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Foot Pain! What’s Wrong?

Expert Panel Questions???

“12 Days before Marathon, I have had pain on the bottom of my foot (arch area) for about 1 week. I am stressing mentally :) Any suggestions on what I should do would be appreciated.”

“I ran a half marathon the other day. About 12 hours after I finished, the outside of my foot started hurting. It’s the bottom of the foot on the opposite side of the arch. It has not stopped hurting since, especially when I walk. What is this?”

(ask your questions to the UtahRunning.com Experts here)

Answer!!!

The short answer to these two questions may be accumulated stress from training at increased intensity and volume of marathon preparation. Damage done to your tissues has exceeded your body’s ability to recover and heal itself. These issues are discussed in “Why does my heel hurt during the power phase of training?” Mechanics out of alignment or a worn-out or improper shoe may exacerbate stresses on the foot. Consider revisiting my article on how to select the correct running shoe.

Regarding why the lateral side of the foot is sore after a run–The short answer here is that you are running on the lateral side of your foot. You may have a cavus (high arch) foot and naturally run on the lateral side of your foot. Running in a stability shoe or using a rigid, high-arch orthotic will make you run more on the lateral side of your foot. Alternatively, you may have a planus (low arch) foot. In this case your shoe may not have enough stability and your posterior tibial tendon may be sore. Your body then tries to protect the posterior tibial tendon by activating the anterior tibial tendon, which inverts the foot and causes you to run on the lateral side of your foot.

Revisit the running shoe article and think hard about what type of foot you have. If pain is not improving, you may have a stress fracture, and you should seek treatment and have an xray.

By Jeffrey Rocco, M.D. Rocco Foot and Ankle Institute 801-644-8795

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Do I have a mild form of asthma?

Expert Panel Question???

“When I run my chest burns like crazy. After a while I start to get light headed and dizzy. Do I have a mild form of asthma?”

(ask your questions to the UtahRunning.com Experts here)

Answer!!!

In addressing chest symptoms whether related to activity or not it is helpful to think of the 4 body areas in the chest that these symptoms may be coming from: the heart, the lungs, the esophagus or the chest wall. Of these four, a problem with the heart raises the most concern and should be addressed first (for obvious reasons). This is followed by the lungs, the esophagus and then the chest wall.

Any chest symptom associated with activity and especially those that include light headedness and dizziness as the run continues necessitates at least a basic cardiac evaluation i.e. a thorough history including family history, a listen to the heart with a stethoscope and an office EKG (electrocardiogram). If there is any concern based on these tests, additional tests may be needed. Once you are reassured that your heart is ok we move on to evaluating the lungs.

Exercise induced asthma (formally known as exercise induced bronchospam or EIB) is not uncommon in runners – up to 30% in some studies – and could explain your symptoms. EIB is defined as a reduction of 15% in your normal lung function at rest compared to after you exercise. People with exercise induced asthma may or may not have underlying asthma but people with asthma almost always have exercise induced symptoms.

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Calf Pain

Expert Panel Question???

“What could be the cause of medial calf pain? I strained my left foot about a year ago and when I started running again my right calf hurt. It went away in about a month; now it is back. Is there something I can do to ease the pain and make it go away?”

Answer!!!

Calf pain is not an uncommon problem in runners because the muscles included in the calf are key to propelling us forward. The calf actually comprises 5 muscles with 2 of these in one “compartment” (a compartment is a bundle containing one or more different muscles) and 3 in another. It is important to know which specific muscle or muscles are injured in order to determine the best treatment options.

The most commonly injured muscles are the two in the compartment closest to the surface – the gastrocnemius and its deeper partner the soleus. These are the “foot to the accelerator” muscles. They are the main muscles working when a runner gets up on his or her toes to push off, run up hills or sprint. As a result, they are most commonly injured during interval, hill or faster paced workouts. The typical injury involves a tear (known as a strain) of the muscle. Strains are often graded on a scale of 1-3 with a 1 being a severe stretch of the muscle fibers, a 2 being a partial tear and a 3 a complete tear.

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Runner’s Knee

Expert Panel Question???

“After a run my knee begins to hurt fairly badly. It hurts a little during the run but mainly after. Is there a certain type of shoe that would help with my knees or is the only solution not to run?”

Answer!!!

Knee pain is probably the most common injury complaint in runners and has a variety of causes. The most common, Patellofemoral Syndrome, actually also goes by the lay name “Runner’s Knee”. It is more common in women but can occur in men too. It is characterized by pain in the front of the knee, is worse going up and down stairs, during squats or lunges and often results in a deep ache in the knee after a prolonged knee-bent position (such as sitting in a class, movie, car or on a plane). The fact that your knee pain is not so bad during your runs but afterward makes this the most likely problem although it can get bad enough to become an issue during runs too. It is thought to be an injury that occurs to the under surface of the knee cap (the patella) when the knee cap and the bone below it (the femur) are not in alignment.

The under side of the patella has a small ridge running vertically through the middle of it and the femur below has a corresponding groove. These two should remain lined up as the knee bends and straightens. A misalignment between the patella and the femur can be due to genetic factors, biomechanical problems or the result of muscle imbalances. Since we can’t do much to change our genetics, the focus is on the muscle imbalances and biomechanics. As a one directional sport i.e. straight ahead, even elite runners are notorious for developing muscle imbalances.

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Energy and Electrolyte Drink Comparison 2010

Proper hydration for athletes requires more than water. Last month we established the critical role electrolytes play for exercising athletes. (See A Tale of Five Electrolytes) During exercise electrical impulses are being carried, muscles are contracting, calories are burning, heat is being produced, and sweating occurs. To keep these systems within optimum parameters, electrolytes need to be maintained and energy stores need to be replaced—all within a fluid medium. The endurance athlete is faced with an ever-increasing variety of products to meet these nutritional needs. We have put together an updated comparison of currently available drinks and some thoughts to consider when selecting an exercise drink.

The volume of fluid consumed during exercise should nearly match the volume of fluid lost by sweat during the exercise period. Fluid losses exceeding as little as 2% of body weight can lead to significant decreases in performance. You can calculate your sweat rate by weighing yourself before and after a one-hour exercise session. This number less the amount of fluid consumed during the session is your sweat rate.

Our bodies depend on fluid to do the business of exercise, but that fluid contains more than water. It contains electrolytes primarily, along with some amino acids and vitamins. Electrolytes are dissolved mineral salts that are found in the fluid both inside and outside of the cells in our bodies. The primary minerals lost through sweat during exercise are sodium, potassium, chloride, calcium, and magnesium. Nutrition during exercise should include these five critical electrolytes. See A Tale of Five Electrolytes for a discussion of why electrolytes are important.

For athletes participating in longer duration and/or higher intensity exercise, the electrolytes lost through exercise can exceed what is available in many sports drinks. Some companies have recognized this and recommend supplementing with electrolyte tablets during exercise. Adequate amounts of electrolytes should be available in the sports drink. In the chart below notice the concentration of electrolyte losses versus the concentrations available in a typical sports drink. You might want to then refer to the label on your favorite sports drink or look at the comparison chart we have put together.

Electrolyte Drink Comparison Chart

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How do I heal a neuroma?

The term neuroma implies a painful, benign tumor of a nerve. Many people mistakenly use the term neuroma to refer to a painful, burning sensation in the forefoot (part of the foot towards the toes). In most cases the burning pain is a result of pressure on the sensory nerves coming from the toes. The pressure is usually caused by a combination of swelling in the metatarsal phalangeal joints (toe joints) and compression of the foot in footwear. The swelling in the metatarsal phalangeal joints is caused by overload of the metatarsal heads (ball of the foot). The shape of one’s foot, poor running mechanics, or muscular imbalances such as tight calf muscles or toe extensor recruitment may cause overload of the metatarsal heads.

To heal a neuroma you have only to alleviate the forefoot pressure causing the pain in the first place. A well-cushioned shoe of the type correct for your foot (see my article How do I pick a good running shoe?) can help considerably. A custom foot orthotic or shoe insert may also help to alleviate pressure. Anti-inflammatory medications may help to alleviate pain and swelling in the joints, and thereby, eliminate neuroma pain. Many patients ask about cortisone injections for neuroma pain. I do not recommend cortisone injections because they can cause atrophy of the skin and the necessary padding in the forefoot.

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