New York, New York: The Marathon Coverage

by pribut on October 31, 2009

I wish good luck and a strong finish to everyone running tomorrow in the New York Marathon and to the runners participating in other marathons coming up the rest of this fall!

As the media frenzy leads up to the New York Marathon, there is more than one story to pay attention to. There is history, current competition, excellent runners, ordinary runners, and a whole city gearing up for a big day. For most runners, today is a rest day and for the evening, a bit of pasta. I recall watching the New York Marathon all the way  back when Bill Rogers and Alberto Salazar each won it multiple times. The first year Salazar won, I watched along first avenue and wondered who was this guy in the bright yellow shorts running so upright and far ahead of everyone else. I then jogged over to Central Park to see the early finishers. Then at the end of the race, I’d be out for my run and watch the “slow runners” coming in at over 4 hours. Of course, no fussing or teasing about a 4 hour finish now! Back then it was also wonderful to watch Greta Waitz win consistently year after year. The New York Marathon continues to be exciting. Paula Radcliffe has an amazing string of victories. And the race itself going through all the boroughs with so many people watching and cheering, and crossing so many (difficult) bridges is a tremendous event.

The New York Times joined in the media frenzy. After a “run-up” of articles the last few months that have been quite good and resulted in a lot of participation at their forums, the marathon made it to their OP-ED page today. Unfortunately the article on the op-ed page lamented our missing champions and the fact that an American hasn’t won the men’s division in 27 years since Alberto Salazar won. The author deems this failure a lack of “narrative”. The piece concluded by making fun of runner’s world for having general articles on improving muscular fitness and articles for beginners.

In actuality, I’m going to recommend the Runner’s World New York Marathon coverage as the best place to read about what is coming up and for fine overall stories and profiles of the runners participating. Runner’s World both profiles world class runners and offers excellent information on the sport of running to lesser mortals. Running is a participatory sport. At a time in which 65% of U.S. adults are overweight, a magazine offering tips about starting running without feeling bad because you are slow, how to improve, what shoes might be best for you, nutritional recommendations, recipes, motivation tips, and even advanced training, can not be a bad thing.

With Runner’s World publishing excellent articles on stretching, overall fitness, strength training, nutrition, along with articles on the best and the fastest, it can only help the overall health and fitness of their readers. I’d encourage all runners to both visit their web site and get a copy to read. There is much inside for every runner, and the articles go deeper than the newstand cover may suggest. Other fine magazines geared to runners include: Running Times, and Marathon and Beyond.

There are a few things we can consider doing to improve our runners. At the same time we need to work on the overall fitness and health of everyone. Runner’s World encourages everyone, and has always done so. While there were many exciting past races, many are still excited to be out running and doing the best they can. To improve the sport (and our health) we have done a disservice to everyone by requiring only one year of gym in high school. Childhood obesity is at an all time high and this does not help. Encouraging more athletic participation and demonstrating team, carry over sports,  and individual sports and making it school centric would be helpful.

Better coverage of track and field and running events  in national news and sports shows would be helpful. Live coverage of major races and track events on television would be a good thing. And how can we not have live coverage of the Olympic events? With a million cable stations available why was there not a package for sale that included multiple channels along with many different events for those few weeks. Years back this was done, and it would have been quite successful the last few Olympics.

We have no failure of narrative, publishing, or research. The American College of Sports Medicine is the most respected organization of professionals in the world. Their journals (especially Medicine and Science in Sports and Exercise) are eagerly awaited by researchers and clinicians working in the field of sports medicine. We have the tales of Dean Karnazes. This year has seen one of the most enjoyable reads on running in Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen, by Christopher McDougall.  We have research, topical magazines, participants, web sites, bloggers, and as much narrative as we could hope for.

The media could certainly do a better job in presenting running events, and the benefits of the sport and helping to publicize  appropriate goals and how they can be established. Complaining that not enough Americans have won lately doesn’t give adequate credit to those who have both talent and have worked hard for their success. And we need to remember that we are all a part of the human race. Going beyond sport is a book published earlier this year by Johns Hopkins Professor David Calleo, Follies of Power: America’s Unipolar Fantasy which points out the reality and significance of  a multipolar world. The international lessons here extend beyond politics, trade and international affairs and into sports. If one pays attention, you may yet find yourself bringing back accolades to your country perhaps even in the form of a Nobel prize.

The United States has a fine and growing group of excellent men and women runners, yet New York is open enough over the years to have welcomed and been joyful for all of the marathons winners and their participants from wherever they come from. (Even those from Boston during the world series. )

Runner’s World NY Marathon Coverage

New York Times Marathon Coverage

Related:
Running In Central Park: Interactive Map

Frank Sinatra: New York, New York

24 Hours To See New York: Gene Kelley, Frank Sinatra

Empire State of Mind (Jay Z, Alicia Keyes)

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Aches, Pains, and Visits to The Doc

by pribut on October 29, 2009

After unusually persistent aches and pains during training or after your race, you may decide it’s time for a visit to your sports doc. Of course, we hope you’ve increased your training slowly, checked your shoes and done your best to  learn how to avoid the doctor’s office.

Now that you’ve decided it is time for a visit, how can you make that visit work in the best way possible for you?  What should you bring? Of course bringing yourself in is the most important thing.  The following items are helpful. And the running shoes are often contributors to the injury and it can be very helpful to examine them.

Try to bring in the following items:

Notes on your injury:

  • When did it start?
  • Where does it hurt?
  • When does it hurt?
  • What has changed in your training?
  • What speedwork or harder than normal running have you been doing?
  • What shoes did you wear before you were injured, when injured and what are you wearing now?
  • What surfaces have you been running on?
  • What have you tried to make things feel better?

Things to bring:

  • Current running shoes ( the newest running shoes you have used)
  • Previous running shoes (recent ones which may have contributed to your injury)
  • Orthotics (if you use them)
  • Running/Exercise Log (if you have one)

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Athletic and Running Shoe Fit Tips

by pribut on October 27, 2009

  • Look for a sport specific shoe.
  • Go to a specialty store. Runners should visit a specialty running store.
  • Take injury history into account.
  • Measure feet each time shoes are fit.
  • Wear the customary socks for to be worn for sport participation. Sock thickness affects the sizing and fit of shoes.
  • Bring orthotics to fit shoes, if you wear them.
  • Fit shoes later in the day since feet expand slightly by then.
  • Leave a finger’s width in front of the longest toe.
  • Make sure both the heel to ball fit and the shoe length are both matches for your foot.
  • Make certain the shoe feels comfortable. It won’t be feeling better in a week, if it doesn’t feel good right away.
  • Check the shoe for manufactured defects. It should line up perpendicular to the ground and not wobble.
  • Replace your athletic shoes regularly. Runners should replace the shoes every 350-450 miles.
  • Remember to forget about the size and focus on the fit
  • Don’t wear a new shoe in a race or in a long distance competitive event.

For more information see:

Dr. Pribut’s Running Shoe List

Dr. Pribut on Fitting and Selecting Running Shoes

Elvis: Put On Your High Heeled Sneakers (Master Out-take)

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Staying Alive: Marathon Day Tips (Part 2)

by pribut on October 23, 2009

Now that you’ve trained properly after having a medical exam and clearance to run, you are nearly ready for the big day. Prudence should keep you upright for the next 26.2 miles. Some have said “Start slow, and finish slower”. But that may not be your plan. Make sure you run within your means. Be certain to taper for 3 weeks. And let’s make another list:

  • 3 training runs of 18 – 20 miles should have you set for your marathon.
  • Taper and run much less for 3 weeks.
  • You may gently carbo load. Don’t “deplete”. Don’t gorge. And don’t eat new or spicy foods for the 4 – 5 days before the marathon.
  • Sleep well the nights before the marathon.
  • Don’t drink too much the night before. Don’t use drugs. (In Woodstock the word was to avoid the brown acid.)
  • Don’t take herbal diet or stimulant mixes. They are not checked by the FDA and may have unhealthy contents.
  • Hydrate wisely. You may hydrate before the race. Don’t drink till you slosh. Don’t overhydrate. For the slow marathoner, hyponatremia (low blood sodium) from taking in too many fluids is a bigger danger than dehydration. Some races have scales for you to weigh yourself on. If you weigh more as the race goes on, you are drinking too much.
  • Wear a medical condition and allergy bracelet or have the information attached to your shoe.
  • Eat your regular long run breakfast.
  • Warm up gently.
  • Don’t start out too quickly.
  • Pay attention to your body. Dizziness, faintness, chest, shoulder, jaw pain or tightness should be checked with the medical team immediately.
  • Drink and eat foods you’ve used before on your training runs.
  • Don’t sit down abruptly at the end of the race. Walk around a bit as a gentle cool down. If you sit, your muscles will likely tighten up and you may not get back up again easily.

General Tips

  • Wear shoes that you’ve had good success with and shoes that are broken in.
  • Make sure the rest of your clothes are also comfortable and broken in also including your sports bra or other sports underwear, shorts, singlet, sweats and socks.
  • Use broken in Coolmax socks or another “wicking” fiber for all of your runs and  on race day.
  • Try to get adequate sleep over the last month so your body can be as well recovered as possible from all the training you’ve been doing.
  • Eat healthy throughout your training. Don’t overeat  or drink much alcohol  on the night before  your  race. Do eat a carbohydrate rich meal for a few evenings before the marathon.
  • Wear outer layer clothes you can throw away as the race goes on and you warm up. If you are going to be at the race line early, dress warm for the morning chill, and be prepared to ditch your outer layers as the race draws near or as you go along and warm up.
  • Use the same fluid replacement and  gel that you’ve practiced with on your long runs. Beware of under hydration and over hydration. If you are running for longer than 4 hours, consider using weighing stations if your marathon has them available to attempt to avoid hypernatremia.
  • Remember to go out slower than you think you should so you can have a negative split and  not burn out somewhere before mile 20.
  • Figure out where some of those cameras will be taking your photo so you can  look  good for your marathon portrait.
  • Don’t forget after the race that you should rest about one week before running again and then “reverse” taper.

Things To Bring:

  1. Race number  and safety pins. Pin this to your clothes two nights before the race.
  2. Running Shoes and all your racing clothes
  3. Clothes to toss, if it is cold. Long sleeve teeshirts, sweat clothes.
  4. Change  of clothes for after the race.
  5. Money for emergencies.
  6. Body glide, if you’ve used it for areas  that rub on previous long runs.
  7. Your own food for after the race  in case the race runs  low.
  8. Plastic  container of water  or sports drink to drink before the race
  9. Toilet paper to carry in your carry-along, in case of emergency.
  10. Very light  weight, miniature camera if you don’t expect to win.
  11. Throw away reading material for the  long  wait before the race.

For post marathon recovery, I have some tips on recovering from the marathon and a reverse taper program.

I just came across the following “tips” video performed by Toby Tanser via Mark Remey at RW

Last Minute Marathon Tips: shot with Nikon D90 from Mike Kobal on Vimeo.

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Stayin’ Alive: Tips For The Marathon (Part 1)

by pribut on October 23, 2009

This running season has seen the devastating news of several half marathon deaths. Runner’s as young as their 20’s and 30’s have died. While the odds of dying in a marathon are quite low, it can and sometimes does happen. Some of the latest numbers show that the estimates of 1:50,000 marathoners has now lowered to a bit less than 1:100,000. Figuring that each of these runners at the start has run about 100 hours on the average during training, that works out to be 10,000,000 ( ten million)  hours run per marathon death. Clusters are seen in many medical conditions, and often they are not linked to anything but chance.

The marathon is not a pre-requisite to fitness, it is optional. The first 30 minutes are for your body, the rest is for your mind. But it is something many people enjoy and it is safer than driving in your car or sitting for the next 20 years in front of your TV or computer. We’ll examine this again later. For now, since these are quick tips, let’s get to them.

Your race form has a consent form that uses language that requires you to certify that you are medically fit and have trained for the event. Before training for an event as long and involved as the marathon (and the general advice is before beginning any new exercise program) a visit for a physical examination is a good idea. Colleges, high schools and even elementary schools require a medical examination and clearance before participating in sports. A sample college medical clearance athletic form shows the level of detail requested. An EKG can be helpful and most definitely Blood Pressure measurement should be done. Among many things the EKG can detect are signs of cardiomyopathy, enlarged heart, a variety of arrhythmias including Atrial Fibrillation, PVCs, and certain changes in the T Wave that are associated with sudden death.  You should probably set up a lifetime plan to check your blood pressure regularly. Your blood pressure can go up unexpectedly and leave you at risk for serious problems. There are often no signs of this, that is why high blood pressure is called the silent killer. The following are my suggestions and not an official recommendation of any organization. Following my perhaps over exuberant and obsessive recommendation are  more official recommendations.

Suggested BP Checks With Risk Factors

  • Over 18 – Under 30 – Every 12 Months
  • 30 – 40 – Every 6 Months
  • 41 – 50 – Every 3 Months
  • 51 – 60+ – Every 2 Months

Several organizations have gentler, less stringent recommendations. According to their web site, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (see JNC 7 for documents and complete recommendations) strongly suggests “screening every 2 years in persons with blood pressure less than 120/80 mm Hg and every year in persons with systolic blood pressure of 120 to 139 mm Hg or diastolic blood pressure of 80 to 90 mm Hg.”

Recommendations for getting your training started:

  • Before starting a new training program, a pre-participation physical is a good idea.
  • Check your blood pressure regularly.
  • Eat healthy food.
  • Train within your limits.
  • Avoid herbal food supplements.
  • Avoid stimulants and be careful with supplements which may contain ephedra, caffeine, etc.
  • Don’t short change your energy supply by dieting aggressively while working out hard.
  • Increase your training gradually.
  • Rehydrate wisely. Use a combination protein-carbohydrate drink after the long run for glycogen and fuel replenishment.
  • Pay attention to your body. Note dizziness, excess fatigue, chest tightness or pain, pain in your upper back or shoulder, chest or jaw. All can be serious warning signs. Stop and get checked. In a race, stop and seek medical attention.

Be careful out there. Prepare for the big day. Remember, by the time you get to the marathon, you’ve already run several half marathons in training and more – likely up to 20 miles. You should be ready. But do pay attention to your body on marathon day. Taper and rest up before it. Don’t get smashed the night before the marathon. Toxins in your body won’t help your performance.

Read Part 2 “Staying Alive: Tips For the Marathon”

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Toenails Are Optional?

by pribut on October 22, 2009

Best quote of the day was by Chris Mcdougall in the New York Times:

“You know any sport has gone off the rails when you have to remove body parts to do it,” said Christopher McDougall, the author of a recent book about ultrarunning called “Born to Run.”

With it’s motto of “all the news that’s fit to print” the Times seems to have not had room to fit the rest of what I’m sure Chris said. First, “Born To Run” is about a quest to run, and Chris’s quest was answered by running barefoot or in minimalist shoes. What I’m sure Chris said was that it might be easier to remove your shoes than have your toenails removed at their roots.

The article highlighted ultramarathoners who had elected to have all of their toenails removed rather than suffer thick nails, ingrown toenails, and bleeding underneath the nails. This is not something that would be done often or by many. It is not something that should really be necessary to do. Many runners, tennis players, and other athletes have problems with “black toe” or bleeding underneath a toenail or two. The first thing to do is make sure there is enough room at the front of the shoe. Be certain you have a fingers width in front of the longest toe. Make sure your socks fit well and don’t pinch your toes. Your socks should be made of a wickable material. Cut your toes just at the end of your toes, not too long, and not too short.

If you’ve developed bleeding under your toenail and it has turned black, don’t panic. If you have Diabetes, or any other medical problem that could cause foot insensitivity or a neuropathy, get to your doctor or some place to be checked fairly quickly. If it hurts see your podiatrist for evaluation and advice. You may gradually have the nail fall off, but the new nail will reattach properly over 90% of the time. With repeated injury the toenail will usually thicken and in some cases it may not attach quite as well.

For toes that repeatedly grow in at the corners, having a portion of the ingrown part permanently removed might be the best option and a wise choice. For a toenail that has fallen off after bleeding underneath, and has a new toenail growing,  the new nail will usually reach the end with no problem. It moves forward slowly like a glacier and pushes the skin down in front of it. On occasion a corner won’t grow out and it will have to be removed. Only rarely does the entire front edge dig in and require removal of the whole nail. But, removing 10 toenails permanently? Sorry, I don’t expect to be doing that any time soon. I’d rather have you toss your shoes, and find a better fit. And Chris would get you out for a barefoot run.

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Walk Don’t Run: Ambling Along With 4.5 Million Year Old Flat Feet

by pribut on October 1, 2009

Ambling Along With 4.5 Million Year Old Flat Feet

A hominid species predating Lucy, (Australopithecus africanus) has been more fully described. Journalists have had first crack at the issue of Science in which the updated description of the species,  Ardipithecus ramidus (from 4.5 million years ago), appears. The rest of us could only see this issue late in the day.  The recently studied Ardipithecus specimens include the feet, which were clearly missing on Lucy (from 3.2 million years ago), but present among a limited set of other Australopithecus specimens. Ardipithecus was originally discovered in 1994 in Ethiopia.

The treasure trove of the day are the eleven fresh papers detailing  Ardipithecus and it’s (with a delay in publication for years) environment including botanical and other specimens found locally, the anatomy, and evolutionary conjectures all published in Science magazine. Details on excavation, locale, personnel, CT scans, three-dimensional reconstruction, dimensions and sizes of the specimens, were included in this comprehensive set of articles.

Ardipithecus was thought to live and spend time in trees, but would carefully climb rather than swing from the branches. Ardipithecus was also believed to spend time foraging for food, primarily plant based, on the ground while moving in a bipedal manner. Australopithecus was not a runner, nor is it likely with feet less well adapted  was Ardipithecus. Among other lower extremity differences between Homo erectus and Ardipithecus were flatter feet and an opposable big toe (metatarsus primus varus – actually  metatarsus primus adductus – a large angle in stance between the first and second metatarsal bones – but I’ll have to check out more photos and study the  articles in detail in Science magazine). If Ardipithecus twiddled her thumbs she could likely also twiddle her opposable big toes. Speaking of toes, one of the changes that is thought to make running possible for the later hominids was a shortening of the length of toes, in addition to an increase in arch height, and a host of other biomechanical changes.

An opposable big toe with a non-functional first ray makes for a decidedly different bipedal gait than even Lucy had. The tight grouping of the cuneiforms present in later hominids allowed the first ray to function effectively in weight transfer and propulsion rather than the little it could do as an opposable digit without stability in ground based bipedal gait. Of course a humanoid great toe does not offer much assistance in the trees. An important feature to note is that Ardipithecus did not knuckle walk, as can be determined from the wrist and hand structure, during bipedal gait, although the upper extremities were long. Nor did Ardipithecus appear to brachiate or swing through the tree branches.

Below are images of the upcoming cover of Science magazine with Ardipithecus on the cover and an image of Lucy missing her feet.

Update: Freely available articles at Science

Ardipithecus

Ardipithecus

Lucy on The Ground with no Toes

Lucy on The Ground with no Toes

Related Articles

Movement and Exercise Spurred Evolutionary Brain Development

In The Beginning: We Were Made To Stand Upright

Walk This Way (Early Foot Prints  of Homo erectus)

Additional References:

Fossils, feet and the evolution of human bipedal locomotion
W E H Harcourt-Smith and L C Aiello.


Bonus Music: Ventures – “Walk Don’t Run” – Primitive filming (B&W)


Recent Evolution of Walk Don’t Run

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Portrait of Eric Heiden, 5 Time Gold Medal Olympian

by pribut on September 30, 2009

The New York Times has a short portrait of Dr. Eric Heiden. Dr. Heiden was the first athlete to win 5 gold medals in an Olympics. Eric is a fine sports orthopedist and he is still an inspiration to athletes and skaters around Eric Heidenthe world. He trained under Dr. James Andrews, another excellent sports medicine doc. Dr. Heiden’s patients have said he is straight forward, honest, and humble. The Times didn’t paint him entirely that way, but the story is still an interesting read. His performance in 1980 was riveting. Even if you had no interest in skating, you’d turn it on to watch him in those Olympics. And yes, 1980 was also the year of the miracle U.S. hockey team. (And 1980 was also the year of an unfortunate summer Olympics boycott in response to the Soviet invasion of Afghanistan in 1979.)

Way back then technology was so bad you’d actually have to watch the Olympics live instead of taped, cut, and canned the way we can now. But, wouldn’t it be nice to have an option to see the next Olympics live? The upcoming Winter Olympics will be held in Vancouver, Canada this February. Vancouver is a fine venue with beautiful surroundings and friendly people. I was lucky enough to attend two meetings there. My last visit to Vancover was a few years ago as a participant with the Joint Commission on Sports Medicine and Sports Science. I’d be happy to visit Vancouver again. But, I’ll be watching the Olympics next year by satellite.

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Clinic: Army Ten Miler on October 3

by pribut on September 28, 2009

Army 10 Miler

Army 10 Miler

I’ll be speaking this coming Saturday, October 3, 2009 at 9:45 am at the race expo in a clinic for the Army Ten Miler. The clinics are at the DC Armory and are free and open to all. There should be ample time for Q&A’s. I plan to touch on the following topics: “exercise good for what ails you”, evolution and running, avoiding injury, getting your shoes right, moving up to 26 safely, and adjusting for injury. If there is any topic you’d like covered in the lecture portion, let me know and I’ll try to work it in. Or feel free to ask during the Q&A.

This year is the 25th anniversary of the Army 10 Miler Race. 30,000 runners are registered for it. It is known to be the largest 10 mile race in the United States and there is no 10 mile race in the world that is known to be larger than this.

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Shoes: Are They Tiny Coffins? (What would Paul Brand, M.D. say?)

by pribut on September 1, 2009

Can Shoes Be “Tiny Coffins”. Yes, they can.

(Please read comment section below. Author Chris McDougall has posted an informative comment and added to the quotes seen in Born To Run.  I’ll extract from the quotes, but be sure to read the comment. (If it says “comments closed”, which the blog does automatically at a set time interval, please click on the blog title which will open this entry in full, with the comments visible.) The thrust of this blog entry will remain the same. For me the deadly shoes I’m speaking of point to the neuropathic foot which was a large part of Paul Brand’s professional life work. )

Paul Brand, M.D. (1914 – 2003) was quoted by Chris McDougall in Born To Run as essentially saying that if everyone stopped wearing shoes, his office would be less busy and most foot problems would disappear in a generation.

Paul Brand 2002

Paul Brand 2002

While many may think Paul Brand had an ordinary waiting room, he did not. Brand did not specialize in treating the usual foot problems. He was a brilliant innovator on the special problem of diseases which cause loss of pain sensation via neuropathy.  He worked for many years at the National Hansen’s Disease Center at Carville in Louisiana. He specialized in  the orthopedic treatment of Hansen’s Disease (leprosy). Among other innovations, his work led to contact casting to help heal ulcers in feet with neuropathy, such as diabetics and those with Hansen’s Disease.  He contributed a good deal to knowledge about the significance of neuropathy in the creation of ulcers and to the care of insensitive feet. (Brand also worked extensively on hands with problems related to neuorpathy and insensitivity.) These neuopathies also affected strength rations of opposing muscle groups which often led to significant foot problems including hammer toes and bunions. Insensitivity combined with altered biomechanics, physical deformity, create special problems in walking and wearing shoes, particularly ones that are not fit well and do not serve to balance areas that are overloaded by pressure (pressure points on toes, hallux valgus, or on the plantar surface (metatarsal area or any other part of the bottom of the foot).

Brand worked with patients whose shoes often did create significant and even life threatening problems. Lacking sensation, because of neuropathy, they couldn’t feel the blisters, ulcerations, and infections developing. Another one of his sayings was “Pain is god’s greatest gift”. A shocking statement, but he said that because those lacking normal sensation did terrible damage to themselves.

As tiny coffins in this case, the shoes which caused the problem could lead to an amputation of a foot or leg in a diabetic which would lead to a second amputation more than 50% of the time within 2 years. Amputation in diabetics also is known to have a high mortality rate over 5 years (up to 74%, note that bypass operations may help). Slow healing ulcers have a death from all causes mortality of up to 50% within 5 years. This is worse than many forms of cancer.

Chris McDougall has provided some direct quotes, ( I believe from one of Brand’s biographical works – which will is now added to my reading list.) I’ll add some of those here. For the remainder, please be sure to read the comment section.

“A high proportion of the world’s population walks barefoot most of the time, and the average person who walks barefoot has much healthier feet than the average person who wears shoes.”, said Dr. Brand. Speaking of his own personal experience he said that “The barefoot walker receives a continuous stream of information about the ground and about his own relationship to it, while a shod foot sleeps inside an unchanging environment. Sensations that are not used or listened to become decayed and atrophy. There is a sense of aliveness and joy which I experience walking barefoot that I never get in shoes.”

Chris reports that Dr. Brand said this of normal people in normal shoes. And adds that Dr. Brand was a proponent of barefoot walking and sports. We will accept that as Dr. Brand’s opinion and statement and warn people who do suffer from pain insensitivity to not take this as advice directed at them. They are usually given special advice to not go barefoot, and in many cases to have carefully designed shoes, often custom, with special insoles or diabetic orthotics designed to decrease pressure, and to lessen excessive pressures over areas at risk. In spite of this care problems may still develop and this is only a cursory and incomplete look at these problems and their causes.  Patients with pain insensitivity must perform a self-inspection daily.

I was lucky to meet Dr. Brand in 2002 at the American Podiatric Medical Association meeting in Seattle, Washington. Dr. Brand opened a special section on insensitive feet which included presentations by his former prodigies on their current work. While I spend more time working with athletes, all knowledge is helpful, and Dr. Brand was a true icon.

While I scoffed the other day at  the quote in the New York Times about shoes as tiny coffins that halted evolution, in cases like these they truly are tiny coffins. They could cause your loss of limb and ultimately put you at a much higher than normal risk of death. Seeing the New York Times quote calling them “tiny coffins” did immediately make me think of the neuropathic foot. We’ve previously discussed the cost of amputation. We also see that diabetic ulcers and amputation are also deadly problems.

Preventative care, helpful? Yes, of course.  Make sure it gets properly included in any health care reform. Medicare ( a government run system) includes special shoes, non-custom inserts, yearly foot checks, and some  insurance carriers include this also. Some policies cover custom orthotics for diabetics, but not for runners. The policies and medicare aren’t quite up to speed but they are improving. Make sure that encouraging healthy life habits and preventative care is incorporated in some fashion and included as a core feature in future health policy to assist in decreasing the overall cost of care and in particular the cost of chronic illness. If you are diabetic, get your feet checked regularly, check them yourself, and learn how to both check and care for them. Exercise as recommended by your physician, and make sure you eat correctly, and monitor and control your blood sugar appropriately. Follow advice from your podiatrist on what foot wear  and socks are best for you.

For the runners, I expect you should shortly find here some blogs on what bad can come to you from your shoe, and what steps to take.

References:

Diabetic foot ulcers: prevention, diagnosis and classification.
Armstrong DG, Lavery LA. Am Fam Physician. 1998 Mar 15;57(6):1325-32, 1337-8.

Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds: A randomized controlled trial. D. G. Armstrong, L. A. Lavery, S. Wu, and A. J.M. Boulton. Diabetes Care, March 1, 2005; 28(3): 551 – 554.

Revisiting the Total Contact Cast. Maximizing off-loading by wound isolation. Petre, M, Tokar, P, et. al. Diabetes Care  April 2005   vol. 28  no. 4  929-930

The total contact cast. A therapy for plantar ulceration on insensitive feet
WC Coleman, PW Brand, and JA Birke. J Am Podiatr Med Assoc, Vol. 74, Issue 11, 548-552, November 1, 1984

Mortality rates and diabetic foot ulcers. Robbins JM, Strauss G, Aron D, Long J, Kuba J, Kaplan Y. J Am Podiatr Med Assoc. 2008 Nov-Dec;98(6):489-93.

What is the most effective way to reduce incidence of amputation in the diabetic foot? Apelqvist J, Larsson J. Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S75-83.

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