QUESTION FOR THE DOCTOR
Sponsored by:  Roanoke Orthopaedic Center

QUESTION:  I was told I need orthotics because I hyperpronate.  I’ve been running for years without any major issues.  Do I need them to avoid problems in the future?                   

ANSWER:    The simple answer is, “If you’re not having problems, why change anything?”  Pronation (the foot “rolling in”) is a part of normal foot mechanics during walking and is accentuated during running.  It is essential for shock absorption and positioning the midfoot to accept load and allow push off during the gait cycle.  Elimination of pronation is NOT a good thing; in some cases, reducing or eliminating pronation can lead to other issues when other parts of the lower extremity have to compensate for a “stiff” foot.  Extremes of pronation may adversely impact extremity alignment, mechanics, and shock absorption and contribute to foot, ankle, or knee problems.  In the proper setting, orthotics are designed to bring foot motion back to a less abnormal range and improve joint alignment and load.  Designed for a specific problem and well fit, they can have a real value, but they should not be viewed as an “essential tool” for all runners.

WRITTEN BY:    Thomas K. Miller, M. D.

NO, IT’S not a spider bite!

For some reason, it seems that every skin lesion is “a spider bite.”  It may be red, swollen, even have drainage, and the thought remains “spider bite.”  Spiders have not suddenly become aggressive.

For athletes participating in contact sports, skin lesions (“spider bites,” ingrown hairs, pimples, turf burns) are at risk for being ignored and developing serious infections.  While horror stories exist about “flesh eating bacteria,” most skin infections are easily managed and can often be avoided.

Simple preventive measures, such as daily cleaning of practice clothes, hand washing before practice with antiseptic scrub, showering immediately after practice, no sharing of towels, and disinfection of locker rooms and practice facilities, can greatly reduce risk.

If a skin lesion develops and is red, swollen, or painful, do not ignore it or hope it just goes away.  Get it evaluated.  It’s not a spider bite!  It’s not “just” an ingrown hair.  It may be nothing; BUT if it IS, you owe it to yourself and teammates to get it taken care of.  Early treatment of a skin infection is straightforward; treatment when an abscess develops or with a serious systemic infection occurs isn’t.

Written by:  Thomas K. Miller, M. D.

Question:  My teenage son sprained his ankle several times while snowboarding last winter.  Is there anything he can do to prevent future problems? 

Answer:     Absolutely.  Snowboarding places a lot of pressure on your ankles and calves.  Ankle injuries occur mostly from hard sideway impacts, such as crashes, and are particularly common after jumping when a combination of compression and inversion (the ankle turning in) forces is experienced.  This may lead to an ankle sprain or to a more serious condition called “snowboarder’s ankle”—a fracture of the lateral process of the talus.

 If your son was just learning how to snowboard last winter, he may have used softer boots, which are more comfortable and allow more maneuverability.  Unfortunately, they also double the rate of ankle injuries compared to hard boots.  A good option is the new hybrid boots, which balance the increased stability of hard boots with the increased comfort of the soft boots.

 Another good idea is a general strengthening and flexibility program for the ankles.  There are all sorts of resources for this, including balance boards, therabands, etc., but one of the easiest exercises is to “draw the alphabet” with your big toe in the air.  This is an excellent way to strength the muscles around the ankle and prevent further injury.

 As always, if this becomes a recurring problem, a visit to an orthopaedic or sports-trained physician to be evaluated is a good idea.   

Written by:   Christopher K. John, M. D.

QUESTION: My 13-year old son had to quit playing basketball this fall because of pain in his knees.  His pediatrician called it “Osgood-Schlatter’s disease.”  When can he resume sports?        

ANSWER:    Osgood-Schlatter’s disease is an irritation of the insertion of the patellar tendon.  It produces pain and swelling in the front of the knee just below the kneecap.  The pain increases with running, jumping, or climbing steps.  It tends to occur between ages 11 and 15 in active sports participants.  About 20% of all adolescent athletes will get Osgood-Schlatter’s disease, but only about 5% of couch potatoes.

Usually, the pain resolves with activity restriction.  Ice, ibuprofen, and stretching exercises for the quadriceps muscles and hamstrings can help.  Occasionally, sports participation must be suspended for a month or two.  Only very rarely do symptoms persist after growth is completed.

Your child may return to sports when his discomfort is tolerable and his muscles have been stretched.  

WRITTEN BY:    Joseph E. Alhadeff, M. D.

Question:     I recently began a running program and have now developed pain in my heel.  It is worse after I run and when I first get out of bed in the morning.  What could this be?

 Answer:        The most important common cause of heel pain is something called plantar fasciitis.  It is characterized by pain under the heel and on the bottom of the foot for a few centimeters in front of the heel bone.  It is commonly worse in the morning and after activity.  The hallmark of treatment for plantar fasciitis is an aggressive Achilles tendon stretching program either with wall stretches or by allowing the heels to hang from a step for 3-5 minutes, 2-3 times daily.  Icing, anti-inflammatory medication, heel cups or over-the-counter arch supports, and massage will help with the symptoms.  Custom-made orthotics are almost never needed.  Sometimes, night splints can be utilized to stretch the Achilles and decrease morning pain.  Activity modification and/or cross training can also be helpful in the acute phase of this condition.  Nearly 90% of people with plantar fasciitis will improve with only these measures.  A very small percentage of people will require an injection of cortisone in this area, and even fewer will require surgery.

Remember, stretch your Achilles tendon and have a great workout!    

Written by:   Christopher K. John, M. D.

QUESTION: What can I do to prevent injuries while playing softball and baseball?     

ANSWER:          Baseball and Softball are two of the most popular recreational sports with more than 40 million participants nationwide.  Injuries are uncommon and most are preventable.  The most common injuries involve throwing, baserunning, and getting hit by the ball.

Excessive throwing can result in serious shoulder and elbow problems.  Pitch counts should be adhered to, and pitchers should not pitch more than 8-12 total innings per week.  All players should warm up and make some practice throws before the game.  If you have persistent pain with throwing, you should not play until the pain subsides or you are evaluated by a physician.

Baserunning injuries are mostly due to the use of fixed bases.  The American Academy of Orthopaedic Surgeons recommends the use of breakaway bases to decrease the risk of injury when sliding into a base.  The use of metal spikes on the bottom of cleats is also discouraged.

Adequate protective gear should be used by all players to avoid getting hit by the ball.  Batters and baserunners should wear helmets.  The catcher should have a helmet, facemask, throat guard, chest protector, athletic supporter, shin guards, and a catcher’s mitt.

Also, the playing field should be inspected for glass, holes, other debris, and possible obstacles.

WRITTEN BY:  Joseph E. Alhadeff, M. D.

QUESTION: I’ve heard that running on trails is less hard on your legs than roads.  Do I need special shoes for this?

ANSWER:    The answer depends on how much trail running you plan to do and the trail surface.  For occasional trail runs and especially on ”groomed” trails or rails-to-trails conversions, regular running shoes are fine.  Don’t plan to use old worn-out shoes, because you don’t want to get “good ones” dirty; you still need the fit, cushioning, and support to which you are accustomed.  Trail specific shoes tend to “ride lower” to the ground for better feel, have a more aggressive tread pattern, be somewhat more supportive, and have mid-foot and toe protection not found in road shoes.  More specialized shoes may offer special tread compounds, waterproof materials, and more protection.  You can select these depending on the type of trails you want to run.  As always, good fit and good feel come first.  For women runners, there are now enough female-specific trail shoes that smaller (and less than perfect fit) men’s shoes need not be considered to get “off road.”          

WRITTEN BY:  Thomas K. Miller, M. D.