Thursday, August 25, 2011

If You're Not Man Enough To Do It Yourself..I'd be Happy to Oblige



More times than I care to count I have had a patient return to the office frustrated that they are not improving. Well,have you done the excercises I prescribed, have you tried the yoga class I ask? Umm... no doc I didn't have the time might be the reply.It's hard to get better if you are not keeping up with the whole program. Some people want an easy fix. It is a lot easier to pop a pill but this does not lead to sustained improvement.

So I challenge my athlete patients like the opening monologue from "Midnight Cowboy",
"If you're not man (or woman) enough to do it for yourself , I'd be happy to oblige!

Thursday, August 11, 2011

Got A Bridge To Sell You In Brooklyn And Some New Fangled Shoes



The rage right now seems to be a new shoe for every occasion. Many companies are jumping on the forefoot running barefoot phenom and pumping out the latest greatest shoe. The companies tout their extensive research and tell you to throw your old running shoes and orthotics into the trash, but is there any substance behind their claims? There are no good studies to substantiate the use of any of these new shoes. Just recently a friend asked me my opinion of the new oesh running shoe. The shoe features a robust forefoot platform and reminds me of the sunglass windshield invention the Steve Martin's character came up with in the movie "The Jerk". One thing they got right is that here is a send aftershock in running hat is more intense than the initial heel strike. Saying that their forefoot platform shoe with a shock absorption system designed to minimize the secondary impact does not mean that it is a better running shoe. Human biomechanics is a complex system with many levers and pulleys. The interactions for each runner are individual and it is not ones size fits all. It is also important to remember that it is the car and the driver that make a racer.

Tuesday, July 26, 2011

The Skinny on Lasers & Fungal Toenails



People have been fascinated with lasers going all the way back to the iconic image of James Bond being nearly split in two in the movie Goldfinger. Goldfinger was the first blockbuster movie ever. No doubt this brought the idea of lasers as being cutting edge into the American psyche. Lasers have been used in medicine for everything from zapping off warts to whitening teeth and now for treatment of those ugly thick fungal toenails. Another unforgetable scene on the Hollywood silver screen highlightd the social stigma attached to feet that aren't pretty. Eddy Murphy from the movie Boomerang pulls back the covers of his bed to reveal that his sleep over guest has jacked up feet. Lasers are part of a program that can help with the thick fungal nails and are an alternative to oral medication. The should not be thought of as effective as the oral but there are no potential side effects unlike oral aGENTS. Sports like running skiing and soccer increase your risk of getting toenail fungus because you sweat inside a closed shoe or boot and you are subjecting your toenails to repetitive microtrauma. The treatment should be only part of a regiment for a pesky problem.
The laser helps eliminate the fungal spores that lie within and underneath the nail. Just as in fading with laser teeth whitening the nail fungus can come back. It should be used as an adjunct treatment either with an oral or topical treatment. It is also important disinfect the areas the fungal spores reside, so the nail does not get reinfected. There are now ultraviolet lights to do this. Lysol is not a great idea because you are subjecting your skin to strong chemicals but there are other more safe disinfection sprays for shoes available. Health insurance does not cover the cost of this treatment. The treatments are administered once a month over three months and do not require anesthesia. You don't have to hiode your feet. You can flash them like your teeth with or without the teeth whitening!

Monday, June 6, 2011

Barefoot Running & Beyond


The barefoot running movement has spawned a cascade of trends in the running shoe industry. The progression has been towards minimalist shoes the ever since Chris McDougall's seminal book "Born to Run". Prior to the sensation of “Born to Run” Vin Lanana has been using barefoot
running in training his runners at Stanford. He believed that incorporating barefoot running in training resulted in better times. When marketing executives from Nike visited him at the Stanford track they conceptualized a minimalist shoe; a shoe that simulate some of the elements of barefoot running yet provide some protection on the feet. needed to grasp and release on a variety of surfaces such as dirt, grass, road, concrete, and gravel.


Our profession should continue to play a leading role in setting parameters
for the new generation of minimalist shoes. It has become obvious to practitioners dealing with overly zealous runners transitioning to these shoes that they will end up in our offices with injuries. Although there are no injury data banks or studies to support these patterns the anecdotal cases should not be ignored.There seem to be more metatarsal fractures, achilles tendonitis and plantar fasciitis cases. In terms of trying to draw conclusions beyond clinical trends it has a non-polynomial solution. There are simply too many variables to factors to draw a conclusion. There are no current injury logs tracking injury patterns with barefoot and minimalist shoe conditions. This information could be something we as practitioners track.




There appear to be regional trends in terms of new purchases of minimalist shoes. While some mid Atlantic stores are reporting 10% of their sales with strict minimalist another 10% with very little structure some Florida markets are approaching 50% and this is often times based on requests by runners and not recommendations by the store.
Another trend that has fueled the industry is a self discovery desire by runners looking for more efficient techniques or a change to try to help alleviate chronic injuries. The self discovery applies to language that industry taps into. The industry has responded not only by cranking out more minimalist shoes but by scaling back shoes with multiple features. The other incentive for industry is the margins are better with less features and they are lighter to ship. Retailers that have responses later in the game have had to wait almost a full year for the most popular Vibram five finger shoe.

Paradigm Shift: It’s a Trend not a Fad

Declarations have already been made by some that there will be a paradigm shift away from stability shoes and orthotics. It would seem that that is a little early to say but this is certainly the perception by many enthusiasts of barefoot/minimalist shoe runners.
Four factors are driving the trend towards minimalism; function, lifestyle, fashion and price. In this case lifestyle and fashion are very closely related. The shift is a reflection of the market demand for more natural functioning footwear. Footwear specialist, Mel Chrestman points to the hangtag on the Merrrell program as a sign of the times. It emphasizes language such as running in a natural gait. The market is demanding a more raw connection to the earth. This is reflected not only in the running line but the hiking line as well. It is also a slightly edgy statement to be walking around in the gym wearing your Vibram five finger shoes. The shoe has become a nexus of marketing and radical function change akin to the Ronco veg-o-matic device of the 1970’s. In addition, some health club members say that the Vibram shoe helps improve balance and strengthen their leg muscles, particularly the calves, while working out. At a recent training run I saw a five finger runner doing a handstand with his feet backing into a tree in his best simean exhibitionist preen. Where the rubber meets the road, retailers are simply not selling the same amount of rugged hiking boots as the consumption is trending toward more stripped down hiking footwear. Chrestman also adds that at a recent Keen marketing seminar for the trail running and hiking industry the marketing research suggested that the $95 dollar price point was attractive to make the purchase.
There appear to be regional trends in terms of new purchases of minimalist shoes. While some mid Atlantic stores are reporting 10% of their sales with strict minimalist another 10% with very little structure some Florida markets are approaching 50% and this is often times based on requests by runners and not recommendations by the store.
Another trend that has fueled the industry is a self discovery desire by runners looking for more efficient techniques or a change to try to help alleviate chronic injuries. The self discovery applies to language that industry taps into. The industry has responded not only by cranking out more minimalist shoes but by scaling back shoes with multiple features. The other incentive for industry is the margins are better with less features and they are lighter to ship. Retailers that have responses later in the game have had to wait almost a full year for the most popular Vibram five finger shoe. That shoe seems to be the poster child for minimalist shoes. Anecdotally, I talked with several runners whose use of the five finger Vibram shoe, says it helped with their shin splints and IBT syndrome. The second generation Bikila has significant modifications from the original which was hardly more than a one piece boat shoe sole with an upper. A lug pattern was placed on the outsole to give it a true midsole and an achilles notch was placed with a true heel counter to prevent slippage and irritation.

Also entering the market are recovery shoes. Most purists reject the idea of a recovery shoe and it remains to be seen whether this is simply a marketing ploy or a functional piece of recovery equipment.



Also entering the market are recovery shoes. Most purists reject the idea of a recovery shoe and it remains to be seem whether this is simply a marketing ploy or a functional piece of recovery equipment.

Walking in Another Man’s Barefeet

The old adage walking in another man’s shoeapplies to running barefoot because until we try it out we are not experiencing the sensations of barefoot running. Malcolm Gladwell had a pilot put him in a death spiral for a few seconds when he was writing about panic and using the JFK Jr. crash as a case study. It should be no different for us then when we are treating this population. Propriopceptive input is one of the things that purists insist is the thing that prevents them from experiencing the same amount of injuries as in minimalist shoes. Biomechanics guru Benno Nigg Phd has supported the notion that feedback can affect injury rates. Declarations have already been made by some that there will be a paradigm shift away from stability shoes and orthotics Time will tell.