Thursday, March 19, 2015
Strengthening Your "Foot Core" May Reduce Injuries
Tuesday, May 13, 2014
Vibram Settles Lawsuit for False Advertising of the Benefits of Barefoot Running
The company extensively advertised that their shoes would strengthen muscles in the feet and lower legs, improve range of motion in the ankles, feet and toes; stimulate neural function important to balance and agility, eliminate heel lift to align the spine and improve posture, and allow the foot and body to move naturally.
Does this mean that all of these claims are false? Does it mean that we should get rid of all of our "zero drop" minimalist shoes? No, but it means that not everyone benefits from the use of these types of shoes and that caution should be taken when transitioning from traditional running style to more of a "barefoot feel".
Personally, I have seen some benefits from sprinkling in barefoot running and using a more minimalist shoe for tempo runs and track workouts. I also have many patients who praise the change to a more minimalist shoe; but I also have lots and lots of casualties from minimalist running. At one point in my Grapevine, Texas office, we had a tally going on a white board of the number of stress fractures linked to Vibram-type shoes.
Bottom line: Minimalist running should be approached with caution and pre-hab strengthening of your feet before shedding your traditional running shoe is a must; but just like very other fad that has passed throughout he running community, its not all bad!
Tuesday, March 18, 2014
Strengthen Your Strides!
Tuesday, August 14, 2012
Strengthening Your Feet for the Upcoming Season!
Tuesday, January 31, 2012
11 Common Sense Tips to Run Injury Free!
Amby Burfoot tried to answer that question in an article in Runner’s World in March 2010. He states that George Sheehan, MD, the medical editor of Runner’s World in the 1970’s, felt that one in 100 people were “motor geniuses” and never got hurt. The rest of us were destined to be injury plagued from time to time.
Ralph Waldo Emerson stated “that there is a crack in everything God has made,” meaning that nothing is perfect and that can be translated to runners as well!
An extensive review of the medical literature by Burfoot reveals a great number of papers on running injuries, but no conclusions. It turns out that running injuries can be caused by being female (funny), being male (more likely), being old, being young, pronating too much, pronating too little, training too much, training too little, having new shoes, having old shoes, and it goes on…..
So what can we conclude? Most of us will get hurt at some time during our running career! So what can we do to prevent major, career threatening injuries?
1. Know Your Limits. This is a hard one. Some people cannot tolerate long distance running year after year. I’ve seen this in my office all too often. Some people try again and again to get to the marathon distance, but just keep getting hurt. Everyone has a threshold. Learn yours. Follow the rules and avoid too much, too soon, too fast syndrome! If you get to 15 miles and get hurt every time, maybe your body is trying to tell you something. Work on your 5K time instead of trying to attempt a marathon yet again.
2. Listen to Your Body. I give this advice every time I talk to a group of runners. Many do not listen. If you get out of bed feeling like you got run over by a train, perhaps a little rest in is order; not a long run! Most injuries do not spontaneously occur; they start with little aches and pains. Ironman triathletes are the worse! Do not “train through the pain”. That’s just plain stupid (and yes, I’ve tried to do it too!)
3. Consider Shortening Your Stride. I have to admit, I hadn’t really thought of this advice until I read Amby Burfoot’s article. It makes sense. Overstriding increases stress, so shortening your stride will soften the landing when you run. I think this is also why the recent “barefoot” or “minimalist” craze has taken a string hold. It’s hard to overstride in minimalist shoes!
4. Strength Training Can Help. One thing that has been shown to decrease running injuries is strength training. This is especially true in women. Core strength training twice a week can really help you avoid the doctors office and prolonged time on the couch.
5. Ice is your Friend! See my video on first aid for tendonitis, rest and repeat every time you have an ache or pain. A little rest, ice, compression and elevation goes a long way!
6. The Surface Makes a Difference. Here’s great tip: Don’t always run on the right side of the road facing traffic! It allows you to see the cars coming at you, but here in Texas, it means you always run on a slight slant that causes a functional leg length discrepancy. (And don’t try to make up for it by putting a lift in your left shoe- that’s stupid too!) Also try to vary your surfaces, one day on the road, one day on the track, perhaps a treadmill day or a day on the golf course. Trails are also a good thing to put in the mix. The same thing, at the same speed, on the same surface all the time can quickly add up to an injury.
7. Too Hard, Too Often is a Recipe for Disaster! When I was younger (about a thousand years ago) I used to “race into shape”. Not a great plan unless you are a gifted teenager! Too much speed work or too much racing beats the heck out of your body. Always follow a hard day with an easy one, or two if you are over 35!
8. Stretch. I’m not going to debate the value of stretching. I’ve done that in other articles. I know there are some people who think stretching is bad. I’m not one of them! All I know is that runners that are tight get hurt a heck of a lot more than those that are flexible.
9. Cross training is not a Bad Word! When I turned 40 (yes, about 5 seconds ago), I took up triathlon. Why? Because I knew as a thin female runner, getting older, I needed to cross train to keep up my aerobic fitness and decrease the stress on my body. This lead to a love of swimming and eventually an Ironman. Who says you can’t evolve as an endurance junkie? Seriously though, swimming, biking, the elliptical, circuit weight training….These all help to maintain your fitness and change up the stressors n your body.
10. Shoes Make a Difference! Find the shoe that works for you. Your podiatrist or a good experienced shoe sales person can help you, but bottom line….get a shoe that fits and is the correct type for your foot type. The reason there are a million shoes are on the market, and growing, is that there is not one perfect running shoe (although this doesn’t stop people from asking for it!)
11. Orthotics Can Help! I realize that many people are shying away from corrective orthotic and trying to embrace the minimalist wave. Not everyone can run barefoot and not everyone needs orthotics. If you continue to have similar injuries over and over, what’s the definition of insanity? Doing the same thing over and over, yet expecting a different outcome! If you are one of those biomechanically perfect gazelles, more power to you! But most of us could use a little help in that department. In many cases, you can correct some biomechanical problems with strengthening and stretching, but let’s face it….most of us are too lazy to do the work to correct our biomechanical imbalances. Orthotics can help. Think of them as eye glasses for your feet. The majority of us could benefit from a tire realignment!
Best advice I can give: listen to your body, increase slowly and have a plan! If you are one of those oft injury plagued runners, take a look at these tips. Are you following the guideline? If so, take a spin in triathlon! It has saved a lot of weekend warriors…….
Thanks to Amby Burfoot and his crew. I have liberally borrowed from their content and just put in my two cents worth. If you want to read his article, “The 10 Laws of Injury Prevention” you can find it in the March 2010 edition of Runner’s World.
Sunday, October 30, 2011
Can I Run on a Stress Fracture?
Lots of good questions in my Grapevine, Texas office and on the website this week. It is definitely marathon time of year! Lots of aching feet and legs from erratic training and “too much, too soon, too fast syndrome”.My favorite is “I have XYZ Marathon in a few weeks, Can I run on a stress fracture?” This was actually asked three times in two days by a patient and once in an inquiring email on www.myrundoc.com
Of course, my answer was, “Really?.....” Ok, so you think you are a tough guy and can run through a stress fracture, but this is a very bad idea!
- Hurts like hell!
- Probably break it into many more pieces
- Probably end up not running for months
- May end up on my operating room table for pins, plates and/or screws!
- Are you really that stupid???
Seriously? A stress fracture is a small crack in the bone that hasn’t fractured all the way through. Guess what happens when you run on it? It breaks all the way through!
So, if you are running in the Olympic marathon and think you are amazingly tough, then try it; but bottom line: NO! You can’t run on a stress fracture! If you try, you probably won’t be running for quite some time after that race, so it better be worth it!
Learning point: If you even think you may have a stress fracture, an x-ray is indicated pronto! Remember that they often do not show up on plain films for up to two weeks after the injury. The tip of my index finger is usually right! Give us a call and we can squeeze you in. The best part of having 5 doctors at Foot & Ankle Associates of North Texas in Grapevine, is that we can always find an emergency spot with one of our doctors!
Thursday, August 11, 2011
Really? Invisible Shoes For Running
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!
Tuesday, April 26, 2011
Triathlon Tips For Newbies!
Have a Plan. It’s not like you just wake up one morning and decide you want to do a triathlon. Or maybe you did and then realized you have no idea how to get ready for one! There are lots of on-line plans and relatively inexpensive coaching available. Having a plan is like having a recipe for success. Make a plan and stick to it!
Be Consistent. If you have ever jumped into a race very undertrained, the experience is not pleasant. You want your first triathlon to be an uplifting experience, not a painful blur. Stick to your training plan and be consistent with your workouts. After the first three weeks it gets a lot easier!
Review the Course. Knowing the course is very helpful in getting through rough spots in the race. You can anticipate the harder spots and know that the finish in near. Also, occasionally the course is not well marked and you can go awry. Knowing the course ahead of time is always a bonus if the going gets rough.
Watch Your Nutrition. Training for your first race is not the time to try a new diet or new foods. Consistent and normal good eating habits will ensure a stable stomach during the race. You don’t want to spend half the day in the porta-potty!
Sleep is Important. Training is taxing on the body and the mind. Getting plenty of rest will help your body recharge and be ready for the race. The sleep you get two nights before is more important than the night before, so if you have pre-race jitters and don’t sleep well….no fear if you have adequate rest in the weeks before.
Pack the Night Before. And use a List! I always set out my transition and all my gear the night before. The morning of the race is always full of chaos and usually starts a 5am, so packing your bag the night before using a checklist will ensure you have necessary tools like goggles and sunglasses!
Visualize Success. Get a mental image of yourself not only crossing the finish line, but being happy with your finish. Your body tends to follow your mind.
Pace Yourself. Many newbies go out way too fast on the swim or start to hammer the bike, only to find themselves walking the run. Pace yourself. The first one is about finishing standing up!
Don’t Freak Out! Janet can tell stories about panicking on the swim. I can tell stories about crashing on the bike. Neither one of us has ever had a flat tire in a race, but we’ve seen enough of them! Relax. Things happen. Your goggles can fall off, you can crash your bike, and you can forget to put sock on with your running shoes.
Relax and Execute Your Race. We have all had stuff happen that didn’t fall into our “perfect race” plan. Go to plan “B”!
Have Fun. Don’t be so serious about the challenge that you don’t enjoy the day. I remember finishing my first sprint triathlon after years of marathon running and feeling. “Wow! That was fun!” Let’s face it, most of us won’t win our first time out, so our reward is the sense of accomplishment (and the beer at the finish!)
Hopefully these tips will help any newbies and all the staff in my office who are training for their first tri! You will get addicted! Triathlon gets in your blood and you will be hooked!
Monday, April 18, 2011
Step into Minimalism Slowly at the Boston Marathon
I had the privilege to be part of the discussion of the evolution of minimalist running and how to transition from stability or motion control shoes to a more minimalist shoe.
The panel consisted of Michael Sandler, who wrote a fabulously crazy but poignant book on Barefoot Running and how it saved him after a severe accident; myself discussing how to strengthen your feet in order to even attempt transition from minimalist shoe gear or barefoot running as well as reminding runners to proceed with caution; Spencer White, head of the Saucony human performance lab, discussing in depth the biomechanical basis for the development of minimalist shoes and how they actually strengthen your feet over time; the legendary coach Dr Jack Daniels, doing coach chalk talk on a white board in order to discuss how to integrate minimalist running as a training tool; and last but not least, Collin Dibble, the owner of Marathon Sports in Boston discussing how to fit runners into the correct minimalist shoe and how retailers have a responsibility to caution and educate consumers on how to slowly integrate these shoes. Whew! What a panel! A fabulous educational experience for all present. I could listen to Dr Jack Daniels telling stories for hours.
After the panel spoke individually for 10-15 minutes each, then it was time for Q&A. Great questions from the audience showed they were actually paying attention. Even Amby Burfoot from Runners World asked a biomechanics question!
Then it was time to separate into small groups and talk with the runners’ one on one. I was happy to see that I drew a small crowd that wanted to discuss everything from how can I strengthen this muscle or that area to how can I transition safely or can I even think about doing this? Great discussion with a local pedorthist who will probably send me hate mail because I told him he was crazy to be running in a graphite orthotics. A few local podiatrists were also in attendance and I was surprised but delighted that they actually agreed with me that everyone does not need to be in orthotics permanently if their biomechanics can be rehabbed instead of permanently braced. We had a lively discussion about this highly controversial subject in our industry.
Let's briefly discuss this alternative thinking. A runners does too much, too soon, too fast and ends up with let's say plantar fasciitis. Traditional thinking is PF is most likely caused by abnormal pronation. Treatment is to put him in a more stable shoe with orthotics to brace his foot, start stretching, anti-inflammatories, rest and lots of ice. Now what? He's better in 6-8 weeks. Now he wants to start running again. Traditional thought is that his underlying biomechanics predisposed him to have the injury so we should leave him in the stiffer shoes with orthotics. What if he really doesn't have a significantly jacked up foot? Maybe just a slightly over pronating foot? Do we have an alternative to offer him? Yes! Now the hard work starts. Lots of strengthening exercises for the medial and plantar foot and lower leg musculature coupled with balance and proprioceptive training followed by lots and lots of stretching. Then slowly wean him off his orthotics and stability shoes over a period of 3-4 months and transition to a more minimalist shoe gear.
Easy? No! Worth it? Yes, if he wants to find his inner gazelle. No, if he really doesn't care about changing the way he runs to be lighter, faster, and in the long run, less pounding. Can everyone do this? No way! Only about 15% of runners will work that hard to change their running style after an injury, so I don't worry about the orthotics labs going out of business.
That's just the tip of the discussion going on in sports medicine today about the trend of minimalism that is sweeping the running world. Hmmm. Sounds like more blogs to come.
Thursday, April 7, 2011
Six Simple Exercise For Stronger Strides!
Here are six simple exercises to stronger strides
Here are six simple exercises you can do daily to improve your intrinsic foot strength. I recommend you walk around your house barefoot for five minutes to warm up your feet. Then really warm up your foot muscles by pretending your big toe is a marker and writing the alphabet with your foot. Do this twice. Now you are ready to begin strengthening your feet.
1. Towel crunches. Your foot has tiny intrinsic muscles that stabilize your toes called the interossei and lumbricals. A great way to strengthen them is to put your foot on a towel and crunch your toes. Do this ten times, then take a 30 second break and repeat to complete three sets of ten. When you get good at this, replace the towel with a pen or marker and grab it with your toes.
2. Heel walking. Heel striking is what we are avoiding, but heel walking is a great way to strengthen your anterior lower leg muscles (muscles in your shin). Roll back on your heels and walk forward balancing yourself on your heels for about 30 seconds, then take a 30 second break and repeat two more times.
3. Deep squats on your forefoot. Roll up onto your forefoot then squat down into an almost sitting position, trying to keep your balance and avoid shifting back onto your heels. Hold this pose for 30 seconds then stand up for 10 seconds and repeat 5 more times. When you get good at this, try holding a weighted bar at you shoulder level and then squat.
4. Inner foot strengthening with a resistance band. (This targets the medial muscles; the posterior tibial muscle and abductor hallucis) Tie the resistance band on a chair leg then use your medial muscles to pull the band toward the center of your body. Other option is to hook the band around your foot, then use the other foot to stabilize it. Pull your foot toward the midline of your body. Hold for 10 seconds then relax for 10 seconds. Repeat 10 times. (An alternative is to balance on the inside of your foot and walk for 30 seconds, following the pattern of heel walking)
5. Outer foot strengthening with a resistance band. (This targets the lateral muscles; the peroneals) Tie the resistance band on a chair leg then use your lateral muscles to pull the band toward the outside of your body. Other option is to hook the band around your foot, then use the other foot to stabilize. Then move your foot towards the outside of your body. Hold for 10 seconds then relax for 10 seconds. Repeat 10 times. (An alternative is to balance on the outside of your foot and walk for 30 seconds, following the pattern of heel walking)
6. Proprioceptive/Balance Training. Balance on one foot with other leg bent. Hold for 30 seconds. Repeat 5 times. When you get good, then roll up onto your forefoot. If you are a pro, then put a 5 pound weight in the opposite hand and touch your toes while balancing on your forefoot. (An alternative progression is to go from one leg on forefoot on level ground, to a foam mat then a Bosu ball or wobble board)
These six simple exercises can help you strengthen the intrinsic muscles of your feet and lower legs to help you transition to a minimalist running style. Remember to also stretch your quads, hip flexors, hamstrings, and calf (gastrocnemius and soleus) as well as your plantar fascia after these exercises to warm down. Small incremental increases in stress make us stronger. Large incremental increases in stress lead to overuse injuries! Achieve your natural stride slowly and carefully to stay injury free.
Watch the video for help with these exercises! Click here
Sunday, April 3, 2011
What's Up With Minimalist Shoes?
Why embrace minimalism? Minimalist shoes can help you achieve a more natural running stride. Why is this important? Many biomechanics gurus are finding that a more natural running stride can decrease your impact by over one third and therefore, in theory, decrease running injuries. What I have found is that it can help you find a faster, more balanced, stream lined version of you or what can be described as your running zen.
Running zen is a total state of focus that is a fusion of body and mind while running. Your goal is to develop your natural stride, which in most experienced runners, leads to being fitter, faster and staying injury free.
Your most efficient foot strike is one that lands exactly below your center of gravity, which is usually right below your hips in a mid-to-forefoot fashion, slightly towards your fifth toe. As you land, your foot rolls slightly inwards and propulses off your big toe. This slight roll is NORMAL pronation and is meant to cushion the running stride. Excessive pronation is the effect of weak foot intrinsics and lower leg muscles and is the main cause of many overuse injuries common to runners. This abnormal pronation is often mitigated by stability running shoes and orthotics, but a better long-term approach in healthy athletes should be to strengthen the underlying muscular weakness. Stronger lower leg and intrinsic foot muscles coupled with a stronger core, flexibility and better proprioception can diminish many of these abnormal forces and reduce injury recurrance.
A motion control shoe works to alleviate abnormal pronation and does a great job stabilizing your foot, especially after an injury; but it does little to strengthen the key muscles and ligaments of your feet.
A highly cushioned shoe may overprotect your foot from the stress of the road, preventing natural strengthening while you build mileage.
So, should we all go back to the ballerina flat looking shoes we wore in the seventies? Unfortunately I remember them well and the tibial stress fractures that occurred while I was in high school. No, old school is not the answer; but perhaps a happy medium.
A minimalist shoe guides your foot into a more natural stride by providing cushioning and flexibility, but does not elevate the heel to increase pronatory forces. It allows a shorter stride and softer landing, while encouraging mid-to-forefoot striking to help you manage your impact. It also allows for intrinsic strengthening while you build your mileage and hopefully puts you on the road to finding your sweet spot in your stride.
Who shouldn’t try a minimalist approach? Those runners with severe foot deformities or significant arthritis. As well as people with nerve issues like diabetic neuropathy. As for the rest of the running world, a caution sign should go up here.
A side note of caution to anyone trying to go “less is more.” When you begin to run with less shoe than you have been in years, it is important to realize that your stride is now very different and you have to relearn the fundamentals of running. Please avoid the “too much, too soon, too fast” syndrome that can sideline even the most cautious of runners.
A better approach to minimalism is to realize that your feet are weak in their current state and you need to add a foot and leg strengthening program to your current regimen. A strong core is imperative for good, efficient running form. The stronger the core, the longer you can hold good posture as you run down the road in search of your zen.
Watch for my next post: Simple Six to Stronger Strides: exercises to strengthen your feet and find the sweet spot of your stride!
Saturday, October 23, 2010
My Kids Had Fun Doing Their First Triathlon!
Dallas Athletes did a great job putting on the event and the volunteers were awesome. Imagine over 300 kids ages 4 to 13, separated into three groups; 4-7, 8-11, and 12-14. It was like herding cats to get them all to the starting line and then in the pool!
The littlest kids were adorable. Life jackets and a parent in tow are legal for under 7. Then they got on their tricycles or little bikes with training wheels and off they went for a one mile bike, then off the bike to run a half a mile. Just adorable were the smiling faces when they crossed the finish line and got their medals.
The older kids were much more serious and nervous, pacing the pool deck while the little kids got started first. Ages 8 to 11 had to swim 50 meters, and then bike 2 miles, then run a mile. Ages 12 to 14 had to swim 100 meters, then bike 3 miles and finish with a one mile run. The serious looks on these kids’ faces said they were not there just to have fun, but to compete!
The parents were an absolute treat to watch as well. It was very obvious that most were either runners or triathletes who had dragged their kids out of bed at 6am and were trying to infect them with the love of triathlon as well.
Tomorrow morning there is over 700 adults signed up to race in the Sprint triathlon version of the Monster Tri. I hope we all have as much fun as our kids did this morning. Run Happy….and Bike and Swim when you can!
Sunday, August 8, 2010
The Barefoot Running Debate Continues
Some of the reasons which were indicated by the researchers for this healthful barefoot advantage to runners include:
1. The tendency of the foot to flex more while running barefoot.
2. The fact that the foot moves around inside a running shoe less than was originally believed.
3. The distribution and frequency of the ground’s impact forces on the foot has a better and less stressful pattern on bare feet.
All good, valid points. Personally I'm sticking to my Newtons to strengthen my feet and I have an orthotic in them to control my late stage pronation in my forefoot. Without that, I get hurt! But that's just me.
So you want to try barefoot running? A good test to see if you are a good candidate is to balance on one foot on your forefoot, keeping your heel in the neutral (perpendicular to the ground) position and hold that for one minute. If you can do this, you can start a gradual progression to barefoot running. I would go buy a pair of Five Finger Vibrams to protect the sole of your feet, then start with no more than 5 minutes on a track or softer trail surface. See how you feel. Then progress no more than 10 percent no more than 3 days a week. It will take you at least 6 months to work your way up to a reasonable time and pace. (And I still think its crazy, but again....just my personal opinion)
If you want to go totally barefoot without a pair of Vibrams, then you should take careful precautions before running completely barefoot. You must ensure that the track or path you’re running on is a non-abrasive surface, and is completely free of sharp or dangerous objects. Barefoot running is best done on a track with a smooth but tractable surface which you have personally inspected and removed any objects which could cut or damage your foot during running, and learning to run barefoot is a skill and must learned-slowly. SLOWLY!!!
I still think the jury is out on barefoot running. It is the latest fad which may or may not stick, but for those that want to try it.....take my advice and go really really slowly down that path. Most of the injuries we see from barefoot running are from progressing way to quickly!

