The Hottest Hotter than Hell Hundred in History!

Wow! If you ever think about doing the Hotter than Hell Hundred Triple Threat, check the weather forecast! This weekend was absolutely crazy, borderline insane, and if nothing else….HOT!

Janet and I, in our usual fashion, were wandering the office causing trouble, when Janet said, “Hey! Want to do the Triple Threat at the Hotter than Hell Hundred bike ride?” I thought it might be fun, and had missed the ride the last few years due to scheduling conflicts. Janet went on to explain that it was a 12 mile beginner mountain bike ride on Friday night, the 100 mile road bike ride on Saturday, and a tiny little half marathon trail run on Sunday morning. Sounded like a full weekend, but what the heck.

We wrapped up seeing patients on Friday and jumped in the truck, heading for Wichita Falls. We checked into the nicest hotel in the whole city (Yes, they have one Marriott Courtyard) and made our way down to the expo to get our numbers and directions for this madness.

After a little bit of shopping and losing a timing chip, we made it to the mountain bike start with a whole 15 minutes to spare. I had already chickened out (I don’t own a mountain bike, didn’t want to borrow one, and heard way too many crash stories), but Janet was ready to go. A good group of about 10 people from our running peeps, Lake Grapevine Runners and Walkers, had also decided to try their hand at this madness; so group psychosis was also occurring. Did I mention the temperature was 103? The head official explained all the loops and turns and a little water crossing right near the end. The gang took off and I decided that perhaps watching the race at the water crossing might be fun.

Fun it was! Not one person made it across the water crossing without dismounting, either by choice or falling face first into the water! I saw one broken front wheel and one flat tire, but mostly just very graceful water landings. Janet came through and was smart and portaged her bike. I ran to the finish to meet the gang and knew immediately we had a problem. Janet had a bruise the size of a small dinner plate on her shoulder and had her not happy face on. Turns out she challenged a tree and the tree won!

We decided to head back to the hotel for ice, Advil, a shower and of course beer. Beer and a good dinner cure all bumps and bruises. We hooked up with our friend Debbie and had a great steak dinner and more than a few beers. Then it was time for bed. 5am comes early!

The alarm went off at 4:30 am and that was the first time I had the thought, “Why do we do this?” We got our bikes and gear together, shoveled down a little breakfast and we were off to meet the peeps. The three of us were awake and ready to take on 100 miles with 10,000 of our closest friends. The temperature at the start was 80. Not bad, with a little breeze. We saw our LGRAW friends, but they decided to start toward the front of the group called “the Scorchers”. That’s the people who ride from 20-25+ mph. We were in “the Keepers”, planning to average 17-20 mph or so. We positioned ourselves at the front of the Keepers, or the back of the Scorchers; however you want to look at it. We all had our bike lights on because it was still dark and that made an impressive sight with all the blinking tail lights, in fact, I felt like if I stared at them long enough I could hypnotize myself into thinking I was still in bed! The cannon went off at 6:15am (they allowed an earlier start this year for those that wanted it or you could start at the official 7am start but given the heat, why would anyone do that?)

Off we went. The first few miles was slow and had a few stops due to the crowd, but by 10 miles or so it started to thin out so you could ride comfortably. The three of us were riding together and then Debbie dropped her sunglasses. (Yes, it was still dark so they were in her side pocket) She went back for them, but only found pieces.

We all skipped the first two aid stations and stopped at 30 miles. So far, so good. Everyone felt good and the heat was not a factor yet. We then stopped at every other aid station until we got to “Hell’s Gate”. This is the official spot (around 60 miles) that you have to get to by noon, or they turn you onto the 100K route and make you go home. We got there about 10 am, so Hell’s gate was still open and we got our picture taken with “Pyro Pete”, a gigantic devil blow up doll!

Hell’s Gate is appropriately named, because the route passed that point is rolling farmland with very little shade, bumpy roads, and it was getting hotter by the second. We started stopping at every aid station and I started putting ice in my jog bra to try to cool down my core. I actually felt alright as long as I kept drinking, but Debbie was starting to look bad and Janet was getting very quiet. I have to admit, between 70 and 90 miles, it felt like someone had opened the oven door and shoved my head in! Or maybe a blast furnace? Even the wind was hot, so it didn’t cool you down at all. We were all feeling the heat, but were still plugging along. We dropped from 18-20 mph to about 16 mph. The carnage all around us was remarkable. The SAG wagons had tons of people and bikes on them, but you still saw the occasional biker under a tree or passed out on the side of the road. My day was complete when I saw an armadillo and a coyote in the same 5 mile stretch! Gotta love Texas in the summertime!

Debbie and I stopped at the 90 mile aid station to try to get more ice, but Janet plugged on. She said there was beer at 98 miles and she really wanted one! We got to the “Unofficial 98 mile aid station” and I thought I was seeing a mirage. There had to be at least two hundred people hanging out and drinking beer, eating chips and sausages, and having a party in an old machine shop on the side of the road! It was hysterical. We found several of our friends just hanging out there, and made many new friends after a few beers. One guy said he finished at 10:30 am then came back to his favorite aid station. Lots of people were completely hammered! Too funny! After a few beers, we collected our friends and decided it was time to make it to the finish line. Two miles of slightly impaired cycling, we were finally finished!

They had a fire hydrant open and spraying everyone at the finish, so we stripped off our shoes and went dancing in the water. So happy to be done!

Back to the hotel for showers and a long deserve nap. It was the local news that let us know it was the hottest Hotter than Hell Hundred on record, topping 109! No wonder I felt like I was in an oven!

After our naps, we joined our friends for beer and BBQ at their campsite. (Yes, a lot of people bring campers and stay the weekend near the trails) Janet and I like camping at the Marriott better!

Then the alarm went off at 6 am this morning! Again, I was thinking, “Why do we do this?”, but I got up and putting on my running gear. Yes, it was time to do a trail half marathon. On the same course as the mountain bike ride on Friday night! Yes, a water crossing and everything! We met our still crazy friends at the start. Everyone had survived so far with just a few bumps and bruises. Janet decided we should walk run the course given our legs hurt from the previous day’s small endeavors, so we walked. And ran up and down these crazy hills and valleys, singing over the river and through the woods. The two of us finished up together laughing to the point of almost crying because we had both reached fully nuts when Janet almost stepped on snake #3 that we saw on the trails just about 400 yards from the finish! That will get your heart rate going!

Happy to have finished, Janet got a really cool cyprus plaque proclaiming that she had survived the Triple Threat….and yes, it was 104 at the finish! What a weekend!

Ps. stay tuned to my Youtube channel, I made a video of the weekend.....

Spareribs Sure Fire Injury Cure

Thanks to the shout out from my friend and running peep Spareribs LaMothe in the Dallas Morning News Running Blog this morning. He made a few great points about injury management in his blog. The two best were to seek professional help early in the injury course. The faster you obtain a correct diagnosis, the sooner you will get better! The second point was to find a doctor who runs! As a sports medicine podiatrist who endulges in border-line crazy endurance sports, I speak your language and have a network of other doctors and therapists that are all on the same page! If your doctor thinks that "LSD" is still a drug and not an acronym for "Long Slow Distance", maybe you need another doctor for your running injury! Thanks again Spareribs!

John J. Kelley, May He Rest in Peace

My heart is saddened by the passing of John J. Kelley, the first true marathon champion who influenced my life. I remember many cold mornings in Mystic, Conn. Sharing soup after a freezing penguin run from Kelley’s Pace, the store he ran after his retirement. He was an amazing man and a true mentor to high school and college students in the area.

I grew up in Ashaway, Rhode Island, just over the Connecticut border. He was a coach to everyone, not just the kids on his team. His store was the closest true running store in the area. I always wondered as a young tenn how he made any money since he chatted with everyone for hours at end. Turns out, he never did. The store was just an outlet for his passion. He always had a New Years party that included a run and a dip in the Atlantic Ocean for the crazy! Many years I joined in during high school.

He died on Sunday in North Stonington, Conn, just a few miles from my hometown. He was 80. I probably saw John for the last time in 2002 at the Boston Marathon. My last conversation was in 1986, just before I graduated from high school and ran away from my little rural hometown as fast as I could. I only wish more young people could’ve been touched by Mr. Kelley. I remember most a day in his store when he told me that I could do anything I put my mind to as long as I developed pain tolerance! He was quite the man!

John J. Kelley will be missed.

Joining the Mile High Club? Tips for Running at Altitude

Are you a member of the Mile High Club? No, not the one that involves airplanes and yoga poses! I’m talking about running at elevations of 5,280 feet and higher.

I’m on my way to Colorado to spend a week with my kids at Keystone. Of course, I’m excited to get in some trail runs, but a little worried about the altitude. I called a few of my friends who live in the Mile High State and got some tips on running at altitude that I figured I would share.

Running at a higher altitude can make you feel like a slug, and an asthmatic slow one at that. However, if you’re careful, and keep some of the following tips in mind, high altitude running can be very enjoyable and great for racing at lower altitudes!

1. Hydrate. Drink plenty of fluids before, during and after your run. Then drink some more. Dehydration occurs quicker at higher altitudes, so this is good advice even if you won’t be running.
2. There’s less air up there. This is a good news/bad news situation. The bad news is that according to my buddy, Dr Jack Daniels (coolest running coach on the planet!), at an elevation of 6,500 feet you lose 10 percent to 12 percent in VO2 max and at 7,500 feet you lose 12 percent to 15 percent. The good news is that a lower density of air means lower air resistance and better running economy. You just keep telling yourself that when you’re winded like an overweight smoker climbing to the top row in the stadium.
3. Enjoy the view. You should prepare yourself for a slower paced run than you’re accustomed to and you’ll find that focusing on the surroundings instead of your watch will make that easier. Running with peeps also helps! Bring a friend or two and you can be asthmatic together!
4. Wear sunscreen. Putting yourself a mile closer to the sun may seem insignificant when you think about how far away the sun is, but I assure you that it will not feel insignificant tomorrow if you fail to heed this advice. Think ahi tuna!
5. Lip Balm, and plenty of it. When you pass another runner you want to be able to wave and crack a smile, not your lips.
6. Take it easy. Stick to easy runs until you become acclimated; if ever. Wear a heart rate monitor so you can see when you are out of your zones. Don’t look at your watch, just set the heart rate alarm. Time means nothing! Don’t try to go out and run a tough session of intervals on your first run at altitude. If you’ll be racing at a high altitude, plan to spend as much time as possible at that altitude prior to the race.

Bottom line: Take it slow and easy and enjoy your runs!

Really? Invisible Shoes For Running

I received a really neat package in the mail that included two pairs of “Invisible Shoes”, sent to me by the folks at Invisibleshoe.com to try out. My first thought was, “This is crazy!”, but as most of my readers know, I will try anything once! I have in the last few years embraced minimalism and have transitioned many of my more elite patients to a more midfoot striking natural running style in minimalist shoes. This is only about 15% of my patients, while the rest still need the control of an orthotic due to foot abnormalities and old injuries. (Yes, I know the debate continues on these issues, stop sending hate mail!)

I currently run in the Saucony Kinvara and wear the Saucony Hattori for walking and gym workouts. I am curious to see how the “Invisible Shoe” compares to the Hattori. I am still not a fan of totally barefoot due to the concrete jungle we live in and I have never liked the Vibram Five Fingers; but mostly because so many of my patients have hurt themselves in them and the shoving my toes apart thing I personally find totally annoying. I use my pair of Vibrams for open water swimming. They protect my feet from rocks in the lake!

A little over view for those trying to figure out what I am talking about. There is no other shoe in the minimalist footwear industry as truly minimalist as the huarache. Think a piece of rubber on your foot is as close to barefoot as it gets. Your feet are free to move in the most natural way with no fabric upper to impede or constrict foot movement in any way. Yes, on the surface I still was thinking this is nuts!

The “How to Make Your Invisible Shoes” directions on the website were easy to understand, but took a little longer than expected to put together. A punch tool was needed but I didn’t have one so we improvised.
All my sarcasm and initial reservations about comfort, fit, or suitability for running were muted after my first few walks and my first run in them, which was interesting. They give you a truly free feeling while running, but the thicker ones were better on the pavement.

My verdict on the “Invisible Shoes” is this. They are a great tool to mix into your running training to strengthen your feet, but definitely not an every day shoe for me. I like the little more cushion of the Hattori better and feel more stable in them. As I sprinkle the “Invisible Shoes” into my training just a little more I will update my thoughts going forward.

Best advice is to sprinkle them in your training. Start with walking for a half mile or so then increase by about 10% each time you wear them. Walk around in them for at least 2 weeks prior to even trying to run in them. Take is easy! No more than 200 yards running the first day and, again, increase by no more than 10% each time.

If it hurts or feels overly tired, STOP! Take it back a notch. Overuse injuries can still occur with minimalist shoes if you progress too quickly. Just like every minimalist shoe, it takes time to strengthen your feet and get used to them. Do the exercises I prescribe to strengthen your feet for barefoot running. Focus on your form and build up SLOWLY.

Thumbs up to the “Invisible Shoes” but they should carry a warning label that warns against “too much, too soon, too fast” syndrome!

Wow! This week I had the worst chronic peroneal tendon rupture I have ever seen! My patient had sustained an “ankle sprain” about two years ago and wondered why her ankle looked more like a “cankle” two years later. She had a large lump just behind her fibular malleolus (a.k.a. the bone on the outside of your ankle). She noticed swelling on and off, but it never really went down all the way. She also had intermittent pain and felt like her ankle was unstable. Like most women with several children, she ignored it until it really became a lifestyle issue. She felt like she couldn’t exercise at all because her ankle felt so unstable.

Peroneal tendon injuries often occur with ankle sprains and are commonly overlooked until your ankle pain becomes chronic. The peroneal tendons stabilize the outside of your foot and ankle and allow you to turn your foot outward. There are two tendons which run side by side, behind your outer ankle bone, then split in the foot; one to the outside while the larger one dives under your foot and inserts in the arch just behind your big toe joint.

People with high-arched feet are more likely to experience peroneal tendon injuries.

Peroneal tendon injuries fall into three categories: tendonitis, tears, and subluxation. They are more common in active, athletic patients and can be acute (sudden) or chronic (lingering) in nature.

Tendonitis is inflammation, acute tears are caused by an injury and tendonosis (chronic tears) are usually caused by overuse and repetitive stress or chronic tendonitis. Subluxation usually occurs in an acute injury, like an ankle sprain, where the tendons actually dislocate onto the outer ankle bone and snap back and forth with activity.

The symptoms of a peroneal tendon injury can include swelling, pain, warmth, weakness and instability of the foot and ankle. Subluxation can also include a snapping feeling and sporadic pain with activity.

Treatment of peroneal tendon injuries is often delayed by misdiagnosis. If you are experiencing any of the symptoms of a peroneal injury, seek medical attention from a foot and ankle surgeon urgently. The longer the tendons go untreated, the more damage occurs. X-rays and physical examination usually lead to an MRI to solidify the diagnosis.

My patient’s MRI showed a severe rupture of peroneus brevis with a bulbous scar tissue formation which you can see in the below picture. Peroneus longus was normal.

Treatment include rest, casting, functional orthotics, anti-inflammatory medication or injection therapy, physical therapy, bracing, and in some cases surgery. Obviously, my patient needed a repair. We excised the torn and hypertrophied part of the tendon, then repaired the rest and fixed her ligaments so she would stop being so unstable and finally lose her “cankle”.


Here is the piece of abnormal tendon we excised. Wow! Big chunk!!



Your disability from a peroneal tendon injury can be significantly reduced by early intervention, so if you are experiencing any of these symptoms, call or contact the office and be evaluated. The sooner you have a proper diagnosis, the faster you will return to normal activity levels pain-free. If my patient had come in earlier to have her “ankle sprain” evaluated, conservative therapy might have healed her tendon injury!