Newsletter Edition 5 Gotham Footcare

Marathon season is upon us! So many of our patients at Gotham Footcare are runners, and many have – or will someday – participate in the ultimate NYC running experience: The New York City Marathon!

On November 3rd over 50,000 runners will take to the streets of Gotham to tackle the 26.2 mile course – and if you are planning to take on this challenge, we want to be sure that your feet are ready to carry you all the way across the finish line. From when to start breaking in your race shoes to how to choose the best shoe for your foot, we’re here to help!

Whether you are in the final stages of training, or just the occasional weekend warrior, read on to learn more about the common injuries that face runners and what know in these last few weeks before the big day. And don’t forget to look out for the dreaded Athlete’s Foot – a common, but underrecognized and easily treatable condition that most runners have faced at some point in their lifetimes…. Yes, even you!!

And if you are dealing with even a minor foot issue today, make an appointment to see us before the race. Here’s to healthy feet, great weather and breaking your PR!

Dr. Gotham

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Ask

DOCTOR

GOTHAM

Dear Dr. Gotham,

I’m currently training for the New York City Marathon and want to make sure I have the best shoe gear for the big race. What should I look for in running shoes?

Sincerely,

NYC Runner

Dear Runner,

Running shoes are engineered for heel-to-toe motion and are lighter than cross-trainers which makes it more comfortable to run in for with repetitive pounding for prolonged periods of time and distances when shock absorption is important. Running shoes have a higher heel drop (the distance from the heel height to the toe height), than cross training shoes for added support and cushioning. While cross-training shoes provide cushioning, running shoes are specifically designed to withstand the higher impact for people who pound the pavement, the track, or inside on a treadmill. Here are a few features to look for you as you choose your running shoes.  

1) Rigid shank: In order to tell if the shoe is rigid enough, you want to take the shoe and bend it in half. You shouldn't be able to, because the shank is the actual structure of the shoe and should be rigid to hold up and support the arch.

2) Rigid heel counter: Squeeze the heel of the shoe to see how firm it is. There should be a good bit of padding called an ankle collar which is intended to protect cushion the ankle and the Achilles tendon. You shouldn't be able to compress it – so when you are running it supports the heel.

3) Wide forefoot: Most of the problems that occur with our feet - particular for woman, and often for runners - are because our shoes don't have a wide enough forefoot. Bunions, hammer toes, neuromas, ingrown toenails, etc. are all caused if you don’t have the wide forefoot. In order to determine whether the forefront is wide enough, I suggest that you trace your foot onto a piece of paper at the end of the day when your feet are most swollen. Then place the shoe over the tracing of the foot. If the tracing of the foot is external to the periphery of the shoe then you know that your shoes are too narrow.

Good luck!

Dr. Gotham

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Do’s and Don’ts of Marathon Training  

The only thing that’s longer than a marathon is the preparation it takes. Runners and athletes spend months at a time getting ready for the big race. During the prep period, it’s crucial that they know how to properly care for their body, feet, and shoes – one wrong move could cause a dream-dashing injury. Here are a few tips to help protect your feet as you prepare for this run. 

DO:

1. Make your training progressive. Gradually change up your routine, increasing the intensity or degree at which you exercise. This also helps develop your muscle memory. Note: key word is GRADUALLY. Injuries can happen if a workout regimen advances at a rate that your body is not prepared for.

2. Anything that promotes blood flow. Stretching, yoga, compression gear, and vitamin E-rich foods are all ways to enhance circulation. Bringing nutrients and oxygen to muscles is highly recommended to boost your performance during both training and the marathon itself.

DON’T:

1. Run Barefoot. Walking barefoot on hard surfaces allows our foot to collapse which can lead to a tremendous amount of stress not only to the foot but to the rest of the body. It can also put you at risk of stress fractures. Also, it’s important to train the way you’re going to run the race, which is with a proper pair of running shoes.

2. Get new sneakers too soon before the marathon. Allow yourself time to break in your sneakers and get comfortable – Dr. Cunha recommends at least 1-2 weeks. Going on walks or jogs with your new pair will prevent potential shin, heel and toe injuries, as well as blisters.

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Common Foot Injuries That Arise During Marathon Training 

We’ve all felt aches and pains after a long run. This is especially true if you’re gearing up for a marathon. But it’s important to remember not to neglect your feet as you train. Yes, your PR is important but so is the long term health of your feet. After all, they are taking the most beatings as you prep for the big day. Here are some common foot issues that may arise when you’re training for a marathon along with tips for pain prevention. 

1) Plantar Fasciitis. Your foot contains a thick band of tissue called plantar fascia that stretches from your heel to your toes. That tissue’s job is to support the muscles and arch of your foot. Too much tension on the tissue can cause it to stretch too far, resulting in tiny tears that cause pain and inflammation. I see this issue in a lot of athletes especially if they don’t wear proper fitting shoes to the gym. It’s important to support your arch to avoid stretching your plantar fascia to the point of pain.

If training for the marathon and you are wearing the wrong shoes, it may lead to problems such as lowered performance, discomfort such as in plantar fasciitis and runner’s knee, injuries, and even early-onset arthritis. On the other hand (or other foot, pun intended), shoes designed to compensate for the impact of your feet can help prevent injuries and improve structural alignment and performance.

Treatments for plantar fasciitis include:

• Home stretching exercises

• The application of ice (using a frozen water bottle)

• Topical and or oral anti-inflammatory medications

• Night Splints that help stretch out the plantar fascia.

• Custom orthotics

• Physical therapy

• Immobilization

• Cortisone injections when necessary

2) Blisters. Blisters are caused by friction which generally occurs because the skin is between a rock and a hard place. The best way to prevent blisters is to ensure that your shoes fit properly and are broken incorrectly. 

Whatever you do, do NOT remove the top layer of skin from your blister.  It will only cause the blister to become more painful and expose yourself to more bacteria which could develop into an infection. Instead, you should lance the blister. Take a clean needle, and poke the blister from the side to drain the fluid. Once the fluid is removed, the pressure will subside. Then soak your foot for 15-20 minutes in lukewarm water with Epsom salt.

I also encourage using Betadine to help dry up the blister which will speed up the healing process. Many people think they should apply Neosporin to a blister, but that doesn’t help dry it out. We have normal hydration to our bodies so whenever something is too wet, you want to dry it out. Whenever something’s too dry, you want to wet it. While Neosporin is great for something like a scab, betadine is much better for blisters because the underlying skin is wet and raw.

Epsom salts can help with blisters because they contain magnesium which can reduce swelling and pain associated with blisters. Magnesium can help irrigate, cleanse, and dry out blisters which also helps reduce the painful rawness of blisters while expediting the healing time.

3) Achilles Tendonitis. Achilles tendonitis is inflammation along the Achilles tendon. The Achilles tendon is the largest tendon in the body and is, therefore, susceptible to overuse injuries from running and jumping type exercises. It is responsible for plantarflexion of the ankle (causing the front of the foot to lower and lift the heel off the ground). 

Achilles Tendonitis is usually due to excessive repetitive stress to the tendon. Typically, this condition is not related to a specific injury but rather due to over exertion of the Achilles tendon. Most cases of Achilles Tendonitis can be treated conservatively with nonsurgical treatments, although it may take several months for symptoms to completely subside.

4) Ingrown toenails. An ingrown toenail is a common condition typically affecting the great toe, in which the corner or side of the nail becomes incurvated (turned inward) and grows into the skin and soft flesh of the toe. This results in irritation of the surrounding soft tissue, often causing pain, redness, swelling, warmth, and sometimes and infection. Many things can cause an ingrown toenail – it could be genetic, you could be clipping your toenails incorrectly or you could be wearing the wrong size shoe which tends to squeeze the larger toe causing ingrown.

Home treatment is strongly discouraged if an infection is suspected, or if you suffer from medical conditions that put your feet at high risk, such as diabetes, nerve damage, or poor circulation. We suggest visiting your local podiatrist to ensure you do not further exacerbate the issue by conducting “bathroom surgery” which could lead to a more severe infection.

5) Bunions. A bunion is a deformity of the front of the foot and the great toe joint. It is often described as a bump on the side of the big toe. When the biomechanics of the foot are imbalanced it can worsen over time. They start when the big toe rotates sideways towards the second toe. The bones of the first metatarsal shifts in the opposite direction and gradually changes the angle of the bones. This produces the characteristic bump, which increases prominently over the years.

If a runner is wearing a shoe that does not fit right, they can compress the toes together causing the big toe nail to grow into the skin and eventually resulting in bunions as well as ingrown toenails. Ill-fitted shoes can also aggravate the symptoms and progression of bunion deformities as the shape of the shoe does not accommodate the normal structure of the forefoot. An ill-fitted shoe can also press up against the great toe pushing it over towards the second toe further exacerbating bunion deformities if the shoe or toe box is too narrow. Most of the problems that occur with our feet - particular for woman, and often for runners - are because our shoes don't have a wide enough forefoot. 

Icing, topical oral inflammatories, wider shoes, padding, strapping, and arch supports to slow down the progression of the bunion, as well as bunion splints that may be purchased on Amazon will help alleviate the discomfort of a bunion.  Unfortunately, these treatment options only address soft tissue inflammation over a brief period of time; they do not alleviate the symptoms in the long term as they fail to address the root of the deformity which is the misalignment of the bone.

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Product Plug: Tinactin Tolnaftate Antifungal Aerosol Spray

Athlete’s Foot is a fungal infection of the foot that develops commonly on the soles of the feet and in between the toes. If you catch it early, Athlete’s Foot can be treated with over-the-counter medicated powders, creams, sprays, or lotions that are specifically formulated to fight athlete’s foot fungus. For these cases, I recommended Tinactin Tolnaftate Antifungal Aerosol Liquid Spray. This product is a clinically effective treatment for Athlete’s Foot. Before you apply this antifungal, clean and thoroughly dry the area to be treated and spray the medication directly to the affected skin.

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Patient Testimonial: Shockwave Therapy Saves the Day

 

Dr. Cunha performed the CuraMedix EPAT shockwave therapy on my achilles tendon. Pain in my tendon had flared up for the past three years and it seemed there would be no end in sight for the discomfort that came from running or high activity levels. I was heading off to military training in the next month and was required to be in peak physical condition. Dr. Cunha sat down with me on my initial visit and went over every single option available to heal the tendon and decrease the pain. He does not push for any particular method or option, but rather discusses the pros and cons, healing time, and success rates of each method. His professionalism is beyond reproach and he truly cares about getting you back to the level you want to be at. 

I felt the shockwave therapy truly delivered stellar results. It was state of the art technology and a brand new device to the office. Dr. Cunha expertly used the device and I felt true results after 4-5 visits.

I cannot recommend Dr. Cunha or his staff enough. They are truly the best in the business of healing your discomfort or pain regarding foot injuries. I will be back if I should re-injure myself and am very lucky for having found members of the medical community who were so competent in their line of work. 

--James C.

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