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When the Wrong Running Shoe is a Problem

When the Wrong Running Shoe is a Problem

Running shoes

This middle aged gent presented to the clinic after visiting two other podiatrists and yet was still plagued with foot pain.

He is a fit and healthy man with no prior foot or ankle injuries. He has been training for the last 6 months for a local marathon. He developed right lateral foot pain approximately six weeks ago. There was no proceeding injury or ankle sprain. It became progressively sorer the more he continued to train. He sought treatment with a podiatrist who recommended custom orthotics. This made the pain worse. He tried them for several weeks and the pain persisted. The advice from the second therapist was to continue with the orthotics and stop running. He ceased running but the pain returned once he went back to running.

By this point this gent was quite exasperated about the pending race and he was still plagued by foot pain. My examination of his foot revealed very little. There was no pain on palpation of any bone or joint or soft tissue. There was no pain on passive or resisted movement of the foot and ankle. There was no swelling or bruising. Medical history was unremarkable. The patient pointed to the area of the dorsal cuboid area and described the pain as a deep aching pain. He had no pain in the foot during the day at the office.

Upon further questioning it was revealed that he had purchased new shoes two weeks before the pain started. He describes his old pair of shoes as being ‘cheap and old’ department store running shoes and decided to treat himself to better shoes. Looking that the shoes they were evidently a stability or anti-pronatory type shoe. A quick gait assessment showed that this gent has a fairly ‘neutral foot type’ with bilateral lateral ankle instability.

The immediate thought was he was experiencing lateral column overload from the anti-pronatory shoes. He did not bring in his orthotics for assessment but it is not difficult to surmise that these were likely contributing to the lateral foot overload. There was not a significant amount of over-correction present in the shoes but it was enough to be causing pathological loading changes in the foot.

I suggested he go and change his footwear back to a neutral runner with an even medial and lateral sole. I was pleased to have a phone call to say that all his pain had ceased and he was back to training full steam.

It is important to note that sometimes footwear can play a big role in contributing to injury and conversely reducing the risk of injury. If you suspect your shoes are contributing to your pain or need a footwear review we can assist and give advice on what sports shoes you should be looking for in future.

What to Do If You Have Suffered a Sporting Injury

What to Do If You Have Suffered a Sporting Injury

Types of Foot Sporting Injuries and How We Can Help You Recover From Them

Sporting injury is a blanket term for anything concerning injuries that are experienced during or after playing any sport or exercise. They can occur at any time, whether running a marathon, playing a round of tennis, or even doing yoga. These injuries can happen because of an accident but more often than not, because of poor form, wrong equipment, overextending the body, and performing without warming up or conditioning the body for exercise. In other words, a huge percentage of being able to prevent a sporting injury is well within the control of the athlete or any person leading an active lifestyle.

What Are the Signs of an Injured Toe, Foot or Ankle?

  • Bruising, tenderness, swelling, or inflammation in the affected area
  • Arch or heel pain
  • Ingrown, discolored, or crumbling toenails
  • Calluses and bunions
  • Itching, stinging, or burning sensations on the soles of the feet or between the toes
  • Lower back pain
  • Shin, knee, and hip pain
  • Mild to severe foot/ankle pain
  • Instability and difficulty moving your foot or ankle
  • You heard a popping sound in the affected area during the injury

Sports Injury

What We Can Do to Help With Your Sporting Injuries

No matter the sport, we can all agree on one thing: almost all of it involves our feet. This is why when it comes to an active lifestyle, whether you’re an athlete or a person committed to doing regular exercise, podiatrists play a big role in maintaining your performance and preventing sporting injuries. Here are ways we can help you:

Diagnose and Treat Existing Symptoms and Problems

An injury is not always a cataclysmic event that instantaneously happens. More often, injuries can be traced from a simple problem such as a bunion or an ingrown toenail, which forces the body to compensate to mask the pain. We conduct a complete physical examination and interview our patient to identify possible injuries and to also check for certain conditions that may increase your risk for injuries. As part of this process, we may use our new Body-Tech machine, which uses a combination of a treadmill, pressure sensors, and slow motion video to analyse the way you walk or run, your stability and your posture. We then recommend the best treatment options based on the findings. Some treatment options include anti-inflammatory treatments, massages, physical therapy, orthotics, and recommending appropriate footwear and exercises to promote recovery and prevent future injuries. We also use a Thor Medical Laser to help treat injuries and speed up recovery and rehabilitation. Football Injury

We Go Beyond the Feet

Contrary to popular belief, podiatrists don’t just assess your feet. We understand the correlation between the body’s posture and alignment and the direct effect of these to one’s feet. Anything that’s not right on the body impacts the feet and vice versa. For example, we study how a runner’s form and how this impacts the feet. A wrong landing of the foot can lead to serious problems such as sprains. We evaluate such conditions and help you achieve the proper posture and alignment to prevent pain and injuries.

We Provide Preventive Maintenance

Aside from treating sports injuries, we help prevent future injuries and maximise performance by correcting existing problems and educating patients on the best exercises, therapies, and footwear for their activities.

Don’t Hesitate to Get in Touch and Find Relief

Think you may have sporting injuries or are prone to sustaining one? Schedule an appointment with us to get proper evaluation and care. Contact us today on (08) 9316 3010 for more information.
Should “RICE” be replaced with “MEAT”?

Should “RICE” be replaced with “MEAT”?

Most people are familiar with the RICE (Rest, Ice, Compression and Elevation) principle for treating sports injuries. It is widely advocated and commonly used for the treatment of acute injuries such as ankle sprains. However some of the medical community are moving away from this principle as it is now thought that this protocol may delay recovery from tendon/ligament injuries. Tendons and ligaments are naturally avascular structures meaning that they have poor blood supply in comparison muscle fibres. Further reducing blood and nutrient supply with the use of the RICE principle may cause delayed healing. Should RICE be replaced with MEAT The doctor who invented the RICE treatment protocol in the 1970s has now stated that the use of ice and rest may delay healing and has recanted its use.
  • Rest (no movement): Movement is required to promote lymphatic drainage (drainage of fluid and waste products) and bring fresh oxygenated blood flow and nutrients to the injured tissue.
  • Ice: There is also a lack of evidence for the use of ice or cryotherapy for soft tissue injuries and Bleakley et al (2004) found that it may delay or slow healing by decreasing the metabolic rate.
Researchers tested whether applications of ice were helpful in recovery after strength training. When the tissue is cooled through icing, peripheral blood flow can be reduced. After the ice is removed, the blood perfusion may then return but the blood vessels may not open for many hours after the ice application. This research found that these fluctuations can cause the tissue to die due to lack of blood flow. It can also lead to temporary or permanent nerve damage.Therefore, ice application does not boost recovery after exercise and can instead cause tissue and nerve damage. Tseng et al (2013) found that topical cooling significantly increased the levels of muscle damage markers in elite athletes as well as causing muscle fatigue. The new injury protocol mnemonic that some practitioners are now in favour of is MEAT. Meat stands for:
  • Movement: It is thought that early movement stimulates healing, promotes nicely aligned collagen fibres and leads to faster recovery times. Kerkhoffs et al (2002) Cochrane review showed that patients improved quicker and had a faster return to activities with functional treatments versus their immobilised counterparts.
  • Exercise: The reasons behind this are the same for movement but establishing an exercise program after the acute injury is important to prevent long term joint instability and improve functional outcomes.
  • Analgesia: Is the use of pain relieving drugs that do not cause delay in healing. Some medications such as NSAIDs have been show to delay or inhibit healing. Acetaminophen can help with pain relief but not block the inflammatory cascade/process, although it does come with risk factors (liver toxicity). Natural pain relieving treatments such as acupuncture/dry needling and low level laser therapy have shown to be very effective at providing pain relief.
  • Treatment: Treatment includes any form of manual or electro-therapy modalities such as myofascial release, ultrasound, low level laser therapy, acupuncture/dry needling and mobilisations. These all promote blood flow, tissue healing and pain relief.
The RICE/ICE principle should still generally be used for acute muscle injuries as there is risk of developing compartment syndrome. Ligaments and tendons are not at risk of developing this pathology. There are elements of both protocols that are beneficial – e.g. compression from the RICE principle is beneficial for lymphatic drainage and reducing oedema but without immobilising the joint. It is important to consider the type of injury and the symptoms that the patient presents with before implementing a treatment plan.

References

Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251–261. Kerkhoffs GMMJ, Rowe BH, Assendelft WJJ, Kelly KD, Struijs PAA, van Dijk CN. Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database of Systematic Reviews 2002, Issue 3. Malone T, Engelhardt D, Kirkpatrick J, Bassett F. Nerve injury in athletes caused by cryotherapy. J Athl Train. 1992; 27(3): 235–237. Tseng CY, Lee JP, Tsai YS, Lee SD, Kao CL, Liu TC, Lai C, Harris MB, Kuo CH. Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage. J Strength Cond Res. 2013;27(5):1354-61. doi: 10.1519/JSC.0b013e318267a22c
Why Isn’t My Injury Getting Better?

Why Isn’t My Injury Getting Better?

Injuries are frustrating at the best of times. They are common in athletes or people involved with any type of physical activity but particularly high impact sports. When your injury isn’t getting better there are some important aspects to consider.

You are trying to go it alone or mis-diagnosed your own injury

Foot Stretch ExerciseOften we see people present with injuries that are months old or even longer. People often think that the injury will heal and the pain will eventually go away. In some instances the injury can become chronic. When injuries become chronic they are not likely to heal themselves over night when you eventually do see a health professional. Long term injuries are most likely going to take long term to resolve. Your health professional team are there to correctly diagnose your injury and provide a suitable management plan. Self therapy like icing and rolling may help temporarily but doesn’t address other factors like strength and proprioception, biomechanical influences etc.

Inadequate Nutrition

Nutrition is a very important factor in the healing process. When you are injured your body’s protein needs increase as well as requiring all of the essential vitamins and minerals that are key to to promoting cellular repair and growth. Eating too little or consuming processed foods have been shown to have a detrimental effect on cell healing. If you feel that your diet could be improved or altered its best to talk to a qualified health professional that specialises in this area as increasing your intake of certain proteins, vitamins and minerals can also have a detrimental effect particularly if you suffer from certain health conditions.

Alcohol

Foot After RunWe know now from clinical studies that alcohol has a negative effect on muscle repair. Drinking alcohol affects your sleep and this in turn affects the amount of a hormone called Human Growth Hormone that is released when you are asleep and is responsible for repairing muscle and cell growth. Alcohol consumption can reduce the release of this hormone by 70%!

Attitude

You need to be committed to doing your rehabilitation exercises and whatever other management/ treatment advice your treating clinician has recommended. Your rehab exercises aren’t going to be effective if you skip multiple days without doing them or if you aren’t doing them with correct technique.

Stopping Activity All Together

Depending on your injury, it’s best not to stop physical activity all together (but you should stop the aggravating activities!)  E.g if you develop plantar fasciitis (heel pain), you can still maintain aerobic fitness by cycling, swimming or rowing, which are not high impact on the heel. You can always work around a specific injury. Tendons, muscles and joints do not respond well to long periods of rest or immobilisation. Conversely if you are still doing the aggravating activities or not allowing enough time to recover, this will reduce your injury healing time.

Working with a good team of health professionals and looking after yourself in terms of nutrition, sleep and committing yourself to the rehab process your injury will soon be a thing of the past!

For further reading:

Laser Therapy For Sports Injuries

Get Tips on Treating Your Athletic Injury at Home in Our Sports Foot and Ankle Blog