Nasty Blisters

During my first Ironman triathlon, a well-meaning spectator decided that it was a good idea to spray the runners with his hose because it was so hot. I understand he thought he was helping because it was over 90° while we were running the marathon portion. The problem was that I developed a significant blister on my heel because of wet socks and friction in my running shoes. Honestly, that blister was more painful than any of my other aches and pains from completing an Ironman. Blisters can be nasty.

So how do we prevent blisters on the run?

And when they do happen, how should we treat them?

Blisters are simply caused by friction between your skin, socks, and shoes. They are significantly increased when there is moisture around. This can be from a well-meaning spectator’s hose or excessive sweating. Poorly fitting shoes or foot deformities like bunions and hammertoes can increase the incidence of blisters. Some people also have excessively hypermobile feet and their biomechanics (or the way they run) can increase the chance blisters.

Blister prevention starts and ends with properly fitting shoes, blister preventing socks, padding or friction-reducing topical Bodyglide on any deformities, orthotics to decrease motion in those with poor biomechanics and even antiperspirant for those who excessively sweat.

Properly fitting shoes means that they are wide enough and long enough to accommodate your feet. They should also be in the proper category for your foot type (neutral, stability or motion control). Shoes should be at least one-half size bigger than your street shoes, and often I recommend a full size larger due to your feet swelling while you are running.

Blister preventing socks are made out of a wicking microfiber and often have two layers so the friction occurs within the sock and not on your skin. Cotton socks are blister magnets and should be avoided.

Padding with cushioned moleskin or silicone sheeting can be helpful with bunions and hammertoes. Body glide can also be used on these high friction areas.

If you are excessively sweaty, you can either use an absorptive foot powder or even a spray antiperspirant before running to decrease the amount you sweat.

Seek the help of a podiatrist if you continue to have biomechanically induced blisters even after following these tips.

Sadly, blisters still occur even when you try to prevent them. If you do experience a blister, if it is not painful; then leave it alone. If it is under a toenail and the nail is now loose or red around it, visit your favorite podiatrist to have the toenail removed. Do not try to attempt this yourself. If you have a large blister that is extremely painful, use a sterilized needle to pop one tiny corner and remove the fluid from under the blister. Leave the overlying skin as a biological barrier and treat with either Neosporin or Betadine to decrease the chance of getting an infection. If you notice redness around the blister, drainage that is not clear or bloody looking; especially if it is looking like yellow or green pudding, seek medical attention. You probably need some antibiotics.

Blisters are nasty and can be extremely painful. Simple tips can help prevent them. Treating them immediately with sterile Instruments to prevent infection is the best way to resolve them quickly so you can get back on your run.

Yoga For Runners #4

The Seated Reclined Pigeon Pose

In part Four of Yoga for Runners: Dr Shyla Arya and Dr Marybeth Crane from Foot and Ankle Associates of North Texas in Grapevine and Keller Texas demonstrate the Seated Reclined Pigeon pose. This is a great stretch for runners with tight hips. It really gives you an intense deep stretch of the hip flexors.

Yoga For Runners #3

The Seated Forward Fold

In today’s episode of Yoga for Runners, Dr Shyla Arya, from Foot and Ankle Associates of North Texas, helps Dr Crane demonstrate the seated forward fold. This is a great pose for runners because it gives an intense stretch of your shoulders, back, hamstrings and calves.

Yoga For Runners #1

The Bridge Pose

Dr. Shyla Arya, from Foot and Ankle Associates of North Texas in Grapevine and Keller, TX, was happy to mentor Dr. Crane in her yoga practice and to share her expertise with Dr. Crane’s running peeps.

Yoga is a practice that combines stretching, strengthening, proprioception and balance. It is one of the most well-rounded activities you can do to augment your training schedules. It will challenge you by showing you the weak and tight places on your body, all of which are roadblocks to efficient gait on your runs.

Yoga doesn’t mean complicated poses and putting your legs behind your head, it simply means union. Bringing together in union the essentials of balanced legs, core, chest, arms, and breath to make you the most efficient athlete possible.

In my yoga for runners class we always focus on hips, quads, hamstrings, calves, and of course…feet…your rooting mechanisms. If you’ve suffered from plantar fasciitis, IT band syndrome, Achilles Tendonitis, ankle sprains—you need yoga!

Check out our #1 pose for runners video here and stay tuned for more!. And join us for a free class Monday night at the pines across from Keller Town Hall for outdoors runner’s yoga! And of course if you have any lower extremity pain-come see us! 

In part one of Yoga for Runners: Dr Arya and Dr Crane from FAANT demonstrate a bridge pose. This is great for runners who sit hunched over a computer all day. It benefits the rectus abdominus, hips, shoulders, hamstrings and adductors.

Sesamoid Injuries

What the heck is a sesamoid? Or what’s that white circle on my x-ray by my big toe joint? These are probably the two most common questions asked in my office when people are diagnosed with a sesamoid injury.

There are two sesamoid bones in the ball of your foot

A sesamoid bone is a bone embedded in a tendon. In your foot, the sesamoids are two M&M shaped bones located in the ball of your foot, beneath the great toe joint. These act as pulley mechanism for the tendons and help you push off with your big toe when walking or running. They also serve as the weightbearing surface for the first metatarsal absorbing the impact placed on the ball of the foot when walking, running and jumping.

Sesamoid injuries which can involve the bones, tendons and/or surrounding tissue in the joint are often associated with activities requiring increased pressure on the ball the foot, such as running, basketball, football, golf, tennis and ballet. In addition, people with high arches are risk for developing sesamoid problems. Frequently wearing high heel shoes can also be contributing factor.

There are three different kinds of sesamoid injuries in your foot.

Turf toe: Turf toe is an injury of the soft tissue around the big toe joint. It usually occurs when the big toe joint is extended beyond its normal range of motion or hyperflexed. This is very common in football, soccer and tennis. This is a completely soft tissue injury but can involve the cartilage of the joint.

Fracture: A sesamoid fracture occurs when a sesamoid bone breaks. This can be either acute or chronic. An acute fracture is caused by a direct blow and you usually will have immediate pain and swelling. A chronic fracture is usually a stress fracture or hairline break caused by repetitive stress. These are common in runners, golfers and ballet dancers. A chronic stress fracture of the sesamoid causes a long-standing pain in the ball the foot and is aggravated by activity and relieved with rest.

Sesamoiditis:Sesamoiditis is basically an overuse injury with chronic inflammation, but without fracture. Sesamoiditis is actually tendinitis of a tendon that has a sesamoid in it. Sesamoiditis is caused by increased pressure to the sesamoids and is usually a dull, long-standing pain beneath the big toe joint. This pain usually comes and goes.

Diagnosis of sesamoid injuries

In order to diagnose a sesamoid injury, physical exam and imaging is necessary. There is pain upon palpation of the ball of the foot and there maybe swelling and bruising. X-rays are taken focusing on the great toe joint. Often times a stress fracture will not be revealed on a plain film x-ray and an MRI, bone scan or orthopedic ultrasound maybe more helpful.


Conservative treatment for sesamoid injuries may include one of the following options depending on the type of injury and the severity.

  1. Padding:a pattern maybe placed an issue to cushion the inflame sesamoid or two off wait it.
  2. Taping:a turf toe taping maybe utilized to stabilize the joint period
  3. Immobilization: the foot maybe placed in a cast or removable walking cast to stabilize the joint as well.
  4. Oral medications: A steroid dose pack or nonsteroidal anti-inflammatory drugs such as ibuprofen can be helpful in reducing pain and inflammation.
  5. Physical therapy: often times these injuries require physical therapy after a period of immobilization in order to strengthen an increased range of motion period
  6. Steroid injections: In some cases Cortizone is injected into the joint to reduce pain and inflammation. No more than three injections in a one year period are recommended.
  7. Custom orthotics: custom orthotics are often quite helpful to off weight the joint especially when it is a chronic injury. These will often decrease the need for surgical intervention.
  8. Surgery: surgery is usually reserved for severe sesamoid injuries that have failed to respond to conservative therapy. Often the sesamoid has shattered into many small pieces and needs to be removed.

Sesamoid injuries are unfortunate because they often take a long time to heal and have long-term consequences. Nonunion of sesamoid fractures (meaning they either take a long time to heal or never heal) are not uncommon due to the decreased blood supply to the sesamoid, because it is within a tendon. Bone stimulator’s can be helpful to try to avoid surgery. Even surgery is not an awesome option because it can destabilize the joint; and it’s difficult for some people to get back to running, jumping and playing with the other kids on a regular basis. If you suspect that you have a sesamoid injury please seek treatment early, because long-term consequences occur with prolonged inflammation causing joint dysfunction.

Are Custom Orthotics Worth It?

If you are a frequent visitor to Foot and Ankle Associates of North Texas in Grapevine or Keller, TX, you probably already know about orthotics. Maybe you have even purchased orthotics.  

Custom Functional Foot Orthotics

A foot orthotic is an insole placed into the shoe that helps control foot position. There are two main types of orthotics: Functional and accommodative. These can be prefabricated; like Lyncos that are popular at Healthy Steps or custom; which the doctor fabricates unique for your feet. A functional orthotic controls foot movement and helps a person walk in a way that best supports joints and muscles. An accommodative orthotic helps distribute foot pressure evenly over the bottom of the foot.  Most patients use a functional orthotic and usually these are custom for long term usage.  A functional orthotic can be useful for many problems and are used to balance the biomechanics of your feet. Think of them as an in-shoe tire realignment for your feet. Accommodative orthotics are very useful to distribute stress in the elderly, diabetic and arthritic populations.

In the foot care aisle at your local drug store or grocery store, you may have seen readymade orthotics for sale.  Does it really matter whether you buy store bought orthotics or custom orthotics from your podiatrist?   Well, some people may be able to get away with wearing store bought orthotics for a period of time. We even start with these type of prefabricated devices so we can get you on the road to better foot health quickly, but most patients do need custom for long term control of their foot type.

When you think about the long term health of your feet, custom orthotics are the way to go!  Store bought orthotics are made to fit many foot problems for a large variety of people; one size fits all usually means one size doesn’t truly fit anyone!  To be truly effective, an orthotic must be fitted for YOUR particular needs.  Wearing an ill fitted orthotic is not only a waste of time, but it can also make your foot problems worse.  Over time these problems can lead to leg, knee, hip, and even back problems. Store bought orthotics tend to not offer long lasting comfort. 

If you find yourself buying store bought orthotics every few months because of foot pain, it may be time to schedule an appointment to see one of the doctors at FAANT. Your podiatrist will produce orthotics that fit only YOUR feet.  The materials used will be those that are best suited for your walking and running needs.

Everyone deserves special treatment! With a real custom orthotic that is exactly what you have. Yes, custom orthotics can be costly, but so can surgery from walking incorrectly over the years.  I’m always amazed that insurance companies will often not cover orthotics, but will pay for surgery! Doesn’t make any sense!! Think of the orthotics as an investment and an investment in your health is one of the best choices you can make for yourself.

How to Stop a Running Injury Before it Starts!

Most consistent runners will relate that they have been injured at least once in the last 12 months. While there is no crystal ball to see the cause of every injury, there are things that you can do to try to prevent or at least decrease the severity of these sidelining injuries. Here are just a few tips to help keep you on the road and out of the doctor’s office. Think prehab instead of rehab!

  1. Don’t Binge Exercise! The most common cause of running injuries that I see is “too much, too soon, too fast” syndrome. We get so excited to get out there that we too much all at once. Our bodies get stronger with small increases in stress over time. We break down with big increases in stress in a short period of time. Although there is no good scientific evidence validating the 10% increase per week rule; it works! Meaning do not increase your mileage more than 10% per week and do not increase you distance and pace at the same time. Work on either speed or endurance; but not both.
  2. Strength Training. Strength training is a great way to prevent many injuries. Almost every runner I see with plantar fasciitis (arch pain) has tight hamstrings and a weak butt. Integrating a total body strength workout at least once or twice a week in your routine can really help balance your core muscles and decrease injuries.
  3. Replace Your Shoes Regularly. This is the one preventable thing that I see the most often in my office. Worn out shoes are like worn out tires on your car. They lead to all kinds of repetitive stress injuries. The rule of thumb is to replace your shoes every 400-500 miles or every 6 months; whichever comes first! If you are running more than 3 days a week, you should be rotating two pairs of shoes.
  4. Socks Matter! A lot of people will just go running in their daily wear socks. Socks do matter and wearing a wicking sock like dry-weave or cool-maxx will help keep your feet cool and dry. This decreases blisters, calluses and athlete’s foot fungus.
  5.  Massage. A regular deep tissue massage or habitual foam rolling will help increase blood flow to your leg muscles and break down any scar tissue. A massage is not a guilty pleasure, it’s a great way to stop a niggling injury in its tracks! If you can’t justify the expense, invest in a foam roller and use it regularly. 
  6. Check your Iron levels. No one likes to go to the doctor and have their blood drawn, but fatigue from iron deficiency is a common cause of injuries especially in women. Simply adding an iron supplement can ward off these types on fatigue injuries.
  7. Listen to your body! It’s always amazing to me how many people push through the beginning stages of an injury and make themselves 10X worse! If you have pain on the run, STOP! Take a few rest days or cross train. You know the difference between the achiness of fatigue and the pain of an injury. When in doubt, shut it down for a few days and rest, ice, compress and elevate! R.I.C.E. If the pain persists more than 4-5 days, you’re hurt. Forget the denial process and find your way into your favorite doctor’s office.
  8. Sleep!This is also one of those things that we as Americans are really bad at. Actually sleeping 8+ hours a night. Just like the fatigue of anemia, going out running when you haven’t had adequate rest will cause you biomechanics to break down and can lead to an injury. If you are tired, it’s OK to skip a run; just remember that lazy and tired are two different things!
  9. Hydration.Why do so many of us run dehydrated? Especially in hotter climates we require at least half of our body weight in ounces each day. Your muscles need the water to process lactic acid and your body will thank you. As a bonus, well hydrated skin actually looks younger! It’s a win:win.

These are just a few tips to keep you on the road towards your fitness goals!

Happy Running!

Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain. It is a condition seen in the old the young, the active and inactive. It can be incapacitating if early efforts in treatment are not made. The good news is that 80-85% of the time, it is successfully treated conservatively. The odds are in your favor if you act quickly to heal it.

Plantar fasciitis is an inflammatory condition where pressure in and around the arch of your foot causes a strain and sometimes even a tear in the main ligament (the plantar fascia) that helps to hold up the arch. This ligament spans the bottom of the foot from heel to the ball of the foot. Think of the plantar fascia ligament as a rope made of many fibers. The fibers can tear and shred causing pain and inflammation. The most common area for pain occurs at the heel, which is the weakest attachment of this ligament. Yet, there are many cases where pain is felt along the course of this ligament especially right underneath the arch itself.

Once the strain and pain occurs, you may notice a pattern in the way it feels. Commonly, you may feel mild to intense pain with the first few steps out of bed in the morning or after sitting, or even after a long drive. When you think about it, our feet tend to point slightly down ward in these instances. This temporarily relaxes the arch and the ligament tightens. When you stand up, you place all of your weight on the foot and the arch once again strains downward. This puts tension on an already injured plantar fascia, essentially re-injuring it every time this occurs. You may then find early on in the injury, that once your ligament has stretched somewhat, after the first few steps, that the pain resolves. Over time however, you may discover that the pain lingers longer than before. This is when plantar fasciitis becomes a real problem and when most people seek help.

The challenge for a podiatrist is to get the injured ligament to heal even though you are constantly using it. This requires a lot of patient involvement in the healing process.

Healing the plantar fascia requires patience and persistence. Stretching plays a big role in helping this condition. The more you stretch, the better. Your doctor will give you information on the proper stretches that target the plantar fascia. By keeping the ligament limber, it will strain less under your weight.

You may be dispensed something called a “night splint”. This comes in the form of what looks like half of a boot-type splint. This splint rests against your leg and foot to hold your foot up, keeping it from pointing down while you sleep. This keeps a constant stretch on the ligament and surrounding tendons as well. This stretch lessens the strain and can help in healing and improving your pain.

Supporting the arch is essential in preventing further strain and inflammation of the plantar fascia. Too many shoes have poor excuses for an arch support. Even what you may buy as an over-the –counter arch support may not be adequate for your foot type. Your doctor will make the proper recommendations for what your foot needs.

Icing the heel and arch can help as this is an inflammatory process. Taking an anti-inflammatory as needed for the pain may help as well. If your inflammation is beyond what an oral anti-inflammatory can manage, you may be offered a cortisone injection in the heel. Nobody likes them, but they sure can help!

Your doctor may also recommend physical therapy to help with deeper stretches and manipulations, as well as also working on areas that may be constricted or tight in other area of your body. They may also choose to use other modalities such as ultra sound and even cold laser therapy.

Extracorporeal Pulse Activation Treatment (EPAT) is a wonderful modality used to deliver pulses of acoustic waves to treat chronic plantar fasciitis and can be performed at FAANT’s office

This fancy stuff is worth every visit if it means getting you better quicker.

In the very worst of cases, surgical intervention may become necessary. Your doctor will discuss this thoroughly with you if conservative treatment has been exhausted.

Finally, you may now understand what can potentially aggravate this condition. The types of exercises you perform may play a role. For the time being, any exercise that causes excessive impact on the arch and plantar fascia such as running or jumping should be replaced with exercises that are more lenient on the injury. Biking, swimming, ellipse cycle and arc trainer are effective aerobic options and much gentler on your healing fascia.

Weight gain plays a role in aggravating plantar fasciitis. Increased weight means increased strain. The non-impact exercises just mentioned are great options to get some of the weight off the ligament and off your body.

Supportive shoes are just as important as the arches inside them. Flip flops and barefoot walking needs to be placed to the side for now since you will get the most strain in the ligament if nothing is keeping the tension off of it. If you want to wear a slipper instead of a shoe around the house, then look for options with good arch support.

Lastly, just be good to your feet. They are the only set of tires you’ve got. Get them to my office at the first signs of fatigue or the first signs of pain. Don’t wait till you have a blow out!