It’s a quiet Sunday morning in the NYC Isaacson house, no heel pain, bunions, podiatry or foot pain to think about, just me, the kids and a long run to enjoy. While perusing the New York Times an interesting article caught my eye about Dathan Ritzenhein, an elite runner and favorite to win the upcoming NYC Marathon, and his trials and travails in training for the marathon. As a foot specialist and runner in New York, I read the article with more than a curious interest.

Among other feats of superhuman runningness are chronicles of his weekly mileage, a bone shattering 120 miles per week, and the goal of increasing that mileage to 130-140 miles per week. Even more amazing are the Kenyans and Ethiopians, who run upwards of 160 miles per week. Contrast that with my own paltry 10-15 miles per week, for which I have been offering myself a genuine and gentle pat on the back, and I am feeling a little.. well, little.

However, the parts of the article that most intrigued me are the tales of rather preventable and treatable foot injuries. I couldn’t help but think- and Dathan I hope this article somehow makes it on to your desk- what would have been if he had been under the care of a foot specialist who could be proactive, rather than reactive. Every runner, and most other athletes, needs a specialist who will evaluate the entire lower extremity before problems arise. Stress fractures in both feet? If I had a nickel for every stress fracture I saw last summer, well I get more than a nickel- but not much, and that can all change with the passage of the healthcare reform law, but we’ll save that for another blog. My patients know that stress fractures result from abnormal stress on normal bone, and as a podiatrist in NYC treating runners and other foot pain; I can often recognize those areas of abnormal stress before they become fractures. Of course you need a pad in the foot to take the pressure off the metatarsal which absorbs 15% more pressure- how about a custom made orthotic to balance the entire foot?

And far be it for me to disagree with a giant of the field like Alberto Salazar, but I have long since recognized, and preached the gospel to my patients, that changing the body’s natural gait is just that- unnatural, and it leads to injury. Attempting to land on the midfoot and forefoot can increase the stress load in the metatarsals, leading to- you guessed it- stress fractures; just ask Dathan. The heel is designed for contact with the ground, it has a nice fat pad for cushioning and allows for a moment of stability before the foot pronates (yes, in all foot types) to adapt to the ground surface.

And another point- why wait for a cyst to pop, when it can be drained under ultrasound guidance in the office, providing instant relief of pain?

Anyway, the bottom line is my fellow podiatrists and I know the foot, and as a runner, I know the runner’s foot. I may not be head of biomechanics at a major shoe manufacturer, but I can customize a pad for just about any foot type and offload any area of pressure. So if you are a runner, and you are reading this, consider being proactive. You have probably been to the fancy running shop where a gait analysis was performed by a sales associate with no doubt extensive training and may even be working with a trainer, but is someone looking at your foot who has 7 years of comprehensive training in feet inside his or her head? Treat yourself to a consultation with a foot expert, a podiatrist and runner, and prevent foot problems before they start.

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Ernest L Isaacson DPM PC
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