This was a goal I had set intending it to take 8 weeks to achieve, but completed it in only 6.

What’s special about this?   I did it without injuring myself!

There was a day when I would get up early and hit the road running 26 or more miles a week.  I suffered through heel pain, stress fractures, back and hip pain, but kept on going making the same mistakes day in and day out.  When I became a podiatrist and started treating athletes at Geller Podiatry I started to see a lot of the mistakes I had made.

It may be due to the fact that I am a runner, but I like to think it is my attention to detail that allows me to work well with athletes.  At Geller Podiatry I examine your back down to your feet, sitting, standing, and walking.  I find a lot of patients complaining of foot problems when the real cause of their pain is coming from an alignment problem in the hip or knee, tight muscles around their low back, or that ever annoying iliotibial band (IT band).  You can’t get better if the problem is not identified and watching patients walk is when I find most of the problems others have missed.

I can’t fix problems above your ankle, but I have a team who I work with.  I will get you to a trusted orthopedic surgeon, chiropractor, physical therapist, or massage therapist to make your problem go away.  As more and more people take to running I am getting more involved in their training.  I can draw upon my personal experience as well as my medical knowledge to help you reach your goals.

Good luck in the upcoming race season and let me help you train.  At Geller Podiatry we offer video gait analysis, shoe analysis, custom foot orthoses, bracing, and even surgery if it is needed.

A recent vacation found me running barefoot on the beach.  After a crisp-paced warm up mile on the packed sand splashing as the waves rolled in, my feet began to ache.  Knowing what I know, I quickly altered my running style, which helped until the way back.  By the time I turned and headed back people were enjoying the surf so I was forced onto the soft sand.  Another mile and my legs and feet were cooked.  I reached a level of fatigue I rarely achieve at home.

What is it about running barefoot?

In the media, people seem to be all for it or completely opposed.  There doesn’t seem to be any middle ground.  At Desert Foot Surgeons, it is my job to educate you so that you can make the choice that best fits your needs.  Maybe you want to run barefoot and maybe not.  Let’s talk about it and see what you decide.

First of all, what are the benefits of running barefoot?  I will warn you that this is all theory!  No scientific evidence exists to date supporting these theories.  Running barefoot is said to increase the muscle strength of small (intrinsic) muscles in your foot.  By doing so it is thought that your foot will become more stable with the added strength thus help prevent injury and possibly even deformities such as bunions, hammertoes, and plantar fasciitis.  A study has shown that collegiate female track athletes who trained barefoot suffered fewer injuries.  Similar high level athletes have shown the same results such as volleyball players.

Here’s the catch with running barefoot…

There is a level of genetics involved in becoming a collegiate level athlete.  Of course there are your 5’6” guys who can dunk a basketball and a 5’9” football player who runs a 4 second 40, but for the rest of us we are not fortunate enough to have the same gifts as these people.  I’m not saying hard work and excellent coaching can’t make someone a collegiate athlete, I’m trying to keep the topic real.  A collegiate level track athlete has been coached for years and puts in significant miles with this coach.  These athletes know how to alter there stride length, change posture, modify their arm swing, go from heel strike to toe strike for different reasons.  Even in the famous book, “Born to Run” by Christopher McDougal, he was coached before he could accumulate any distance running barefoot.  So that leaves one question:  do you have a coach?

I’m not going to tell you that running barefoot is good or bad for you, that’s not my job.  My job at Desert Foot Surgeons is to examine your feet sitting, standing, walking, and even running.  With that information I can help you achieve your goals, but it might take some work.  If you want to run barefoot we are going to have to work on some things. Stretching programs, strengthening, balance and running in shoes with or without orthoses might be the first few steps before you ever step out there barefoot.  You might need help from a coach or trainer.  I can get you to the right people.  I don’t want you to be injured and the number of stress fractures in my practice has tripled this past year solely due to barefoot running.  To review injuries while training review my previous blog about marathon training.

This is the first thing a lot of patients say to me.  Pain in the toes or ball of the foot is very common, but making the right diagnosis is harder than you might think.  This part of the foot has only one muscle running from outside (little toe side) to inside (big toe side), but there are 7 tendons surrounding each joint, bones, joint capsule, ligaments, nerves, and fat.  Every step you take transfers weight across the ball of your foot as you move forward.  The 3 bones on the inside of your foot move as a unit and the two on the outside are another unit.  Each bone also has motion of it’s own besides the motion of the toe on the metatarsal bone.

Enough of the anatomy lesson, let’s get to the point.  A neuroma is a pinched nerve.  Plain and simple, there is nothing more to it.  The nerve lies in the space between your metatarsals (those are the bones in the ball of your foot) and divides to send a smaller nerve into each side of the two toes in front of it. The nerve gets pinched against a ligament running sideways from one metatarsal to the other.  Easiest way to think of it, the nerve is constantly irritated by pinching against this ligament.  That causes inflammation and then scar.  The longer this keeps happening the scar gets bigger and bigger until there is a lump.  Sometimes you can feel this lump “click” as it rubs against the  ligament,  ouch!!  If your toes are bent upward the nerve is more likely to rub against the ligament so pain is usually worse in heels, going down stairs (you land straight onto the ball of your foot), or hiking up hill.  Why does the nerve get pinched?  There are two reasons.  First, if you have toes that are buckled, bent, sitting on the top of your foot, the nerve is always pressed up against the ligament.  Second, there is abnormal motion between your metatarsal heads (that means an unstable foot).

Treatment for neuroma is: 1.  Relieve inflammation, 2.  Stabilize your foot so the pinching stops, 3.  If all else fails surgery.

1. Every article on this website talks about relieving inflammation.  Do you remember why?  That’s right, because, at Desert Foot Surgeons, I always say, you can’t heal until the inflammation is gone.  Ibuprofen, Naproxen, Celebrex and other pills can be prescribed to fight the inflammation.  Steroid injections can be given if the lump is really big or your pain is just that bad.  The steroid can shrink the scar a little bit. Note:  Sclerosing injections are different from steroid injections.  These use a chemical to destroy the nerve leaving you numb in that area.  Before considering a sclerosing injection seek a second opinion to make sure the diagnosis is correct.
2. The underlying problem causing the pinched nerve is your unstable foot.  Arch supports are a good place to start, but if your foot is hard to control expect me to suggest custom molded foot orthotics.
3. Surgery for neuroma is something that I find controversial.  I have surgically removed very few neuromas throughout my career, while colleagues of mine seem to remove a few each week.  Why do so many doctors surgically remove neuromas?  In my opinion it’s because the orthotics are not made correctly or the diagnosis is wrong.  Remember I’m the doctor seeing the patients who have failed treatment by other physicians, or were deemed too difficult or too sick to treat.  Be cautious when considering surgery for a neuroma.  With that said, surgery consists of either removing the nerve that is damaged by scar or cutting the ligament that the nerve rubs against.  If you’re the type of person who has toes that are buckled, than the treatment is to straighten the toes and not touch the nerve.

So there you have it.  Morton’s neuroma is a pinched nerve in the ball of your foot as the result of you having an unstable foot.  If you relieve inflammation and stabilize your foot using orthotics the pain goes away.  At Desert Foot Surgeons, I have not needed to surgically remove neuromas.  Before you have surgery I would suggest you get another opinion.  The diagnosis might not be correct.  Think about all of the things in that area of your foot.  I will discuss other problems in the ball of the foot in later articles.

In the foot people can have unsightly problems and what’s worse pain.  A bunion is a lump on the inside of the foot behind the big toe.  The size can vary and the toe can begin to move closer to and even under the 2nd toe.  When the smaller toes are buckled that is a hammertoe.  Here’s the key:  because we wear shoes, bunions and hammertoes hurt much sooner than if we went barefoot all the time.  Let me make this perfectly clear, wearing shoes does not cause the deformity, but wearing shoes does make a deformity hurt sooner than it otherwise would.

Bunion and hammertoe surgery can be cosmetic, which in my opinion means the deformity will look better after corrected so that you feel better since pain will be gone.  That’s a little bit different from other forms of cosmetic surgery.  When I perform bunion surgery or hammertoe surgery I always keep in mind the fact that you will be walking on the end result for years to come.  Because the bunion and hammertoe develop in an unstable foot I have to make sure the problem does not return.  Face lifts, tummy tucks, or breast augmentation have their long term considerations, but honestly you will not be walking, hiking, or running on these parts of your body.

There are people who want to fit into those 4” spiked heels at any cost.  They want their wide foot narrowed and long toe shortened.  I’m not talking about business executives who have to maintain a specific style of dress in order to advance their career and suffer horrible pain in these shoes.  I’m talking about people who would otherwise have no pain, but insist on wearing these heels for social purposes.  I caution those people who do not have pain!  Foot surgery can result in scar within the joint leading to stiffness and arthritis.  There is no true preventive surgery for arthritis.

One final word.  Recently a Beverly Hills Podiatrist coined the term “Cinderella Surgery” for correcting a bunion, long 2nd toe, and bunionette (on the outside of the foot) so that women can wear their high heels.  He did a very nice piece on the television show, The Doctors.  My problem is this:  I always say, feet are like snowflakes no two are alike, well here is a podiatrist telling women he can perform the same procedures on their feet in every case so they can walk immediately after surgery and their feet will fit into their stilettos.  That is just not possible without making some sacrifices.  To read about these sacrifices that might be made check back every few days for my new articles on cosmetic bunion surgery and cosmetic hammertoe surgery.  

I asked about his recovery from the race.  I heard about the celebration that night soaking in a hot tub with friends drinking and eating whatever was there.  His wife had scheduled him for a massage the day after the race.  Paul said it hurt more than it felt good and had no lasting effect.  Stretching was impossible because of the pain and stiffness.  The tight muscles made it nearly impossible to run the few times he had tried.  When I asked if he was following any schedule or program he reminded me of his pre-race training program, but had nothing to follow for recovery.  Do you know what Paul did wrong?

What you do immediately after the race is as important as what you did to get there.  You know that running 26 miles is serious business, that’s why you were so careful in your training program.  After the race you will be exhausted mentally and physically.  Your recovery plan has to be set before you race so you won’t have to think about it.  Your muscles have worked hard for 26 miles and all nutrients in your body have been used.  When your body works hard for a long time you get inflammation.  Treat your body right and this will go away quickly so you’ll be running again in no time.  Ignore the inflammation and you’ll suffer.  I’m sure you’ve heard stories about people who ran a marathon and were never able to run again.  If you ask them about their post-race recovery I bet you’ll get a blank stare.

As soon as you finish the race:

You’re exhausted and legs feel weak, but this is the time you need to keep walking.  Don’t stop and get a chair massage, don’t chat at the booths.  Get your packet, medal, snack pack, and drink water as you walk around.  Make a mental note of what hurts.  I don’t mean big areas like your entire leg.  I mean specific areas like your calf muscle, front of your thigh, back of the thigh, front of your leg, arch, heel, toe.  Pay attention to any pains so that you can address these after a thorough cool down.

Your kidneys have been fighting to balance your hydration and electrolytes.  All the waist products coming from all that muscle action of running 26 miles is filtered by your kidneys.  They have worked overtime and need to recover.  Anti-inflammatory medications stress your kidney more.  This is not the time to take anti-inflammatory medications like Ibuprofen or Naproxen.  Refuel by drinking water, electrolyte drinks are OK, but water has to continue even if you’re drinking electrolytes.  Eat like you did while you were training.  Protein helps repair muscles and carbohydrates help with fuel. 

I don’t know how to describe it, but there’s an excited feeling in your legs, some people tell me a throbbing, others say it’s like their legs are just revved up.  Don’t stretch until that feeling in your legs goes away.  You can ice the sore spots and gently stretch.  When you get home take a cool bath.  Use a foam roller or gently massage sore muscles.  If possible schedule a massage in the evening, at least 4 hours after the race.

Things to avoid:

1. Sitting for more than 10-20 minutes
2. Soaking in warm water or hot tub
3. Sauna
4. Anti-inflammatory medications

The first week:

Inflammation can last 24-72 hours.  You will have to pay close attention to your body. If you treat the inflammation right you’ll be running again after a few days.  Ignore the inflammation and it can become a repeating cycle that is difficult to break even with my treatment.  Have more massages, practice yoga, swim or bike.  Don’t be aggressive, your goal is to stay loose.

If you have no aches and pains by day 3 you can begin gentle-paced, low mileage runs.  Do not exceed the mileage you did the week before the marathon.  Begin every three days with light resistance training on off days.  Any aches and pains need to be addressed.  Don’t wait to see me for any pains that remain.  The sooner these are addressed the easier they are to treat.

The 2nd week and forward:

If you’ve made it this far without needing me you’re doing well.  Gradually increase run frequency and distance back to your training levels as tolerated.  You might find that you are more easily fatigued, but that is normal for the first month.  Anything more than that and you should seek medical attention.  Don’t forget to have your running shoes checked.  During this return to training period you will need to have new shoes.  At Desert Foot Surgeons we offer video gait analysis to see what the naked eye cannot.  Come have your gait analyzed in or out of shoes.

Congratulations, you did it!!

Recently three people came to see me for the most common running injuries.  Even though these people had different pain, were different ages, lived in different cities, and had different lifestyles, they all had similar stories about training for a marathon.  All three had not run for exercise consistently in more than 5 years.  A friend had convinced each one to train for the marathon.  Not one of the 3 had a training program made specifically for them, but all were using a group training schedule from either a magazine, the internet, or joining a training group.

The first patient complained of heel pain that was worse with the first steps out of bed then again in the evenings especially after running.  I diagnosed this patient with plantar fasciitis and relieved her pain by teaching her how to stretch and ice, gave her foot orthotics to support her sudden increase in activity, and plantar fascia night splint for the morning pain and stiffness.  Plantar fasciitis is a common overuse injury.  The muscles in your arch stretch beyond their limits when you walk or run.  A sudden increase in activity, change in shoes, or an injury is usually related to the start of pain, but very few people realize this until I point it out.  In this case the patient had a new activity, running.  She also had new shoes that she bought for this training.  Had I seen her before she started training I could have watched her walk on slow motion video and analyzed how her foot might be effected by running.  Stretching could have been started before training began and help individualizing her training program could have been arranged.  Her heel pain and time away from training could have been avoided, but she will be able to run the marathon.

The second patient came to me with the complaint of pain and swelling in the top of his foot.  He was training for a marathon and noticed the pain increasing gradually as his distance increased.  Pain was present all day long, worse in shoes, and swelling increased the more he walked.  Running had stopped because of the pain.  X-rays showed a stress fracture of his 2nd metatarsal.  This is the bone behind your second toe and is commonly the bone involved in stress fractures of the foot.  Stress fractures are broken bones that happen gradually when you have a sudden increase in activity.  The sudden increased pressure on the bone causes inflammation that weakens the bone, but you’re still not aware of it so you keep on training.  When the weak area of the bone breaks you get the big ouch.  Treating the fracture early is easiest.  A removable cast and anti-inflammatory pills relieve the pressure and inflammation allowing the fracture to heal.  Once you heal the real treatment begins.  There is a reason the fractured bone has more pressure than the others and it’s my job to find out.  Detailed exam of your foot structure including video gait analysis will be done so that custom foot orthoses can be made.  This will correct the pressure problems in your foot and prevent further fractures.  Unfortunately in this case the patient came to me once his bone had broken.  His goal of completing a marathon will have to be postponed until later in the year.

The third patient wasn’t far along in her marathon training when she developed pain in her lower legs.  This pain was very bad when running and improved with rest.  She wanted to run the marathon so bad that she trained until until her leg started to swell.  By the time I saw her my major concern was a stress fracture of her tibia, the main bone in the lower leg.  The beginning of her story was more like shin splints, but I had to make sure so a few tests were done to prove this was not a stress fracture and she improved with treatment for shin splints.  Medial tibial stress syndrome is the newer term used in sports medicine for shin splints.  The cause is always related to pronation, see my article “Are You a Pronator”.  Most foot problems can be related to pronation, but medial tibial stress syndrome occurs in the leg.  To make a long story short, it’s the rotation of your lower leg when you run that causes this pain.  Custom foot orthoses are the only way to make this go away and stay away.  I had to modify this patient’s training program and get her help to strengthen her thigh muscles, but she will be running in the marathon.

Running is good for you!  No one will argue that point, but getting started is the hard part.  Buying a running shoe from a specialty store is a good idea, but now a lot of stores are using pressure mapping to tell you how your foot works.  First of all, you cannot tell how the foot works by standing still on a pressure plate.  At Desert Foot Surgeons I use video gait analysis to see exactly how your foot works while you run or walk barefoot and in shoes.  Second the study of foot motion is called biomechanics.  This takes years of study to master and is only provided in podiatry schools.  I have many friends in the running shoe business and have learned a lot about shoes from them.  Likewise I have taught my friends a lot about biomechanics.  I won’t pretend to know more about shoes than these professional salespeople and all of my friends will not pretend to know more about the function of the foot than I do.

Come see me before you start running.  I can help you with more than just shoes and orthotics.  I can get you personalized training or even physical therapy.  If you have shoes already video gait analysis will show if they are working for you.  Preventing injuries is much easier than treating injuries.  Running is good for you, just do it smart!

Athlete’s foot is an infection of the skin caused by fungus. Besides redness, itching, burning, and cracking skin, as I experienced, there can be blisters and oozing. If left untreated the infection worsens. The toenails can become infected causing thick and discolored toenails, but that’s a topic for another day. The fungus can decrease your skin’s defenses leading to infection with bacteria noticed by swelling, redness, and more severe pain.

Treatment of fungus begins by removing the source of the infection. Fungus grows in dark, moist places. Can you figure out what I was doing wrong? In my case I was wearing wet shoes everyday to run. Shoes take 24 hours to dry so alternate your shoes everyday. That means don’t wear the same pair of shoes two days in a row. Always wear clean and dry socks, wash your feet thoroughly and make sure you dry between your toes.

Other treatments for fungus are readily available at your store. Medications are usually creams, powders, sprays, gels, or solutions. The antifungal medicine needs to be applied twice each day for about one week. Beware of using creams. If the infection is mostly between your toes creams might keep the area too moist and fail to kill the fungus. Try powders, sprays, or solution between the toes. If you don’t improve after a week you need to see a physician.

Do you have young boys with stinky feet? Look more closely at their feet. Many times a parent brings in a young teen with redness, blisters, scaling and cracking skin, and the overall complaint of “stinky feet”. Dr. Geller has treated many children with pills to kill the fungus infection besides using creams or powders, clean dry socks, and changing shoes. Some people think treating fungus with oral medicine causes liver damage. They are referring to older medicines not used today. The newer pills to treat fungus are safe if prescribed by an experienced physician. Dr. Geller used pills to treat a fungus infection in his son.

Do not delay treatment of athlete’s foot. Bacterial infections are much more painful and challenging to treat. The earlier you are seen the easier the treatment.

Dr. Stephen Geller, AZ Podiatrist