Dr. Pribut On Running Injuries

 

Online Chat With Dr. Pribut

 

USA Today Foot Hotline: Dr. Stephen Pribut

Thursday, June 6, 2002 1 p.m. ET

Washington, D.C. podiatrist Stephen Pribut

 

Foot Hotline: Dr. Stephen Pribut

Thursday, June 6, 1 p.m. ET


Comment from Dr. Stephen Pribut: Good afternoon everyone. We are about to start.

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Coeur d'Alene, ID: I'm a long distance runner already wearing orthotic arch supports. I now have problems with a falling second metatarsal on my left foot (just behind the toe joint). I use Spenco inserts over the top of the orthotics and have cut a hole where the metatarsal makes contact. That works to a limited degree but are there orthotics specifically made to support a fallen metatarsal, as well as arch?

Dr. Stephen Pribut: I've never actually seen metatatarsals actually "fall". I have seen many that are painful or are longer then the first metatarsal.

It should be possible to customize an orthotic to alleviate pain and stress in this area.

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Cincinnati, OH: My big toe and the toe beside it bend towards the outside of each foot at approximately a 35 angle. When I walk long distances my feet kill me! What is this condition? What is the treatment?

Dr. Stephen Pribut: This sounds like what is called a "bunion". Make sure that your shoes can accomodate your foot and that they are wide enough and deep enough for your forefoot.

The American Podiatric Medical Association has information on "bunions" at their website: http://www.apma.org/topics/bunions.htm

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“I've never actually seen metatatarsals actually "fall".”

dallas,Tx: the bone behind my little toe on my left foot sticks out and hurts after i am on my feet a while could be arthrites ?? im 68 years old a retired construction worker never had any problems before.Not complaining just wondering

Dr. Stephen Pribut: This sounds like what is called a "tailor's bunion". It is a protrusion of the fifth metatarsal head.

Make sure your shoes are wide and do not rub on the area. If it continues to hurt a visit to a podiatrist would be a good idea.

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Buffalo, NY: I have entermitent pain is my toes. It almost feels like severe cramping and can last for several day.

Dr. Stephen Pribut: It is hard to tell without more information what this might be. It could be a "pinched nerve" or "neuroma" or it might be from circulation or some other reason. An examination of your feet and legs would be important to tell exactly what the problem is and how to solve it.

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Lubbock, TX: I have a constant, burning pain in my big toe. Originally being diagnoised as arthritis, I was prescribed medicine for that, along with arthritus in my shoulder (diagnosed at the same time). While the medicine worked on my shoulder, it did nothing for the pain in my toe. I have been to specialists in three fields, but none have found the source of the problem. It doesn't seem to be related to the skeletal structure, but nevertheless....is a constant burning, painful feeling which worsens during the day. It has become very painful to walk for any period of time. 30 minutes at the grocery store can have me experiencing overwhelming pain. Appreciate any ideas or recommendations. I've soaked, used massage, shots, etc. So far, nothing has worked.

Dr. Stephen Pribut: A thorough examination by a podiatrist would be a good idea. Sometimes "big toe" problems are caused by the bones that sit below the first metatarsal. These bones are called sesamoid bones and the condition that exists when they cause pain is called sesamoiditis.

Often times a custom orthotic can be used to relieve pressure from this area and stress from the joint.

If you are having pain in your feet you should visit a podiatrist. It is not normal for your feet to hurt.

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Houston Texas: Several of my toenails have morphed into these strange callous-like forms, literally accumulating upwards from the toe (as opposed to growing long like normal nails). They are also often purple. The guy at the running store says its the simple result of running in shoes that are too small, so I've bought much larger ones. Seems to be helping. Is it as simple as that? Will my nails gradually return to normal? Do I have to do anything else? Thanks

Dr. Stephen Pribut: Your running shoe salesperson seems to be right on target. If the damage to the root of the nail is not too bad, they should return to normal within about 4 months.

Sometimes there is a fungus infection of the toenails that can also make the nails thicken.

If the problem continues a visit to a sports medicine podiatrist would be a good idea. The American Academy of Podiatric Sports Medicine has a listing of their members online at: www.aapsm.org/

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Richmond, Virginia: I have an almost constant pain in both of my heels. It's very painful to walk on first thing in the morning. After walking for a few minutes the pain eases but upon sitting down and then starting to walk again the pain returns. What could this be and what should I do about it?

Dr. Stephen Pribut: The most frequent reason for pain in the heels is plantar fasciitis. Sometimes heel spurs occur (and about 25 other things too).

The best home treatment is to start wearing shoes around the house at all waking times. Make sure your shoes are not too flexible in the middle. They should not bend closer to the heel then at the point where your toes bend. Try wearing good running shoes for casual wear.

Do gentle calf stretches (leaning towards the wall) for 10 seconds and 10 times once each day.

You may try using an over the counter orthotic.

If pain persists visiting a podiatrist can help. In an office treatment regimen such as physical therapy such as ultrasound, electrical (HVGS) stimulation, anti-inflammatory medicine, and custom orthotics have a very high success rate.

More information online:
Heel Pain

 

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Atlanta, GA: Does continuing to run(controlling the pain by Aleve) while trying to recover from PF impair your progress?

Dr. Stephen Pribut: I would recommend trying to stay below the amount of running that causes considerable pain afterwards.

I'd also recommend considering running less - such as if 5 - 7 mile runs hurt the next day - try 2 to 4 mile runs.

And - Make sure you have a plan that consists of more then just taking Aleve.

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Warwick,Rhode Island: I know that something is going to have to be done about my hammertoe. It is becoming more and more uncomfortable. Realistically speaking, what can I expect from surgery and what is the recovery time?

Dr. Stephen Pribut: The person who evaluates your hammertoe should be the best person to ask about what to expect.

But, ordinarily I would expect the patient to use a post-operative shoe for 3 to 4 weeks and perform no standing exercises during this time. A return to bicycling or swimming at about 5 to 6 weeks and running at 6 to 7 weeks.

Plan to use a running shoe for weeks 4 through 8 for your normal walking.

Make sure you keep your foot elevated during the first months recovery time to keep swelling to a minimum.

The best treatment for swelling is prevention.

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Clarksburg, WV: Can you tell me if there are any doctors in WV who are doing Shock wave Therapy?

Dr. Stephen Pribut: I do not know of any doctors in WV doing Shockwave.

More and more areas are having this therapy. There are doctors in Chicago, Miami and many other areas who perform this.

There are other treatments to consider first, however.

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Washington, DC: I have a mystery - the toenail on my left big toe hasn't grown at all in months! There is no pain, swelling, discoloration, or any signs of infection. What could cause this?

Dr. Stephen Pribut: Toenails ordinarily do grow slowly. It takes over 6 months for the nail to grow out completely.

Fungal toenails will usually grow even slower.

It is hard to know what might make a toenail grow slow without any sign of thickening, discoloration, circulatory problem.

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New York, NY: Many years ago my second toe was needlessly shortened because of a "very mild" hammertoe. I won't go into the details but suffice it to say there was nothing wrong with my toe, and in my naivete I allowed it to be done. I've regretted this decision more than anything else in my life. Is there any procedure that can restore my toe to its original length?

Dr. Stephen Pribut: There is no good procedure nor can I think of a good reason to lengthen a toe. I have seen drastic surgery in which the fifth metatarsal head was removed for a corn on the outside of the foot - but that surgery was not performed in the United States and would not meet any current standard of care.

A normal hammertoe operation would slightly shorten a toe.

Before considering hammertoe surgery - make sure you try shoe changes - longer and deeper and possibly wider for the little toe - before deciding to have surgery performed.

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salem, massachusetts: After surgery on my foot two years ago for synovitis and to shorten a toe to correct a hammer toe, I am now experiencing a constant ache in the ball of my foot. This, despite now wearing only low shoes with a wide toe box, inserting a gel metatarsal pad. Even walking in a running shoe is painful. The doctor says the foot "looks" great after surgery. Can you give me any advice for relieving this pain that is restricting my activity?

Dr. Stephen Pribut: There are many instances of biomechanical problems of the foot that can be treated by custom orthotics.

The foot and your toes can look "great" but it might not be functioning properly. If it doesn't feel "great", then I'd recommend a visit to a podiatrist.

It sounds like you've made a valiant attempt at using OTC orthotics and inserts and good shoes. You may need to go one step further.

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Port Orange, Florida: Can you please tell me the nearest facility that offers the shock wave treatment for plantar fasciatis. I have tried everything from tapping to casting-and nothing seem to help- signed desperate!

Dr. Stephen Pribut: I would recommend contacting the podiatry school in Miami:

Barry University School of
Graduate Medical Sciences
11300 NE Second Avenue
Miami Shores, FL 33161
Phone: 1-800-695-2279, ext. 3130
Fax: 305-899-3243
http://www.barry.edu/gms/podiatry/

There is a podiatrist there that has used this treatment successfully.

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Comment from Dr. Stephen Pribut: There are many other institutions and individuals who have used shock wave treatment besides Barry University. For more information I recommend contacting the American Podiatric Medical Association directly at info@apma.org or visiting their website at: www.apma.org.

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Coral Springs, Florida : I have 2 problems. The first is I have a bump that feels like a bone on the top of each foot. This is uncomfortable in closed toe shoes. I also have what looks like athletes foot on my toe nails and was wondering how to get rid of it?

Dr. Stephen Pribut: Continuation of last answer:

There are many other institutions and individuals who have used shock wave treatment besides Barry University.

For more information I recommend contacting the American Podiatric Medical Association directly at info@apma.org or visiting their website at: www.apma.org.

Coral Springs:

The bump on the top of the foot may be what is called a metatarsal-cuneiform joint exostosis (bone bump). For small ones I recommend making sure that the shoe or shoe laces do not press on it. You may skip a lace if you are wearing lace up shoes or running shoes.

Fungal infections of the toenails are hard to treat. There is no effective over-the-counter medication. There are options for topical and oral medications available from your podiatrist or dermatologist.

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Alexandria, VA: What can be done about calluses on the bottom of your foot that have become extremely painful?

Dr. Stephen Pribut: If you are having pain in your feet you should visit a podiatrist. It is not normal for your feet to hurt.

I never recommend treating anything that is "extremely painful" by yourself at home.

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Washington, DC: For the past several years, occasionally my toes (typically my second and third toes) will cramp and curve toward the bottom of my foot. It is very painful and can last from seconds to minutes. What causes this and how can I stop the cramping?

Dr. Stephen Pribut: I can not tell what this is. A general medical and foot examination may be important. Even medications can have side effects (or low potassium caused by a variety of ways) that can cause cramping.

Mechanical factors can sometimes create cramping.

For biomechanical causes of cramping I recommend a supportive shoe that does not bend in the middle and gentle calf stretches.

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Boston, MA: I have plantar fasciitis. My doctor said I should have surgery, but I just found out about shock wave therapy. Is shock wave more effective than surgery? And there are a couple of devices that deliver shock wave, is there a "better" device? Thank you!

Dr. Stephen Pribut: Shock wave therapy is not yet the be-all and end-all of therapy. It is a consideration and may become more widely used in the future.

Before having either surgery or shockwave - 6 months or more of conservative therapy is recommended. In some cases a change of orthotic to a somewhat softer material can help.

There are 2 main devices that are used in the US for the shock wave therapy. I don't think there are adequate statistics available to say that one is better then the other at this time.

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Waltham, MA: After you receive shock wave therapy, how long can you go without pain?

Dr. Stephen Pribut: It takes the therapy several weeks before it is actually working. There will be pain during the recovery process which may last several weeks. In most cases you will need ancillary follow up such as orthotics. If the therapy is successful the pain should not return within 1, 2 or more years.

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Wilmington, DE: How effective is derotation arthroplasty for the small toe -- will it eliminate my constant pain or should I expect that the procedure would lessen the pain? What's the success rate and recovery time for this surgery? Is a podiatrist or orthopedic surgeon recommended? Thanks so much, Dr Pribut!!

Dr. Stephen Pribut: Derotation arthroplasty on the small toe should work well in more then 90 - 92% of the cases.

Recovery would be similar to other hammer toe surgeries - 4 weeks or so in a postop shoe. Running shoe for another 4 weeks.

Don't forget to go easy for those first four weeks and keep your foot elevated.

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Port Orange, Florida: I was wondering if you could tell me the closet facility that does the shock wave therapy for plantar fasciaitis? I have been living with this pain for about 9 months. Have tried the tapping, icing, casting.. and nothing works!-

Dr. Stephen Pribut: See the note above for Barry University in Miami Florida. They would be able to refer you to a closer center if one exists closer to you in Florida.

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Salt Lake City UT: I'm curious about the shock wave treatment. What training do the Physicians receive? Is this treatment available in my area?

Dr. Stephen Pribut: There is a short term course that is given before administering shock wave therapy.

If you ever get to see a video of shock wave treatment you will see that it is not complex to administer. It does require experience to know when to administer it and the dosage and the amount of "jolts" to provide. But the administration could actually be done by someone who does not perform surgery and I wonder if technicians will be performing this in the future rather then surgeons.

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san antonio, tx: I have a pain at the spot where the Achilles tendon attaches to the heel. Anti-inflammatories tend to take the pain away. Does this sound like Achilles tendonitis or is it possible that I have a bone spur in the area? Also, can you recommend any home treatments for this pain?

Dr. Stephen Pribut: It sounds like insertional achilles tendonitis or possibly a small detachment at that point.

I'd recommend an evaluation by a sports podiatrist.

Before your visit you may try a heel lift in your shoe (and avoid spongy heeled shoes).

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New York City: I recently hit my heel very hard. It is very sore to walk on, but it never bruised or swelled up. Is this something I need to check out?

Dr. Stephen Pribut: I recommend visiting a foot specialist for pain that has not gone away after a few days. If it hurts it is not normal.

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largo, fla.: I have increased my walking recently in hopes of shedding unwanted pounds and after walking for about an hour, I have pain in the back of my heel. What could it be? thanks

Dr. Stephen Pribut: Achilles tendonitis could be the culprit:
Avoid uphills.
Avoid mushy shoes.
Try a heel lift in your shoe.
Do not over stretch.

If this fails - a visit to a sports medicine podiatrist or other sports medicine specialist should be helpful.

More information on Achilles tendonitis is available here: https://www.drpribut.com/sports/spachil.html

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Statesville, NC: Dr. Pribut: I have constant "burning" (last 8-9 mos) on very bottom of both feet. I am 56. Feeels like they're always on a heating pad. Is not terribly painful, but sometimes I take shoes off at work to gain some relief and also keep feet outside the covers at night. What causes this condition and is there a short or long-term treatment. Thank you very much.

Dr. Stephen Pribut: A pinched nerve or neuroma may cause this pain. A foot examination should hopefully give an answer fairly quickly and would be worth it after months of annoyance.

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Arlington, Virginia: My big toe aches severely occasionnally. I hurt it several times playing baseball over the years. Now, there is an oversized knot at the joint. About three years ago, a podiatrist injected steroid and that helped me for more than a year. It also allowed me to bend my big toe which was difficult before. What do you recommend?

Dr. Stephen Pribut: There are probably three main options - orthotics to unload the joint, surgery, and deeper shoes. I personally recommend first the shoes and orthotics before the surgery - but a visit to your podiatrist may give you more information that is specific to your problem.

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La Canada, California: I'm a runner. I had a bone spur on my left heal five years ago, which was cleared up with orthotics. Two years ago I developed a bone spur more toward the middle of my right foot. What is happening and what should I do?

Dr. Stephen Pribut: I am not familiar with spurs that occur in the middle of the foot and would want a more specific diagnosis before commenting. Returning to the doctor who successfully treated the heel spur should hopefully be helpful.

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Comment from Dr. Stephen Pribut: That seems to be all the questions we've received today. Thanks everyone for participating. Enjoy your summer and your walking and running programs!

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