are caused by friction. Repeated rubbing of damp skin creates more friction than dry skin. Reduce dampness as well as the rubbing, and you'll reduce blistering.
So we all know that to prevent blisters, you need to minimize friction. This begins with shoe selection. Shoes should fit comfortably, with about a thumb's width between your longest toe and the end of the shoe. Remember that this is often your second toe, not your great toe! Narrow shoes can cause blisters on the great toe and little toe. A shallow toe box can lead to blisters on the tops of the toes, while loose shoes can create blisters on the tips of the toes. Shoes that are too big can cause sliding of your foot which can blister the soles as well as the tips of your toes.

Always try on shoes in the afternoon or evening, because feet tend to swell during the day. Walk or run around the store before buying them and then wear the shoes around the house for 1 to 2 hours to identify any areas of discomfort. It often helps to break in shoes by wearing them for 1 to 2 hours on the first day and gradually increasing use each day.

Socks can decrease friction between the feet and shoes. Coolmaxx or synthetic moisture wicking socks or even special double-layered socks can minimize shearing forces. These can wick moisture away from the skin more effectively than wool or cotton can, further decreasing the likelihood of blisters. You can also carry extra pairs of socks to change into if your socks become too damp on a long run.

Another preventive measure is to use padded insoles or moleskin to decrease friction in a specific area. Drying agents can also help. Foot powders and spray antiperspirants are inexpensive ways to decrease moisture. For severe sweating, there are prescription antiperspirants you can get from your physician that provide even more effective drying.

A study of West Point cadets revealed a more than 50% decrease in blisters in those cadets that used spray antiperspirant before running, but many experienced some skin irritation; so test the antiperspirant on a patch of your foot before trying this on the run.

A thin layer of petroleum jelly or Body-Glide can also be applied to the feet to decrease friction. Conditioning the skin by gradually increasing activity tends to lead to formation of protective calluses rather than blisters.

Blisters are a fact of life in distance runners. Almost one in three marathon runners experience blisters at some point in their training.
So how should a blister be treated?

1. If the blister is small and not painful, leave it alone! Place a small band-aid or piece of moleskin over it to protect it and treat the cause so it will not become bigger.
2. Large or painful blisters that are intact should be drained without removing the roof. This is a biological barrier and helps with healing. First clean the blister with alcohol or antibiotic soap and water. Then heat a pin over a flame until the pin glows red, and allow it to cool before puncturing a small hole at the edge of the blister. Drain the fluid with gentle pressure, then apply an antibiotic ointment and cover the blister with a bandage. Change the dressing daily—more frequently if it becomes wet, dirty or loose.
3. Once your blister has been drained, you should treat it as an open wound. Dress it daily with a bandage. Keep it dry and clean for a couple days and if you engage in the activity that caused it in the first place before it heals, take care to provide extra padding and secure the area to prevent any rubbing that may irritate the wound. Change the dressing anytime it becomes moist or soiled and keep an eye out for infection.

When should I see a doctor for a blister?If you experience increased redness, swelling, pain, or green or yellow discharge you should take it to your physician immediately to make sure it's not becoming infected.

Bottom line: blisters are a common annoyance for many runners. These tips should help you conquer this pesky problem before it slows down your run.

Run Happy! And hopefully blister free!