Sunday, January 20, 2013

Hot Foot & Cycling from Bicycling Magazine

Not too Many have circled the spokes like Dr. Saxena & he keeps it simple with his advice In Bicycling:

Painful burning on the ball of the foot (a.k.a. hot foot, or metatarsalgia) is usually a result of hot weather or poorly fitting shoes—or both—on long, hilly rides. "Pressure can pinch nerves in one or both feet and shut down a ride fast," says Amol Saxena, DPM, a time-trial cyclist and podiatrist in the department of sports medicine at the Palo Alto Medical Hospital in California. "If hot foot strikes while you're on a ride, there isn't much you can do other than stop, take off your shoes and let your feet cool down." Saxena takes these precautions to keep his feet cool and comfortable during races.

DO THE SQUISH TEST When shopping for cycling shoes, pull out the insole and hold it up to the bottom of your bare foot (in front of a mirror). "if you can see any part of your foot beyond the borders of the insole, you need a wider shoe," says Saxena. A tip: When you find the perfect shoe, buy another pair for backup.

TAKE A LOAD OFF Move your cleats a few millimeters closer to the heel of the shoe to take pressure off your forefoot. or switch to a larger-platform pedal to more evenly distribute the pressure across your feet.

CUSHION THE BLOW Over time and after many miles on the bike, your feet start to lose their natural padding, which can make riding painful. adding more supportive insoles to your cycling shoes can help. if you're shopping for new shoes, take the insoles along to make sure you get the best fit.

BE A MATERIAL GIRL Choose socks made of high-tech fibers such as Coolmax and Thermax, which wick away sweat. and don't buy a pair right off the rack; try them on with your cycling shoes first.

Tuesday, January 15, 2013

Benno Nigg PhD: Biomechanics Guru Saying Farewell At Calgary International Running Symposium

The following is an interview I did with Benno Nigg, Phd published in Podiatry Management last year. He will be delivering the keynote lecture at the Calgary International Running Symposium Seminar August 14. Much is written about biomechanics. The breadth information is overwhelming and only some of it is relevant. Many conclusions presented are based on trying to sell a shoe, a book or an opportunity to be in the spotlight. Podiatry can claim partial success in staying current with the literature and leading new research. It is important to have an open mind regarding what is scientific fact in our practices and what is podiatric folklore. Another field that has undergone an overhaul moving from conventional wisdom to applicable science is baseball. Players were rated by scouts on the basis of their looks i.e. solid chin and archaic metrics. Then a former aeronautic engineer named Eric Walker, decided to write a pamphlet that bucked against the conventional wisdom. The pamplet was implemented by the Oakland A's and is the subject of the book and movie "Moneyball". He decided to review how winning teams and was based on statistical criteria that had more relevance to a player and teams success. One example: when baseball was first played players had no baseball gloves and so fielding errors measured as a statistic were an important part of the game. Now errors can actually penalize a gifted player that was fast enough to run to make a play or smart enough to be in the right spot to make a play. The statistic is less relevant to the modern game and this is how we should be viewing what we are applying in our practices. It turns out that in baseball an on base percentage is a more telling statistic of a player's intrinsic value to a team than anything else. In peeling another layer of the onion, a team's aggregate on base percentage was more indicative of success than whether one or two dominant players. Some variables are important but one must look at how the data is applied. As an example, scouts look at foot speed which is based on a timed straight run but that does not always translate precisely to running the bases for example rounding first for a double and the slide into second. In talking with Benno Nigg, Phd, this same philosophy becomes evident. He has been on the investigative side as a hired consultant for shoe companies before he has largely turned his focus to pure research. He is very careful not to draw conclusions that are inferences when he reviews studies. As an example when I asked him recently about a study that Dan Lieberman did on heel vs forefoot injury patterns in shod cross country runners he pointed out that you cannot compare this to barefoot running. He also pointed out that the subjects were cross country runners which does not translate exactly to everyday runners. The following is an interview I conducted with him: If you think the science of biomechanics is static, best to think again according to Benno Nigg and his recent book "Biomechanics of Running shoes: The Disturbing truth about Running shoes, Inserts and Foot Orthotics" Why should a podiatrist buy your book, "Biomechanics of Running shoes, The disturbing truth about Running shoes ,Inserts and Foot Orthotics " Podiatrists that are interested in the actual functioning of the lower extremity and in the reasons for specific intervention may get some help when reading this book.. What do you think the role of podiatry should be with runner's given your view on orthotics? Orthotics can play a major roll in terms of initial recovery from injury. In my view the podiatrist's strategy should be to combine initial orthotic use with recommending strengthening exercises for the small muscles crossing the ankle joint. I also see a role for orthotic in clear structural issues such as an anatomic leg length discrepancy. How have you maintained your objectivity when hired as a consultant for a manufacturer? My primary goal is to help customers understanding their product or intervention. Additionally, I have a standard clause in my contracts that I can publish the results of such studies within 18 months. One particular company I was working with on sport surfaces stopped our consulting relationship after the results did not support their initial claims, however, we went on to publish the results. It is interesting to realize that some companies are interested in more basic science projects, testing models that do not have an immediate financial return but increase the general understanding of a product. What major study or studies caused you to change your views about shoes? There are different aspects where we changed our view substantially. Typically, we had results from a series of studies that did not support our initial speculations. For instance: (1) Impact forces: Initially we thought that impact forces are dangerous and that we have to change shoes and orthotics to reduce external impact forces. A series of studies showed that (a) epidemiologically, impact forces are not a good predictor of running injuries and (b) external impact force peaks are not sensitive to the hardness of the shoe. (2) Excessive pronation: Again, we thought initially that “excessive pronation” would be dangerous and that we should change the shoes to reduce pronation. Again, a series of studies showed that (a) pronation is not a good predictor of injuries. How do you reconcile observation on increased injuries noted such as tendonitis and stress fractures with vibram 5 finger shoes but having no hard evidence to support the observation? How do you think the average clinician should assimilate this? I don’t know how the average clinician should react, except that he/she should functionally analyze every single case and provide functional interventions. Scientific studies should be initiated to assess the actual epidemiology of all these new “footwear solutions” and assess the actual effects of these interventions with respect to epidemiology and biomechanics. What do you see in the future will for running shoes? The future running shoes will have more functional characteristics, they will be lighter and less bulky and some shoes will have sensors to help improving the “ride”. What role do you see for core stability and fatigue in causing injuries and what research do you think substantiates this. There are two major strength centers in the body that are currently associated with injury and reduction of injuries, the core strength and the strength of the muscles around the ankle joint complex. There is initial evidence that both strategies (strengthening these muscles) have a positive effect on reducing injuries. However, the results are initial and need more work. Intuitively, the two concepts seem sound. What should the podiatry schools be emphasizing in the biomechanics classes? I think that major emphasis should be on functional biomechanics and functional solutions. Often, podiatrists want to solve every problem with an orthotic . If the problem is in the Achilles tendon the emphasis for finding a solution should be on reviewing the mechanics of the Achilles tendon. Do you believe that studies will be able to isolate the many variables of runners, running shoes and injuries? Yes, we have developed methods that allow identifying all important variables for running and running injuries. Ben Pearl, DPM References Lewis, Michael ,Moneyball W.W.Norton & Company 2003 Nigg, Benno Phd interview 2012

Monday, January 14, 2013

Spring is just around the corner!

Excited about warmer weather and finally enjoying those vacation days? 


        Don't miss out on the
      sun and sand because of
          embarrassing ingrown nails -- 
         visit Dr. Pearl
              and get started with
          personalized laser treatments
            and have the look you want
                                    for spring.

The natural growth cycle of the nail occurs in six months, so starting now means having healthier nails by the time spring and summer roll around.  You can avoid the potential side effects of oral medications and enjoy monthly holistic laser treatments where you can see results after only two or three sessions.

With only a few months left before beach weather, now is the perfect time to call up Dr. Pearl and be ready to join in on the fun!

Monday, January 7, 2013

What We can Take Away from RGIII

It does not take a Monday morning quarterback to say that at some point RG111 should have been giving some sort of reprieve.  The franchise is riding on that wobbly knee.  Of course the problem is the culture of the NFL.   You're supposed to be Superman.  But yo can't ASK Superman if he's ok to stay in the game.  The coach and doctors need to watch him and Tell him when to come out.  When they had the lead they could have taken him out for a series and at least given him a break after the point at which he took off his helmet after a hard hit on the sideline.  A study of runners at Indiana University showed that the point most people get injuries is when they fatigue,  Now magnify this a gazillion times in the pace  and pounding of the NFL and that knee buckle was not if but when.  Now if he had gone back in after a series out maybe he would have had that similar injury but suppose Kurt Cousins put in earlier manages to score some points and just maybe you can rest up your franchise player for another week or another season.

Saturday, January 5, 2013

Exposing Myths About Nail Health & Lasers

Here is the real deal on lasers, toenail funs and oral medications:


If I get a nail fungus infection it must have been from a pedicure.


Most nail infections are from exposure to shoes, locker room  and bathroom.  Some pedicure facilities are substandard in terms of disinfection of instruments but the spores that cause the problem are everywhere and it is more likely you got it in your own house.


A laser will cure my nail fungus in one treatment and it works 100%.


A laser is a great tool.  Anyone that promises 100% on almost anything  regarding the cure for toenail problems is not giving you  the real deal.


If I do nothing with a nail fungus it will probably stay the same.


Most of the time it gets worse.


The cure is permanent.


Whether you use a laser or take oral medications the problem will come back if you are not diligent about disinfection of shoes and applying a topical to prevent early reinfection.


The oral medications will hurt my liver.


Most people are fine as long as their baseline liver enzyme level checks out. There can be side effects with the orals such as headaches, nausea etc.  The trend is that patients are looking for more holistic
healthcare and that is why use of the laser has become more popular.

Thursday, January 3, 2013

Focus With Sports Psychologist Scott Goldman Part II

The new year is a time to rededicate our goals:
This applies to giving our best effort in a performance or sustaining an injury prevention fitness program...  

Establish Routines
• This tells your mind and body “it is time to start.” For example, before shooting a free throw, bounce the ball, take a deep breath, find your spot, then release.
Develop Cue Words
• Cue words are specific phrases that remind you of key elements that help successful performances such as “stay low” or “explode from the blocks.” They can also be used to center your attention to the present task. For example, “next
point” and “let it go” can be helpful in refocusing after an unsuccessful attempt.
• The frontal lobe part of your brain is known for impacting quickness of response and improving your focus. Therefore, engaging in tasks that exercise this part of your brain would improve your focus. Research has shown the following tasks to improve your frontal lobe activity: reading aloud and fast, “Where’s Waldo?” books, Sudoku, crossword puzzles, anagrams, and some video games such as “Brain Age” and “Mind Medley.”