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Runners: Tips for Winter Survival, by Hal Higdon

I was going to write a dissertation on running in the winter season, but I came across this post by the always helpful Hal Higdon and felt he covered the topic well. Click here to read Hal Higdon's advice on surviving the winter "off season".

I Survived Longhorn 70.3!

Yes, RunDoc survived her first Half Ironman!

Wow! We were blessed with a great day for racing on Sunday. Slightly overcast and chilly at the start. The elite wave went off just after the sun came up over the water. What an amazing sight. They are so very fast!! I got in the water on the 5th flight (old ladies ha ha) and spanked the swim! It took about 5 minutes for me to get comfortable, but given the water was 70 degrees I was happy to have my wet suit on. Steady rhythm and out of the water in 44 minutes.

Transition was hilarious. The wet suit strippers unfortunately stripped off the bottoms of the girl next to me (so much for public nudity being prohibited) so she was mortified and I couldn’t stop laughing. I had trouble finding my bike in the sea of bikes but then got changed and off I went. I had to keep a steady heart rate during the bike so I would have something left for the run. I also had to make sure I took in enough nutrition and drank enough so I wouldn’t be dead before I started to run. Rolling hills are your friend, but some killer turns were nasty. I only passed 4 people that were actually moving forward. The other 12 or so were either crashed (sorry Diesel) or were somewhere between throwing up or passing out. Being the stellar cyclist I am (NOT), I think at least 2000 people passed me on the bike.

Oh well, I still got through faster than my goal and after a smooth transition started to run. Well, you may call it running but it was more like a slow crawl at first. Then a walk. My stomach was in knots. After a quick trip to the port-a-potty and a little vomitus, I was feeling much better. Guess I actually ate too much on the bike. I was 4 miles in and started to actually run. The run was three loops so I got to see my awesome cheering section of sherpas three times. They reminded me on the last loop that I would make it under 7 hours if I just kept a steady pace (which at this point was 10 minute miles). Boy did it get hot on the run. Thank God for the cold towels, wet sponges and water stations about every mile. It was amazing to me how many people were walking and crawling at the end. Some were even staggering. I finished with a strong charge and made it in at 6:57:59. Yea! An hour faster than I predicted, and under 7, so Janet’s prediction came true. All weekend she was chanting 6, 6, I know you can do it in 6.

A cold Shiner was my reward after the finish line and a good time was had by all. Worst part of the whole weekend was the drive home (and the sunburn)…Thank God Janet was on sherpa duty and loves to drive! What did I learn? Patience and perseverance mixed with a little stubbornness will get you through, but a few more long bricks probably would’ve helped me take an hour off my time. Off season a new bike is definitely in order and oh yeah….wear sunscreen!

A great first Half-Ironman experience! Funny thing, I hurt a lot less the next day than I did after my last marathon. Guess I will have to try another one next season…who knows maybe even a full in 2011! Run Happy my peeps!

Why is My Second Toe Curling?

A great question was received this weekend from a hiker in Louisiana: I am not a runner but have been hiking with a backpack for over 19 years with a non painful bunion most of the time unless we travel too many miles in a day. My question is most recently I have begun to have pain in my second toe . It appears to be developing into a hammer toe. Are there non surgical things to do? Also who would be better to see a podiatrist or and orthopedic surgeon? Are there devices I could wear at night that might help? Thank you for your time.

Great question! Why is my second toe curling? What can I do about it? Who should I seek advice from?

In most circumstances, your second toe is curling because it is trying to stabilize your forefoot in gait. A bunion deformity (a.k.a. Hallux valgus) causes the weight to shift to the second MPJ (or knuckle). Over time, the flexor tendon causes the toe to curl and eventually a hammertoe can occur. This will then become a rigid deformity of the toe and cause pain in the joint.

Non-surgical treatment attempts to take the stress off the joint using a Budin splint, hammertoe crest pad, or an orthotic with a metatarsal pad. Once the toe is rigid, surgery is neede to correct the deformity and reduce your pain.

The best advice I can give if you are experiencing hammertoe pain is to seek the advice of a board-certified podiatric foot and ankle surgeon. You can find a local one at http://www.footphysicians.com/

Hope this helps! Run Happy! And without toe pain!!

Why is There an Epidemic of Heel Pain?

Why does it seem like there is an epidemic of heel pain in the United States? Everyone I talk to has had plantar fasciitis or at least has heard of it. Many can even spell it correctly. (Isn't that scary!) Most people suffer for months and even years before they seek medical attention. Even those treated with traditional methods seem to take just about forever to get better. And there are more voodoo treatments available than Carter has liver pills. Why is that? Seems to me that there is a lot of money in heel pain!

So let's take a closer look.

What is plantar fasciitis? Simply stated, it is inflammation of the ligament that holds up your arch, also known as your plantar fascia.

What causes heel pain or plantar fasciitis? Most experts agree that plantar fasciitis is caused by too much stretching of the plantar fascia, usually because of excessive pronation or flattening of the arch of your foot while you walk. Some people just have excessive stretch because they have flat feet. Others have really high arches and their fascia is under a lot of stress in normal walking. Some are just too heavy. It can be triggered by an injury like simply falling off a curb, excessive stress by a new exercise program, poorly supporting shoes, and many other increases in stress like a new job or carrying heavy objects. There is even one theory that states that plantar fasciitis is caused by weakening of the muscles of our feet from wearing shoes all of our lives. Hmm...Will have to look at that a little closer in the biomechanics lab.

Why does it afflict so many people? Let's think...oh yeah...most of the United States is overweight. Most people choose absolutely awful shoes to wear due to their sense of fashion. Slaves to fashion usually have painful feet! And the flip flop phenomenon has accelerated the epidemic! Those that aren't fat and in poor shoes are usually crazy obsessive exercise-aholics.

Now that we know why it seems that everyone suffers from heel pain at some point in their lives, how can we treat it without breaking the bank? Let's start simple. Better, more supportive shoes are the key to success. Arch supports if the shoes aren't enough. You need to stop the stress that caused the arch to strain in the first place. Then treat the inflammation with over-the-counter anti-inflammatories, if you can tolerate them, and lots and lots of ice. Slow down. (That's tough for more people) And gently stretch the arch of your foot and your Achilles tendon.

When should you seek medical attention? If you have arch and heel pain for more than three or four weeks, and you have done the simple things to alleviate the pain; it's time to see your podiatrist. Not time to go to the shoe store and spend a bizillion dollars on off-the-shelf inserts and funky "proven to work" shoes. Not time to go to the pharmacy for hundreds of dollars worth of gadgets and creams. Time to see your podiatrist, who is the expert in heel pain.

How will your podiatrist treat your heel pain? Every case of plantar fasciitis is different, but some standards of care do exist for treatment protocols for heel pain.

First order of business: You need to rule out anything else by taking an x-ray to make sure it's not a stress fracture or tumor in your heel bone. A physical exam is also needed to assess why you have heel pain.

Then your podiatrist will usually assess your shoes and possible prescribe arch supports or orthotics if your need them. An injection or two of an anti-inflammatory into the heel is often used to break the pain cycle. Physical therapy is also often helpful. A night splint or brace is sometimes used. And if all else fails, you may be put in a cast to rest the area.

Contrary to popular belief, you do not have to suffer from plantar fasciitis forever. Most patients (>85%) will get better with aggressive conservative treatment. It is tedious and frustrating, but the diligence and consistency in the treatment protocol yields excellent results.

Here is the bottom line: if you seek the attention of your podiatrist early, you will get better faster and your treatment will not break the bank. Procrastinators will end up spending a lot more money and the chance of needing surgery to alleviate your pain goes way up!

Is Your Achilles Tendonitis Really Bursitis?

Did you know that there are more than 250,000 Achilles tendon injuries in the United States each year? Of these injuries, almost 25% require some kind of medical intervention to heal. A fully ruptured tendon requires surgery. Most other injuries can be treated conservatively and will resolve without surgery.

The most poorly understood Achilles tendon injury is actually not an injury of the tendon, but an inflammation of the bursa sac that separates the tendon insertion on the heel bone from the back of your ankle. The fluid in the bursa actually allows the tendon to move smoothly over the bone. When the bursa sac becomes irritated from frequent or abnormal movement, it becomes inflamed and bursitis can set in.

Achilles bursitis, also known as retrocalcaneal bursitis, is a common overuse injury in runners, hockey players, football player and many other athletes. Improper shoe gear and too much, too soon, too fast syndrome are usually the cause of this pain in the heel. It can also be seen in non-athletes who wear poor shoe gear or low cut shoes. Often it is seen in people with rigid, high arched feet.

Bursitis is a painful swelling that occurs in the back of the heel just deep to the Achilles tendon insertion on the heel bone. This inflammation makes it painful to squat, lunge or run uphill. Many shoes press on this area and make the pain worse. Even running on uneven or soft surfaces can increase the inflammation.

First line therapy for Achilles bursitis is rest, ice, heel lifts or heel cups and gentle stretching. Many patients require physical therapy and functional foot orthotics for complete relief of symptoms. Severe cases my even require a period of non-weight bearing casting or bracing prior to physical therapy in order to decrease the inflammation of the bursa. Chronic cases may even require more invasive therapy with extra corporeal shock wave therapy or injection of platelet rich plasma to jump start the healing process. Surgery is rarely needed unless bursitis is ignored for a significant period of time.

Long standing Achilles bursitis can cause significant difficulty in ankle movement and often a spur will form within the insertion of the tendon. Left untreated, this can eventually cause a rupture of the Achilles tendon at the insertion and lead to life long disability. If you are experiencing painful swelling in the back of your ankle, seek the help of your podiatrist early, so you can get back to running quickly and avoid any long term effects of this chronic inflammatory syndrome.

Will I Be Able to Run After Bunion Surgery?

Running After Bunion Surgery?

Great question! I hear this question at least several times a month from my active, athletic patients. Of course, my first response is always, “Are you able to run now?” This is not sarcasm, but a true fact finding mission. If you are unable to run before your surgery, due to the pain in your bunions, then if you can run afterwards - I am a hero! The same goes for the opposite. If you are running pain free before surgery, and really only want your bunions fixed due to the fact you think your feet are ugly, if you can’t run afterwards - you really don’t like me very much!

Let’s talk about this a little more in depth. A bunion is the result of undue stress on the big toe joint, which causes a protuberance of bone or tissue around that joint. Bunions can be very painful, inhibit normal walking, and make it difficult to fit into some shoes. Contrary to popular belief, bunions are aggravated, not caused, by tight shoes. They usually are due to inherited faulty foot mechanics which put abnormal pressure on the front of the foot. Pain is the primary reason patients seek medical attention for bunions. A majority of bunion surgeries are performed on women because they wear tight-fitting, high-heeled shoes that worsen the underlying foot problem and cause abnormal stress to the joint.

There’s good news for anyone considering bunion surgery. A survey in 2003 by the American College of Foot and Ankle Surgeons (ACFAS) had surgery performed by a foot and ankle surgeon to correct bunions within the past 6 to 24 months found more than 90 percent of patients who had the procedure say they experienced significant pain relief, increased their physical activity, and would recommend it to others.

Many runners who can benefit from the surgery avoid it and continue to endure pain because they have heard that surgery doesn’t work and is excessively painful. Their biggest fear is that they may not be able to ever run again! The truth, as evidenced by the survey results, is that advanced surgical techniques have allowed us to effectively correct bunion deformities with excellent outcomes in terms of pain relief and improved quality of life.

Ninety-six percent of the survey respondents identified pain relief as a desired outcome of the surgery, and 86 percent also said they hoped to improve their walking and increase their physical activity following surgery. On a scale of 1 to 10 with 10 representing “much pain,” the survey respondents averaged a score of 7 when assessing their pain before surgery, and the average score dropped to 2 when they assessed their pain six months after the operation. Ninety-two percent said they were able to increase their physical activities -- walking, golf, tennis, exercise -- and 90 percent said they would recommend bunion surgery to others.

That being said, in most cases, we can treat the pain caused by bunions conservatively. In fact, we feel strongly that surgery should be a last resort. We surprise many bunion patients with our ability to help them avoid surgery when they have been told previously they have no choice but surgery. A custom foot orthotic to off weight the bunion in your shoes is often very helpful. Many patients run for years pain free in orthotics before they decide to have surgery. If you have tried all conservative treatment, however, and bunion pain is causing pain or limiting your activity, surgery as you can see, can be a very effective option.

If the pain in your bunions has caused you to decrease or eliminate running from your life, contact our office for alternatives. Do not let the pain in your bunions change your life!

Run Happy!

Huckabee Encourages Health Reform at APMA National Meeting

Huckabee encourages Heath Reform at the APMA National Meeting

Health care reform is on the tip of everyone’s tongue this week. The debates in Congress and the attempt to pass some kind of legislation that most Congress members have not even read, let alone understood, is the news leader. I was lucky enough this week to be present for Mike Huckabee’s keynote speech to the American Podiatric Medical Association in Toronto, Canada. The former governor from Arkansas inspired and encouraged the APMA to discuss more than health care reform but to think of revolutionary health reform in the United States as the answer to our health care woes.

What does he mean by health reform? He encouraged the physicians to stop thinking about fixing the health care system. The system isn’t broken. It is actually considered the best in the world. If you start discussing socialized medicine overseas, you will quickly realize that most wealthy foreigners would rather have surgery or cancer treatment in the US than in their own countries. We don’t need to fix the system; we just need to work on unhealthy American habits. The combination of obesity, lack of exercise and smoking, lead to most of our chronic health problems in the US. The system is overwhelmed by chronic disease! Why not come up with a system that encourages healthy living, therefore decreasing chronic disease and actually increasing productivity in the country?

Mike Huckabee knows a lot about unhealthy living and its consequences. Several years ago he was diagnosed with Type 2 diabetes and was told he was now in the last decade of his life. His physician outlined what death by diabetes looked like and encouraged him to take control of his future. He lost an incredible amount of weight, starting eating better, and even started running for exercise. Multiple marathons later, he is no longer a diabetic and is healthier than he has been in years. Mike Huckabee took control of his health and wants every American to experience this life-changing heath makeover.

Why do most Americans have unhealthy habits? Is it laziness? Is it hereditary? Is it social? Actually it is a combination of all of these things in most people. We need to encourage healthier lifestyles and teach our children the importance of healthy choices. Multiple studies have shown that regular exercise including around three hours of aerobic exercise and an hour of strength training each week leads to decreased depression, diabetes, heart disease and osteoporosis. This has been well documented, but most Americans are not listening.

How can we encourage healthier life styles and off load the currently overwhelmed health care system? How about an overhaul of the health insurance system with incentives for healthy choices? I do not believe in penalizing people for obesity or smoking, but how about incentive discounts for a healthy BMI, non-smoking and regular exercise? Just like when car insurance companies give discounts for safe driving records. We could even put an accumulative healthy point system with sliding scale premiums for regular checkup and prevention programs.

Think of what this type of system would look like. The current reforms of the health care system being discussed will lead to a two tier system where the wealthy will have the best care and the rest will be stuck with the socialist model which has been shown not to work in many, many other countries. If we focus more of health reform instead of care reform, we can decrease the load on the current system, decrease health care expenditures and actually have a healthier, happier, and more productive society. Political parties aside, call or write your representatives and let them know you are unhappy with this rushed consideration of the most important legislation in decades. Let us not quickly put in place a program doomed for disaster that will significantly decrease the standard of care in the American health care system. Let us uplift the health of the American people instead.

Book Signing at Borders Books in Colleyville

Dr Crane's next book signing is at Borders in Colleyville, July 14th from 6-8pm.

Come by and say "Hi!"

Ow Ming! Is Yao Ming's Basketball Career Over From a Foot Fracture?

Ow Ming!

Houston Rocket's Yao Ming's career may be over due to a non-healing foot fracture. He was sidelined during the playoffs on May 8th with a hairline fracture of his navicular. As of today, this has not healed properly. The nature of his non-union and his prognosis is being kept quiet by the team physicians, but it is evident that there is a problem. Most stress fractures heal completely in 6 to 8 weeks. This is not the 7 foot 6 inch center's first fracture. He has been out portions of the last three seasons with stress fractures in his leg and foot. Perhaps his lanky frame just can' handle the stress of the NBA? Why is it that some fractures don't heal?

Looking at his present injury, stress fractures of the navicular (the cornerstone of your arch) are often slow to heal due to three factors, blood supply to the bone itself, underestimating the extent of the initial fracture so delaying aggressive treatment and too much abnormal stress on the healing bone. Other medical issues can delay bone healing like lack of Vitamin D, poor calcium uptake and many other systemic problems like diabetes, hypothyroidism and peripheral vascular disease. Many of these fractures are actually missed due to lack of specific x-ray findings. Many fractures are actually misdiagnosed for months. Plain film x-rays are often read as normal so the fracture is missed until symptoms increase. Early symptoms can be diffuse and non-specific so the index of suspicion is also low. A bone scan, MRI or CT scan can identify the specific fracture. CT scan is often the most helpful in identifying the extent of the fracture and guiding treatment. For a non-displaced stress fracture, cast immobilization is the first line therapy. Studies have shown that non-weight bearing immobilization in a cast for at least 6 weeks is usually around 80-86% successful. For those that do not heal this way, surgical fixation of the fracture can be helpful and a bone graft may be needed for long standing non-unions. New technologies like electronic and ultrasonic bone stimulators and injectable platelet rich plasma can help even the most stubborn fractures.

Follow up care for a navicular fracture often includes physical therapy and custom foot orthotics. Abnormal biomechanics of the foot often are one of the causes of these fractures, so biomechanical control is crucial to distribute the abnormal stress so an athlete can return to sports and have a lower risk of recurrence.

Yao Ming has had multiple stress fractures during his career increasing the likelihood of traumatic arthritis from avascular necrosis (not enough blood supply to heal so the bone crumbles) in his foot causing him to retire. The next few months will tell the tale for this multi-million dollar All Star. Can he heal his fracture and return to sport? The Rocket's fans are praying for divine intervention to cure their dominant center.

Train Smarter In the Summer Heat!

I declared myself heat tolerant this weekend in my recent Twitter. I did a 3 hour bike ride in 99 plus heat at 5pm in the Texas heat and could still spit when I was done! That’s a success in my book! It definitely took 2 full weeks of suffering in the heat and a good hydration plan to finally feel like my body had made the transition to feeling relatively comfortable in the soaring Texas summer heat.

Dehydration, heat stroke and hyponatremia are your biggest worries while training in the summertime. Whether you are in Texas or Rhode Island, when the temperature soars over 90 degrees, heat illness can seriously hamper your endurance training. Most of us have an “A” race on the calendar in the fall and require a lot of base training in the summer. No way around those long runs and even longer bike rides in the heat. The average triathlete can sweat up to one liter of fluid an hour while training and sweat contains about 3 grams of salt per liter. How can we conquer the heat? Preparation and constant hydration! Diligence is the key! Always stay one step ahead of the hydration curve. Remember that heat illness really can kill you and hyponatremia has taken out more than one healthy marathon runner and triathlete!

Here are some simple tips that will help you train safely in the heat:
1. Hydrate all day long. Drink water throughout the entire day. Most people actually start their training runs already dehydrated. Especially when the temperature reaches triple digits, it is important to always have that water bottle near by.
2. Prepare for your longer training runs and rides. This means dropping water bottles along the route before you start or making the route circle around many times so you can stop and pick up more water at your starting point.
3. Drink a mixture of sports drink and water. Definitely mix it up. I always have a bottle of each on my bike.
4. Consider salt tablets if you are running or biking more than 2 hours. Unless you can carry salty pretzels on your run, salt tablets are a must if you are sweating heavily.
5. Never be afraid to get off your bike and run through a stranger’s sprinklers! You may look like an idiot, but cooling off and wetting your clothing can only help you stay cool! Putting ice down your shirt can also be helpful!
6. Listen to your body. Especially in the beginning of your heat training, listen to the symptoms of heat illness. If you are nauseous, cramping, can’t spit, have dry mouth, notice your hands and wrists are getting puffy and you are starting to feel goofy; STOP! Go home to run or ride another day.
7. Avoid anti-inflammatories if you can. Ibuprofen and Tylenol actually can affect your kidney function. This can increase you chances of suffering from hyponatremia.
8. Sunscreen, sunscreen, sunscreen. A bad sunburn will thwart your normal heat-regulation system. Heavy duty 70 plus water-proof sunblock is your friend!
9. Weigh yourself before and after your training. Replace your weight loss with more fluids.
10. Carry money. You never know when you may get lost and need to stop at a store for more sports drink or water.
11. Train with a friend. They may notice your symptoms of heat-illness way before you do. Denial is never a good companion.

Heat-illness is real! Be smart while training this summer! Follow these tips, heat acclimatize over a period of several weeks and be diligent about your hydration plan while training in the heat. Let’s get to those fall races stronger and without any heat-related training drama! See you on the run!

Denna Kastor Talks About Taking a Break After Breaking Her Foot at the Olympics

There was a good Q & A in Running Times talking to Deena Kastor about her foot fracture at the Olympics. I think it's funny that she broke the same bone I did last year. Her discussion about the need for rest and recharging sounded like an echo. I think it is so important for us to realize we need rest after an "A" race or marathon. Also, as women, we need to understand the relationship between Vitamin D and the uptake of calcium. To read more about Deena's injury click here for the complete article. For more on metatarsal fracture in runners, click here.

Run Happy! Rest easy....and more than anything else...run forever my friends!

To purchase a copy of Dr Crane's new book "If Your Running Feet Could Talk" click here.

Running With Arthritis

Running Forum Questions:

I recently received this email from a runner in Virginia asking a good question on running with arthritis:

“I have been running since I was 13yrs old and I am 42 now. Friday I was diagnosed with osteoarthritis after 6 weeks of no running but cross training on the elliptical. The doctor thought it was tendonitis but after not getting better he decided a MRI would be appropriate. The MRI confirmed it was osteoarthritis. I am starting physical therapy on Monday 3x a week.

My question: Is it possible for a runner who has osteoarthritis to be able to run again. I feel like my world has been rocked and shaken. Running is HEAVEN for me and nothing compares. It is my total stress reliever and if I do nothing else in a day if I've run my day is totally complete. I am the mother of 3 great kids and I guess I should be thankful I can do the cross training now because I get cranky when I don't get to do something. I just feel like this means my running career is over. My mileage before getting injured was about 25 a week.

Please let me know your thoughts. I have searched the internet for help on other runners who are going through what I am and have osteoarthritis of the foot with no luck so far. Thank you so much for taking my comment. I'm praying for a miracle. I know it's not life threatening but it's my mental state I'm concerned about.”

RunDoc Answers:

Let me start my answer with a story. I have a runner in his late 30’s as a patient who had the unfortunate luck to be blown up in the Desert Storm conflict while he was serving in the Marines. He has severe arthritis in both feet from his injuries. He has had at least 5 foot surgeries including a fusion of his subtalar joint in one foot. He ran the 2008 Marine Corps Marathon in less than 41/2 hours. If he can run a marathon on feet that are that bad, I am confident that you can get back to some kind of running.

The name of the game is accommodation. You will need a great pair of orthotics made by a podiatrist that knows what they are doing and specializes in biomechanics. They can fabricate a device that will transfer the stress from the arthritic area to a strong, healthier part of your foot. That coupled with physical therapy, core strengthening exercises and a good pair of running shoes will get you back on the road! For more information on living with arthritis click here!

Run Happy! And Pain Free!

How to Cope With Race Day Jitters!

It’s just a few days from a big race and I’m already anxious. What am I afraid of? Running a bad time? Totally bonking? Looking stupid in front of my friends and patients? Drowning in the open water swim? Getting a flat tire? Perishing on the street? Where does all this performance anxiety come from? After 30 years of competitive running you would think I would have conquered race day jitters, but they are always there…kinds like an old friend…or a fungus….

So, how do I cope with race day jitters? Positive self-talk, preparation, visualization and organization!

A race is just another long training day in the company of a few hundred, or sometimes a few thousand, of your closest friends. Most anxiety comes from fear of the unknown and lots of negative self-talk. Reality – your friends and family really don’t care what your time is, whether you place or not, and the world will not end if you run a bad time! My patients are just amazed this old lady is still racing! Times are irrelevant! Setting high goals will just stress you out! Focus on running your best race that day! Relax! Have fun! Go into the race realizing you have nothing to lose and everything to gain. I treat every race as a learning experience. Even if you get kicked in the face in the swim and lose your goggles, get a flat tire or totally bonk on the run; you learn something you can use another day!

There are many things you can do to stay relaxed. Here are just a few I have learned along the way:

1. Be prepared! Have a pre-race checklist of everything you need. Set out all you clothes and gear the night before and go through the list. This includes checking your bike tires and inflating them. Finding a flat the morning of the race will send your heart rate through the roof. I set everything out on the living room floor then pack my bag. The bike goes on the car the night before after a thorough check. My nutrition is all set out and the coffee pot is prepped!

2. Never change anything the day of the race. This is not the time to try that new pair of Newtons! Stick with your routines. Treat this as just another long training day! Eat what you would normally eat before a long workout. Extra sleep always helps, so go to bed early!

3. Go to the race with a friend. Having your peeps with you can really help diffuse anxiety. Travel to the race together and help each other calm down. DO NOT let your friends make you crazy. Some people actually feed off others anxiety. If this is you, you may be better off with your Ipod as your friend while you set up your transition!

4. Visualize finishing. Visualize the entire race the night before. Go to the race website if you are not completely familiar with the course. Visualize a nice calm swim, a smooth transition, an awesome bike and a killer run! See yourself run a PR. My best races have been played over in my mind a thousand times before they ever happened. Remember what it felt like the last time you had a great race! Embrace that feeling!

5. Get to the race early. Get organized! Find the bathroom and then relax. Warm up and keep up the positive self-talk! Remind yourself that you have done the work and the race is just a celebration of how hard you have pushed yourself and your mental toughness! Claim your reward!

Race day jitters can completely derail your race before it has even started. Don’t let the negativity ruin all your hard work and preparation! Relax! Follow these tips and remember to banish the negative, and stay positive throughout the race! Try to have fun! Whether this is your first marathon or your 100th triathlon, remember to celebrate your training and have a great race!

Fat Parents Have Sick Kids!

I heard a statistic today that startled me. If you are born after the year 2000; you have a one in three chance of having diabetes. One in three! That is truly scary!

A second frightening statistic is that this is also predicted to be the first generation of Americans that will not live longer than their parents.

Why? Both of these sobering statistics are a direct result of childhood obesity and a sedentary lifestyle. What are we doing to our children? We owe them a better future. Politics aside, we are already mortgaging our children's future with our current economic issues and national debt. We are also dooming them to suffer from many chronic illnesses by the lifestyle we are teaching them by being lazy, fat Americans.

The typical American diet has substantially changed in the last generation. We no longer sit down to family dinners and tend to look for quick, often drive-through solutions. Our generation has more food choices than ever before; but tends to choose the fast, more often less healthy, alternatives. Why? Laziness! We are so busy trying to be super-productive that we don't take care of ourselves or our families. Our children are mirroring our behaviors when they make their food choices.

Exercise? Not most Americans. The minimum recommendation is to engage in moderate exercise at least five days a week or 20 minutes of vigorous exercise (aerobic activity) three days a week, plus to do strength training twice a week. A recent polling showed that only 17% of Americans managed to find the time to lift weights at least twice a week and engage in vigorous exercise three times a week or at least moderate exercise five times a week. Only 50% exercise at all three times a week! What kind of example is this for our children?

Many parents feel our children get their exercise from physical education classes in school, but less that 50% of school children have some kind of physical activity every day in elementary school. This number worsens as they progress in the school systems. Our children's activity level has plummeted dramatically in the last generation due to lack of physical education, lack of unsupervised play, computers, Internet, video games, etc. We can not depend on the school systems to teach our children to exercise and eat right. This must come from the example set by their parents. Right now, most Americans are setting a poor example!

Americans are not suffering from a lack of information. Most know what to do, yet choose not to. Since the early 1980's, the benefits of exercise has been preached on every street corner, yet we don't listen. Nevertheless, the cultural changes in the past decade have been so staggering in terms of decreasing physical activity in every sector of life and increasing the intake of garbage calories and fast food, that nothing short of a major paradigm shift is necessary!

Bottom line: a combination of obesity and lack of exercise contributes to more than 300,000 deaths each year in the United States as a result of heart disease, stroke, diabetes and other conditions. The statistics for the next generation are even more onerous. Only through changing our behavior patterns can we influence our children's future behaviors and reverse this trend.

Dr Crane's New Book Available Now!

Dr Crane's new book : If Your Running Feet Could Talk now available on Amazon.com

Click on the title for more information.

Dr Crane has written a prescription for surviving and avoiding injuries on the run. This book provides practical advice and resources to the running community to keep you running healthy and strong. It is meant for the novice and intermediate runner who needs solid advice on getting started, training programs, aches and pains, and recovery. Persistence and determination is the key to surviving then ultimately avoiding most running injuries. This book couples years of blood, sweat and tears on the pavement with sound medical advice for all runners.

Please enjoy and send your comments for the next version to contactme@myrundoc.com

Run Happy!

Confessions of a First Time Triathlete

This blog is a guest writer...Janet Dixon, my sidekick pedorthist proves how tough she really is. I am so proud of her....here is the story of her first triathlon!

Well folks, I finally did it. I finished my very first triathlon. I also had every possible thing go wrong today as well.....

So - I wake up at 450am. I thought hey, we are close by and since both Dennis and Claire were joining in as a cheer section for me, we can sleep in a bit longer. That was the first mistake.
Woke back up at 515am. Tummy is grumbling - so are you hungry or are you nervous? Suddenly a bowl of cheerios seemed to be the thing to do so I have at it. At this point I am pretty darn calm and ready to roll. I look for Claire and guess what - the 12 year old is still out like a lightbulb. So I chill as I hear Dennis yap at her to get up. She rises - takes a shower, we now are in human form.

Departure time scheduled for 545am. Hmmm - stomach is feeling funny. Here comes the nerves. I make one last stop to the restroom - much better. Time is now 555am.
Arrive to the race and we are guided to the overflow parking lot a block down. Darn it...should have got here earlier. My cell phone rings and it is Marybeth. I decide to mess with her and tell her I am still sleeping. She reacts, I laugh and tell her I am actually in the area.
So, rule number one - GET TO THE RACE EARLY!
Bike and accessories in tow, I head to transition. I am SO GRATEFUL, I elected to have markings done the day before at packet pickup. There was a huge line and it felt great to squeeze right past folks.
Rule number two - GET MARKINGS DONE EARLY IF OFFERED!

I head to transition and all of a sudden, I am nervous. Now remember my deal a few weeks back on getting into the unitard? Yeah...a two piece seemed to be such a better option at this point.
So I rack my bike and I am a happy girl! I find Marybeth who at this point is thinking where the hell is she and I surprise her in my zingy way. One problem, she tells me I am racked at the wrong bike rack....darn it!
Rule number three - MAKE SURE YOUR BIKE IS RACKED CORRECTLY!

Ok, so I feel pretty stupid and I am still in need of facilities - big time.
I look for Dennis and Claire and calm down. I tell myself, look nimrod, this is just to see what happens, to finish the race in one piece then look to see where I can improve for the future. Remember, I am and will complete a half ironman in less than six months
So facilities time - of course, as usual, there is a women's restroom line but not for the dudes. So unfair I thought. Finally, the visit to the facilities is complete. I feel fabulous!

The wait for the pool was interesting. Triathletes come in all shapes and sizes. I told myself to stop worring about what I looked like in my second skin. By the time September rolls around, I will have hopefully lost a few rolls of my own if you know what I mean.

The swim begins, I jump in. Water feels great! I start to swim....I am excited, I am doing this, I have propellers for feet, I am so glad to be doing this....I don't breathe! All of a sudden a foot nails me in the right side of my neck. Right where I had a neck injury. Right arm immediately goes numb. I almost call it and get out of the pool - no, I tell myself, you can manage this now breathe and move it!

Rule number four - PACE YOURSELF IN EACH LEG OF THE RACE.
After 150 yards Janet is tired....Janet can't breath right, Janet went out WAY TOO FAST! So, I flip over and backstroke the rest of the race. I don't care, I am not taking first place - I am here to finish. Ok I thought, I will pace more during swim training - I just learned to swim starting three months ago so I don't beat myself up for this.

Ah, transition! I found my bike - good sign. Wait - where is my computer at? Crap, it's in the bag. What felt like an eternity I finally found the Garman. I am feeling disorientated - I can't get the stupid Garman on my bike! So with computer in hand, I begin the ride.
Rule number five - HAVE AMPLE TIME IN TRANSITION TO ENSURE EVERYTHING IS LINED UP.

So off I go on the bike. Ah, things feel much better. As I cycle, the Garmin magically fits on the holder and I grab something to drink. YES! I watch my pace climb to 18, good - now hold it I thought. Hmm - did I fail to mention it was a very WINDY day? Oh wait, it gets better. Half way through my chain falls off! Can you believe this? Luckily, I got the oily thing back on - gross I thought. Yep - that affected my ride a bit however, the bike portion I can tell is going to always be my favorite part of a triathlon.

Transition #2
I was completely ready to jump off my bike at the right time and I did. I was impressed. When my feet hit the ground - oohhh what a weird feeling! Trying to run after cylcing is really weird. My brain was ready however my feet were not. I racked the bike - no idea if it was right or not, threw on my running visor, grabbed my running belt. SNAP - running belt and bib number detach from one another. So what, it's still hanging on by one loop - move your arse I tell myself.
Ok - so what rule are we on? Ah yes,

Rule number six - YOU MUST STAY CONSISTENT IN EACH AREA OF A TRI AND TRAIN APPROPIATELY. Yep, all those days in the pool, cycling...what about running? Hmm - my bad.
Running at this point was mute. I ran the first loop and suddenly I was tired. Oh gosh I thought to myself, I am going to walk during a measly 5k? What a hosebag I thought to myself. So, I walked a bit. Then I felt bad...then I got mad. Why didn't you prepare - what is wrong with you - if you come in last, you will let Marybeth down - where are your expectations - you are embarrasing yourself. All this past through my head then my stomach took over...I was hungry. Where is my gel? Yep - BACK AT TRANSITION! Sooo......Rule number seven - make sure you have adequete nutrition for each stage of the tri. So much for the cheerios and one goo before the swim - I want to eat. In fact, I want to chew off my right arm...I AM HUNGRY CAVEMAN GIRL....

Then I see members of the running club yelling out my name, starting running you goober I thought, you can't look that bad to your running group. So I pick it up until over the hill, I start to walk. Darn it...

Second loop felt like mile 19 of a marathon. I am amazed how hungry I am. Marybeth shows up. Springy and happy like she just woke up - note, she finished a half hour ago - she runs me in. She tells me we get a medal. We do? I didn't know that. Well, heck , I have to start running!
Now on top of starving, I mentioned previously I had a cervical injury. I lose my right index finger feeling. I don't want to stop however I fess up and tell her I have to walk. I feel like I am the biggest dope for walking. The throbbing stops, I try to run - comes back.

Finally, the last hill - I slow jog it in. I finish.
I thank Marybeth for her kindness and spirit. I look over to my right and see Dennis and in an instant, all of the insanity that happened during the race didn't matter. I find Claire - I am good. I did it...slowly, but I did it.

I will be a half ironman - you watch. It will probably scare a few people, it will surprise many. I am hooked. Next tri - no walking and I will forever have the above seven steps inbedded in my brain.

I learned today.
I am a triathlete.
I am caveman...girl!

Now go out and do something good for yourself today, I will be running a bit more...... ;)

Newton Shoes Make RunDoc Faster in Triathlon!

Congrats to all who finished King Tut Triathlon in McKinney Texas today!

RunDoc finished her second triathlon today! Not a pretty picture, but not bad for someone who has no idea what she is doing! This was my first open water swim. So much for getting ready in a pool. Does not prepare you for sighting and then looking up and getting blinded by the sun. Had no idea where I was and according to my family, who were spectating, at one point I started to drift toward the shore. Instinct I guess. I finally got back on course and finished but scared me to death :) But I wasn't last, so not so bad :) Did I mention the water was 62 degrees....brrr!

On to the bike. A rolling, hilly course and I had a nice slow ride...ha ha...It took me at least 10 miles to be able to feel my hands and I still couldn't feel my feet when I got off the bike....

On to the run....Thank God for my new Newton shoes! (Did I mention they are hot pink?) I still couldn't feel my toes but they forced me to throw my center of gravity forward and helped me get my stride. They were like a friend helping me get my groove back after the bike:) My run was decent but not outstanding, but would have been much worse if I had worn my regular training shoes! So kudos to the Newton guys today (That's for you Diesel)

Overall...I lived for another day...I may have been running for 30 years, but this triathlon stuff is a work in progress.

Bottom Line...I had fun today...came in 10th (not last) so on to Caveman Tri in Flower Mound next week.....

Run Happy and try a pair of Newton's at your next race!

PS. A Great Big THANK YOU goes out to Janey Dixon for getting up at 4am, driving me to the race, cheering for me, then giving me a Shiner at the finish! Love Ya!

Are Runners More Susceptible to Upper Respiratory Infections?

Do You Have a Spring Cold? Sinus Infection? You Are Not Alone....

I’m just getting over a spring sinus infection. Again! I’ve always considered myself a middle-of-the road, moderate intensity runner. I run two marathons a year and dabble in triathlon in the spring and summer. Nothing crazy. Yet, every spring I seem to be susceptible to the dreaded runny nose syndromes. I’ve always chalked the whole thing up to Texas allergens, but is that it? Or does my running make me more susceptible to the common cold? Interesting question posed to me by an ENT colleague. She pointed out that many marathoners experience significant increase in upper respiratory infections in the post-race months.

Let’s look at the research. A recent survey of 30 different studies of runners and decreased immune function that may lead to increased upper respiratory infections revealed little agreement from the experts. Yes, they all agree that moderate activity may enhance immune function, but they describe this as brisk walking for 30 to 45 minutes a day. What runner does that little activity? Most studies also agreed that high-intensity exercise temporarily impairs the immune competence. Hence the increased incidence of upper respiratory infections in marathon runner and especially ultra-marathon runners.

Athletes, when compared with their couch potato colleagues, experience higher rate of upper respiratory infections especially in the few weeks after intense training and races. In non-athletes, increasing physical activity is associated with a decreased risk of upper respiratory infections.

This so-called open window of altered immunity is temporary, lasting from three to 72 hours after an intense, prolonged event. Nevertheless, it presents an ideal opportunity to viruses and other invading pathogens, especially those that enter the body through the respiratory system.

Sounds bad, so what can we do to increase our immunity and avoid the runny-nose syndromes?
Several vitamins and minerals, including vitamins A, E, and C, and the minerals zinc and iron, are essential for normal immune function. Vitamins C and E, in particular, are also powerful antioxidants. It has long been known that long-distance running and other endurance events can increase the levels of free radicals—molecules that oxidize and cause damage to cells, including immune cells. The body produces its own antioxidants to counter free radicals and oxidative stress.
Many runners, operating under the theory that more of a good thing is better, take vitamin and mineral supplements. And while moderate amounts may very well be beneficial for the active individual, there is little evidence to support taking megadoses, with the possible exception of vitamin C. Some studies found that taking vitamin C (about 600 milligrams/day) for three weeks before an ultramarathon reduced postrace cold symptoms. Other researchers have found that vitamin C supplementation made no difference. Sounds like a multivitamin with extra vitamin C can’t hurt, but may not be our savior!
Should you run when you’re sick?

If you have a cold, most doctors recommend waiting a day or so after your cold symptoms disappear to resume intensive exercise. Mild to moderate exercise (such as walking) when you have a cold is fine. If your illness is more serious—fever, fatigue, muscle aches—you should wait two to four weeks before resuming your training regimen. Like any of us do that!

Just as intense, extended physical stress can depress certain immune responses, so too can chronic psychological stress and inadequate sleep. So during periods of intense training and before long races, the take-home message is this: keep other life stresses to a minimum if possible. Get enough sleep, avoid rapid weight loss, and eat a healthy diet. Sounds like a no-brainer!

Bottom line: marathon runners are more susceptible to upper respiratory infections. Getting more sleep, decreasing your overall stress and taking a multivitamin with extra vitamin C may help.

Power Naps Boost Productivity!

Here is an essay on the power of the nap!

I pride myself on getting more done on a daily basis than your average bear. My secret? The Power nap! And a great list!

Recently, on Facebook, one of my friends commented that they didn’t see me as a napper. Probably because most people see me as a hyper whirlwind of activity. What they don’t see is that I have two speeds: Fast and stop!

I truly believe in the power of the nap! I have a comfy couch in my office and have been known to take my 20 minute power nap when the paperwork and activity list is out of control; and I just need a few minutes to focus. Works for me and makes me more productive.

For all you unbelievers out there here is a little science to back up the pro-napping stance!

While small children typically take naps in the afternoon, our culture generally frowns upon mid-day sleep; however, even in those who get enough sleep (but particularly in those who don’t), many people experience a natural increase in drowsiness in the afternoon, about 8 hours after waking. Why not take a little nap? Research shows that you can make yourself more alert reduce stress and improve cognitive functioning with a nap. Mid-day sleep, or a ‘power nap’, means more patience, less stress, better reaction time, increased learning, more efficiency and better health. Here’s what you need to know about the benefits of sleep and how a power nap can help you!

How Much Sleep Do You Need?
The body needs 7-8 hours of sleep per day; 6 hours or less triples your risk of a car accident. (Interestingly, too much sleep--more than 9 hours--can actually be harmful for your health; recent studies show that those who sleep more than 9 hours per day don’t live as long as their 8-hour-sleep counterparts!)

The Effects of Missed Sleep: Sleep is cumulative; if you lose sleep one day, you feel it the next. If you miss adequate sleep several days in a row, you build up a ‘sleep deficit’, which impairs all kinds of things:
1. Reaction time
2. Judgment (scary that we sleep deprive our resident doctors)
3. Vision (maybe a nap will get rid of those reading glasses, ha ha)
4. Information processing (Yes, that means thinking)
5. Short-term memory
6. Performance
7. Motivation
8. Patience (especially with stupid people and small children)

Fatigued people also experience more moodiness, aggressive behaviors, burnout and more stress. (If this sounds like you, you need a nap!)

The Benefit of a Power Nap: Studies show that 20 minutes of sleep in the afternoon provides more rest than 20 minutes more sleep in the morning (though the last two hours of morning sleep have special benefits of their own). The body seems to be designed for this, as most people’s bodies naturally become more tired in the afternoon, about 8 hours after we wake up.

How Long Should I Sleep?
Many experts advise to keep the nap between 15 and 30 minutes, as sleeping longer gets you into deeper stages of sleep, from which it’s more difficult to awaken. Also, longer naps can make it more difficult to fall asleep at night, especially if your sleep deficit is relatively small. If you only have 5 minutes to spare, just close your eyes; even a brief rest has the benefit of reducing stress and helping you relax a little, which can give you more energy to complete the tasks of your day.

Tips For a More Effective Nap:
If you want to obtain more sleep, and the health benefits that go with getting enough sleep, here are some tips for more effective napping and sleep at night:
Avoid too much caffeine after 3pm. It’s a stimulant that can disrupt your sleep and stay in your system longer than you think; its half-life is four to six hours!
If you don’t want to nap a long time, set an alarm!
If you don’t have time for a power nap, or don’t feel comfortable napping during the day, try yoga or meditation; it gives your body a rest and produces slower brain waves similar to sleep.

I praise the power of the nap! Try to incorporate a power nap in your day! You will thank me!

Got Toenail Troubles?

Toes can be a runner's weakest link. For some, it's the knees, for others, the back. And for many, the toes, or at least one of them, can be the problem that tortures an otherwise trouble-free runner. Any runner can get into toe trouble with the right (or wrong) conditions. From blisters, corns, and calluses to stress fractures and ingrowns, those cute little toes can become a big headache.

Toenails alone can be the source of a long list of troubles. Chief among the potential problems is the ingrown toenail--with or without infection. Other, not too pretty problems, are nail thickening due to fungal infections, black toenails due to repeated trauma, and of course other irritations, inflammations and infections. Here are just a few common causes of troubled toenails.

Ingrown Nails

You may be familiar with the warning, "Don't cut the nails too short." Trimming too short can cause the leading edge of the nail to grow forward and cause pressure on the soft tissue at the toe tip. Although this can happen, by far the more common cause of ingrown toenail, and the pain that goes with it, is the curvature of the nail into the tissue on both the medial (inner) and the lateral (next to the other toes) sides of the nail. You can get the picture by looking head-on at your thumbnail. From this vantage point, it looks as if the nail were clipped onto the top of the thumb. Toenails follow a similar curve.

If there is excessive pressure on the nail against the soft tissue from the forefoot of the shoe, problems can develop. Pressure on the side of the nail, where the toe touches the shoe, can push the soft tissue against the incurved edge of the nail. Then the toe gets inflamed, enlarges, and more pressure is felt on the toe. With enough pressure, the nail edge will break the skin surface allowing bacterial or fungal contamination into the toe, causing infection and even more swelling and pain. The warm sweaty environment of a running shoe makes an ideal site for proliferation of infection. Infection can spread around the rest of the nail, further increasing pressure and pain.

Using local antibiotics like bacitracin and antifungal creams may help, but it's hard to reverse an ingrown, infected nail without an office surgical procedure using local anesthesia. See your podiatrist! Never try to cut the nail "to relieve pressure" yourself. This is a recipe for disaster. It will heal faster and better with a smaller chance of recurrence if you see a podiatrist for treatment. Ingrown toenails do not lend themselves well to bathroom surgery.

Runner's Nail

Long distance runners and ballerinas both may be known for their athletic prowess and war-worn, beat up feet. Thickened toenails are so common among long distance runners, the condition has been dubbed, "Runner's Nail." The thickening and changes in color are caused by repetitive pressure of the shoe on the nail. The resulting thickening makes the nail even more vulnerable to additional problems since it is raised closer to the top of the shoe. These can be treated with a urea compound to soften the nail.

Fungal Toenails

A fungus (like the one that causes athlete's foot) can infect the nail and also cause thickening and discoloration of the toenail. This problem is distinguished from the Runner's Nail by infection. The fungus invades the nail when there is an injury or trauma, which may be so subtle you don't even know it is there. Once infected, a fungal nail is very difficult to treat. New laser therapy works, but prevention is a much better bet. If you notice changes in your toenails, see a podiatrist for diagnosis and treatment.

Black Toenails

Although you can get a black toenail from a sudden, painful trauma that causes bleeding under the nail, for runners it is more likely a chronic, repetitive trauma to the nail caused by short shoes, running downhill, or wearing loose shoes. This repeated micro-trauma causes only a light amount of bleeding and minimal pressure buildup, so little or no pain is felt. In many cases, you only realize this is happening when you notice your toe is discolored. But don't ignore it. The nail can gradually become thicker, and more problems develop.
Eliminate the cause of the irritation, and a new nail will gradually form. It takes six to nine months for a new nail to form, so be patient. If the nail thickens, you can file it down. If there is pressure and pain under the toenail, see a doctor. Drainage from a blackened nail can be a sign of melanoma and should not be ignored.

Why did that toe turn on you?

Trauma, either acute or chronic can contribute to all of these toenail troubles. Trauma--like stubbing a toe--can cause changes in the growth pattern of the nail and eventually it can cause thickening, discoloration, or infection. More often, excess pressure and repetitive trauma is caused by the mechanics of the foot inside the shoe.

Trauma can come from shoes that are too small or shoes that don't grab the midfoot firmly. If the shoe is too small, every step causes the toes to press against the front of the shoe. Tight shoes restrict blood supply to the toes, increasing the risk of infection. If the shoe doesn't grip the midfoot adequately, each time the shoe hits the ground and stops abruptly due to friction, the foot will slide forward unless it is firmly held in place inside the shoe. Momentum forces the foot forward inside the shoe until the toes collide with the front portion of the shoe.
It is important to prevent this sliding or pistoning of the foot inside the shoe. If the shoe comes up high enough on the front of the foot, it can help prevent the foot from sliding forward by holding it at the ankle. Most running shoes, however, don't come up high enough to be effective. In most cases, the lacing across the midfoot has to do the job. You can also glue extra tongue padding in the shoe for a tighter grip on the foot. The extra padding allows the laces to be tighter without pain. Both the padding and tight lacing stop the foot from sliding forward in the shoe.

The best way to prevent most of these problems is to get the right fit. Find a running shoe store where the employees are professionals who understand runners' needs and the differences in the shoes the sophisticated industry is producing. Shop late in the day or after a good run to allow for the natural swelling of the foot. Don't rely on street shoe size or assume that the size is the same from one shoe to the next. Try on both shoes, lace them firmly, and run. A good running shoe store will let you run up and down the block. Get a promise that you can return the shoes after several days of wear inside at home. Don't ever expect running shoes to "break in." They need to fit well from day one.

As you can see, toenail troubles are often from self inflicted trauma or trauma from shoes. If your toenail are looking funny or painful, see your podiatrist for answers to your toenail troubles.

Physical Education in Schools Severely Lacking!

Childhood Obesity in the News Again!

I was watching ESPN this morning while I was eating my breakfast. Yes, this is my usual morning routine as a sports junkie! A story came on that I felt compelled to share with my readers. It highlighted a cause that is near and dear to my heart: Childhood obesity. So many of my adult patients are obese and if we curb this trend in our children, they are much more likely to be healthier adults. As a parent, I make sure my children are as active and healthy as they can be. Obese parents tend to have obese children. We need to break the cycle.

Here are the highlights of this story:

There's a childhood obesity crisis in the country, virtually any expert will tell you, and there is no shortage of reasons: increasingly sedentary lifestyles driven by video games, television and computers; a fast-food society in which soda machines and greasy cafeteria food are ubiquitous in kids' lives; and dwindling opportunities for exercise, particularly during the school day.

Put simply, at a time when every penny is being pinched by every school in every district in every county in every state, physical education is taking a beating. The experts and educators say there is no doubt that the erosion of P.E. has been a major contributor to the skyrocketing obesity rates.

And, of course, the more kids are unhealthy, the less they can exercise. This is their circle of life.
The National Association for Sport & Physical Education -- a non-profit organization made up of P.E. teachers, coaches, athletic directors and other professionals advocating for physical activity -- says students should receive 150 minutes of P.E. per week.

How many schools actually meet this standard….almost none!

For the entire article and video click here.

Take home message: we cannot rely on our schools to provide physical activity for our children. As parents, we need to turn off the TV, video games, and computers. Make our children go outside and play. Make healthy play a family tradition. On cold, rainy days teach your children stretching, yoga, or get small dumbbells and do a strength workout with them. Make it fun and most of all…share it with them! This will make family time a healthy time! Memories are made of this and your child will thank you when they are a healthy adult sharing the same kind of family time with their children!

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!

Got Heel Pain? Video Blog

RunDoc discussed heel pain and its many causes as well as treatments



For more information on adult heel pain, click here!

For more information on pediatric heel pain, click here!

Cold Weather Slowing Your Runs?

In Texas, the saying goes that if you don’t like the weather; wait 5 minutes, it will change. This week alone it’s been 70 degrees and 24 degrees. No wonder the whole world is sniffling. Personally, I hate the cold. I’m a tiny person so I’m very cold intolerant. My bike goes inside on the trainer when the weather hits 40 degrees and I look like an Eskimo running. How do we keep motivated during the winter? Things seem to change for me when it’s cold outside. It seems much harder to get out of bed, much harder to run out the front door and a whole lot harder to finish a long run.

In spite of my obvious aversion to cold temperatures, I have trained for years all winter long. In Texas, this means crazy temperature swings. As a teen, in Rhode Island, it meant bitter cold and snow. In fact, I can remember as a high school cross country runner racing in snow and ice and wearing shorts (like an idiot). Training in the cold can make you tougher, but take some advice and dress for the elements. Thank God they finally invented cold weather gear that does not weigh a ton and make you look like you are ready for skiing, not running!

The real goal of cold weather running is to maintain motivation, not get too cold and not get too hot. Easier said then done! One solution to this is to just head indoors and stick to the treadmill. I absolutely despise running on treadmills much more than running in the cold, so unless it’s raining; I’m outside. In addition to the boredom, the repetitive motion of the treadmill can put you at risk for other injuries such as stress fractures. It’s best to have some variety.

The key to staying comfortable and cold weather condition is to be prepared for changing temperatures. Dress in layers and don’t be afraid to overdress. Wear a hat and gloves. I even pull out chemical finger warmers if it’s really cold. If it all possible try to run small loops somewhere near your car or a place where you can discard layers if you start to get hot. You don’t want to be nine miles from home and running with hat in hand, sweating with two jackets tied around your waist.

If you are overloaded with too many layers, you can just as easily overheat when it’s 30° outside. This will make you nuts because you will lose the energy needed to finish your run, just like a hot day, and you may become soaked with sweat be more prone to thermal injury such as frostbite. As soon as your run is over, do not stand around outside. Immediately change into dry clothing. Your core body temperature will drop precipitously immediately after a run. This is why they always shroud you in a blanket at the finish of a marathon, even when it’s hot outside.

Aside for making sure that your temperature is regulated, there are special environmental considerations when running outside in winter. If it happens to snow where you run, you obviously have to watch your step. Be very careful running on ice. Running on snow is easy, but ice will put you on your back before you know it. If you’re lucky it’ll just be an embarrassing fall, but you can get seriously injured this way.

Always wear a hat to keep your head warm. This can be a baseball-style cap, but once it gets colder than about 40° however, you will likely have to switch to a knitted cap that will do a better job of keeping your head warm. It likely goes without saying that you should avoid natural materials such as cotton, that retain moisture and can put your risk of getting too cold. Always use synthetic materials.

As a general rule, you can get away with shorts or tights and a long sleeve T-shirt when it’s in the 50s. If it drops down into the 40s, you need to add a hat, gloves and an additional layer on top. A vest is a nice addition. Once it gets down into the 30s, it’s better to stick with tights or pants and wear three layers on top, as well as hat and gloves. If you’re brave enough to run when it’s in the 20s, you might also want to wear a jacket on top of your many layers. Unless you really like to torture yourself, or live in Alaska, it’s probably better to just stay inside when the temperature drops into the teens.

Keep in mind, your body can become acclimatized to colder temperatures if exposed to them often. However, for people like most of us who are only rarely exposed to cold temperatures, they’re more likely to be a poor judge of when frostbite or other cold injuries are starting to set in. Use common sense. Texas weather is nutty, so the layered look is a must this time of year!

Walking Program to Kick Start New Year's Resolution

Many of our patients, much like their estimated 75 million obese neighbors, are stuck in a never-ending, life-threatening cycle: Obesity aggravates the pain in their feet; sore feet make it almost impossible to exercise for weight loss; and without exercise, their weight continues to increase which puts them at risk for worsening of diabetes, heart disease, high blood pressure, stroke and other life threatening diseases.

It’s the New Year and more than 50% of New Year’s resolutions have something to do with weight loss. This includes a resolution to exercise on a regular basis. Do not let foot pain thwart your resolution to exercise! The best way to break the pain cycle is to seek help from your podiatrist. Often simply placing you in the correct shoes with arch supports or custom foot orthotics will decrease your foot pain and fast track your resolution to exercise.

Many of our patients have not exercised in years, so they have many questions on how to get started. Before starting any program, it is important to discuss exercise with your doctor to see if you have any restrictions due to heart disease, diabetes, or arthritis. Get a physical! It’s a great way to start off the year. After your physical, visit your podiatrist to discuss your foot and ankle aches and pains.

There is no perfect exercise program for anyone, but if you are more than 20 pounds overweight, I recommend you start with a walking program that also has a strength and flexibility component worked in. What does that mean? Start with walking, not running, and add stretching and a little weight training to balance your program. If you need help with program specifics, consult a personal trainer or physical therapist.

Walking really is the easiest and least expensive exercise program that can be done indoors or outdoors; and this can progress to a running program as you lose weight and get healthier.

Did you know that inactivity is the second leading preventable cause of death in the United States, second only to tobacco use?

Need more motivation? Here are six great reasons other than the obvious physical fitness improvements to start a walking program:

1. Walking prevents type 2 diabetes. The Diabetes Prevention Program showed that walking 150 minutes per week and losing just 7% of your body weight (12-15 pounds) can reduce your risk of diabetes by 58%.
2. Walking strengthens your heart. In one study, mortality rates among men who walked less than one mile per day were nearly twice that among those who walked more than two miles per day. Women in one study who walked three hours or more per week reduced their risk of a heart attack or other coronary event by 35% compared with women who did not walk.
3. Walking is good for your brain. In a study on walking and cognitive function, researchers found that women who walked the equivalent of an easy pace at least 1.5 hours per week had significantly better cognitive function and less cognitive decline than women who walked less than 40 minutes per week. Think about that!
4. Walking is good for your bones. Research shows that postmenopausal women who walk approximately one mile each day have higher whole-body bone density than women who walk shorter distances, and walking is also effective in slowing the rate of bone loss from the legs.
5. Walking helps alleviate symptoms of depression. Walking for 30 minutes, three to five times per week for 12 weeks reduced symptoms of depression as measured with a standard depression questionnaire by 47%.
6. Walking reduces the risk of breast and colon cancer. Women who performed the equivalent of one hour and 15 minutes to two and a half hours per week of brisk walking had an 18% decreased risk of breast cancer compared with inactive women. Many studies have shown that exercise can prevent colon cancer and even if an individual person develops colon cancer, the benefits of exercise appear to continue both by increasing quality of life and reducing mortality.

I don’t know if we’ve convinced you yet, but a walking program is a great way to start the New Year! Write down your fitness goals. Put a sticky note on your bathroom mirror that asks, “Did you exercise today?” or a picture of yourself 20+ pounds lighter. Come visit Janet at Healthy Steps and get a new pair of shoes to start your program. (She gives great advice as well). Make 2009 your year to keep your New Years resolution and become your ideal self!

Walk or Run Happy! Moving in the Right Direction!!