Overcoming The Fear To Run After A Fracture

On August 7, 2010 I broke my foot playing soccer.  This was a fifth metatarsal fracture to the Left foot.  I undertook some strict self care and got back to the point where I was released to run.  Even with this release and visualizing the healing on x-ray personally, I had some fear of returning to running.  Whether justified or not, I know better and still had that trepidation. 

Why Would I Be Scared?
- Fear of Reinjury: Although injury is always a risk, after a truly healed fracture, the chance of reinjury is usually less, not more.  Threrefore it is important to discuss this with your physician and get cleared to return to running.  I cleared myself to run, conservatively, and should have no fear of reinjury.

- Does My Foot Still Hurt?  After any injury, there is some residual stiffness and process of getting back to normal.  At times I have thought that my foot may still hurt, but in reality it had no pain with pressure or pushing on it.  Was this a valid fear?  If it is truly healed it shouldn't be an issue.

- I Am Heavier Than I Ever Have Been:  As a runner, I have kept my weight under control by running.  When unable to run, and not changing my eating habits, I have gained weight and that (of course) makes it harder to run.  Although this is a valid concern, if you are careful with return to running this problem can fix itself.

Overcoming My Fear
1. Remove Possible Excuses:  The easiest way to justify not running (when afraid or otherwise) is to not be prepared to run.  As cold weather is in full swing here in Utah, I ensured I had sufficient winter running wear to allow me to run when the time came.  This included a good quality pair of running shoes and possibly a traction device if ice could be a problem. 

2. Set A Date A Time To Start: In truthfullness, do any of us have time to run?  Life will use any time we have for other purposes.  Some purposes are valuable, and others are just time fillers. We always have time, however, to do what we want to do.  Therefore, set a date and time to start running and don't let anything stop you.  You schedule other things in your life and keep them.  By making this strict appointment, you do the hardest part of running again, starting.

3. Don't Over Do It:  It is irrelevant what distance and speed you were running before, you are starting over.  Start slow and run relaxed.  You should start with a shorter distance and slower speed and work back into what you were doing.  My rule of thumb (for me) is to run until I am not hating it anymore and then turn around a run home.  If you always hate running, that may not be a good rule, but for me it was just about one mile out so I started with two miles.  I usually love to run once I am running again. 

4. Run Baby Run:  The only true way to overcome this fear is to run.  After the first run, you will have much less fear and can work on the routine to get back to normal.

Remember the reasons you are running and get back to the routine that you were in before you stopped.  If we can help you get back to running, let us know.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Prepare To Run, As Karl Metzer Must Have For His 2000 Mile Run

Whether you are running 2 miles or almost 2000, the preparation is similar and important aspects should be considered.  Karl Metzer, an Ultra-marathoner extraordinaire, is currently crossing the country from Sacramento, California to St Joseph, Missouri along the Pony Express Trail on its 150th anniversary.  As he crosses through Utah, I thought it appropriate to focus on preparations that would be necessary for such a run (and any run to a lesser extent).

My recommendations would include:
       - Fluid => Important to keep the fluidity of the blood and reduce lactic acid build-up in the muscles.
       - Food => With high nutrient values at rest intervals and even throughout the run.
       - Shoegear => As a runner, shoes should be replaced every 400 miles.  He will be using many pairs of shoes.
       - Running Gear => Whether the shirt, shorts, jacket or hydration/nutrition belt, the proper gear can reduce injury and protect against unforeseen running risks.
       - Support System => We all need support in our running, and his support system must be robust.

Run smart and run safe through these careful preparations for your run. 



Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

When Should I Run Again After A Fracture?

As a runner with a 5th metatarsal fracture, I understand the desire to return to running.  This type of fracture doesn't just hurt physically, but interferes mentally because you may need to cancel your race and can't get the runner's "high" that comes with a nice run.  In fact, runners often get in a hurry to get back and can cause additional injury from not waiting until the appropriate time to return to running. 

With this thought in mind, and while currently only 2 weeks into the healing process, I thought it would be useful to discuss how I will be transitioning back to running.

- Pain is improved can I run?  Depending on the extent of the fracture, pain can significantly improve and sometimes resolve at 2-3 weeks, with most fractures being painfree at 4 week.  Although painfree is a good sign it is not a guarantee that healing is complete and running can be initiated.  I am 2 weeks into a fracture and have a painfree foot (finally).  My x-rays, however, show a fracture that is still healing.  If I were to run too quickly, I could create a situation requiring a return to cast or boot and possibly even surgery.

- What is the most accurate indication of healing?  Bone healing, as with fractures, is usually confirmed on x-ray.  If the x-ray shows sufficient callus formation across a fracture, the area is healed.  This means the bone is stable and reinjury risks are decreased.  I wll therefore be confirming healing on x-ray and only start running after the bone is visibly healed on x-ray.  I want to get back to running painfree, and will not rush it for that reason.  I plan for years of running, not just one more race, etc.

- How do I get back to running?  The best way to get back to running is to do it slowly.  You have been limited activity for 6-8 weeks and should take twice to 3 times that (at least) to get back to where you were.  Start slow, preferrably on a surface that will protect you from reinjury.  As I transition back (hopefully in 4 weeks), I will be running upto 1 mile only for the first 3-5 days, and then start progressing slowly back to my normal running routine.  Again, I will take close to 12 weeks to get back to the point where I am ready to train for a marathon.  This will preclude me from running my marathons this year, but will allow me to run many marathons to come.

Just like you use care in training to not under or over train for any particular event or race, you should use care to not progress to soon or too quickly back to running after a fracture.  Your body will thank you!

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

When Life Interferes With Running

We love to run.  In fact, I run to relax and enjoy every run I am able to participate in.  But what do you do when running is not possible because of interferences of life?  I am currently facing this issue with a fractured foot that will not heal with continued running.  Here is what I am doing to "survive" while not able to run.

- Focus On Health:  This includes taking in sufficient fluids (at least 6-8 cups a day of water), eating healthy foods and avoiding unnecessary interferences in my health.  This will allow me to feel better even without the runners high and allow me to heal more easily.

- Focus On Healing:  I can truthfully say that my fracture makes me angry, but I have stopped focussing on that.  I now think about what I need to do to heal.  This includes wearing my cast boot like a cast (24 hours a day, except for showering).  As I focus on these aspects, it is easier to follow the doctor's instructions (even if they came from me for me).

- Be Prepared To Start Back Slowly:  After my injury, I will need to start back running more slowly than usual.  This is important so that I don't get irritated as I start back.

Healing correctly is imperative to returning to running without limitations.  For this reason I need to stay focused and not allow it to interfere with my regular activities or get me down.  Although this fracture is inconvenient, it will not have any longterm effect on me.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Barefoot Running, What's The Truth?

Barefoot running is not new, in fact it has been around since the beginning of mankind. Often man had to run to find food, or keep from being food. This reasoning is often the justification for barefoot running. They will often even quote "studies" that prove running shoes are bad, or barefoot running is good. 

But what is the truth about barefoot running? Here is a good discussion that was brought to my attention: http://www.prolaborthotics.com/Blog/tabid/90/EntryID/132/Default.aspx

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Should I Change My Running To Increase Speed?

Here on the internet, I have seen articles on barefoot running, including a recommendation to run 100 miles barefoot, and I have seen recommendations to run on the forefoot or midfoot.  I recently have adjusted my running to increase speed and wanted to discuss some of these claims.  Before it all, I recommend that you continue what is normal for you!

Forefoot or midfoot running has been said to increase speed of long-distance runners.  This is based on a single study that found that 23.7% of runners used a midfoot pattern and that in this study these runners were faster.  It is based on the fact that sprinters run on their toes (forefoot running).  More recent studies, however, including one by Dr Hamill, a professor of kinesiology at the University of Massachusetts at Amherst, have shown some benefits to each type of running.  Rearfoot running, for example, has been shown to be more energy efficient.  No significant speed differences were shown, when all other factors were as efficient as possible.  My recommendation, therefore, is that you not try to adjust your running pattern to forefoot or midfoot from rearfoot or even to rearfoot from forefoot/midfoot.

Barefoot running is a subject that should be considered carefully.  If you walk and run barefoot already, then again I would not recommend you change. If you are thinking about it because of some book or website, please consider the following recommendations from the APMA:

Barefoot running has become an increasing trend, and a possible alternative or training adjunct to running with shoes. While anecdotal evidence and testimonials proliferate on the Internet and in the media about the possible health benefits of barefoot running, research has not yet adequately shed light on the immediate and long term effects of this practice.


Barefoot running has been touted as improving strength and balance, while promoting a more natural running style. However, risks of barefoot running include a lack of protection, which may lead to injuries such as puncture wounds, and increased stress on the lower extremities. Currently, inconclusive scientific research has been conducted regarding the benefits and/or risks of barefoot running.

The American Podiatric Medical Association, along with the American Academy of Podiatric Sports Medicine, encourages the public to consult a podiatrist with a strong background in sports medicine to make an informed decision on all aspects of their running and training programs.

Again, my recommendations (and the pattern I am following) is to continue to run in the way that is natural for you.  Run smart and keep running for a longtime to come.  I will be speeding up my running, but through natural processes of speed work and careful training regimen.
Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Running In The Snow...Yes It Can Be Done Safely

Although it is only October, we have already seen a couple snow storms.  In fact, my yard still has a little snow.  This brings to mind the trouble many of us have running on the roads when ice and snow become common.  I would like to give a couple traction options for running in the snow:

•STABILicers SPORT - An adjustable slip-on cleat that can be placed under a walking or running shoe to add traction.    This is a good option for walking, but not as good an option over a running shoe.  It may interfere with the ability to run as would be done without the cleats.  It does a great job, however of limiting slipping.

•Kahtoola MICROspikes  - Strategically placed steel spikes that easily slips over shoes.  This product works well in minimizing slip on packed snow or ice and allows running or walking in winter conditions. 

For a video of this product in use: see http://www.kahtoola.com/microspikes_video.html

•Yaktrax Pro -  A device that also slips on the shoes, but works much better in producing traction without the sensation of having something on the foot.  In fact, these are quite light and work well even when running at full speed.  This is the item I will be utilizing when running in the snow this year.

So best of luck continuing to run even in the cold winter months here in Utah.  Run Smart and Be Safe!


Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com