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

Fifth Metatarsal Fracture & The Runner

As a runner, I understand how hard it is to not participate in your sport.  But sometimes it is necessary to change your routine to allow healing.  I will discuss one such situation, a 5th metatarsal fracture.  This diagnosis was recently seen in a gymnast in my office and I thought of all the runners that suffer a similar injury.

The fifth metatarsal has a bony process (the styloid process) back towards the heel area.  In this area a tendon, the peroneus brevis, attaches and manipulates the foot with walking and running.  When a foot or ankle is twisted or an ankle is sprained, this tendon can cause abnormal pull on the styloid process and cause breaking of the bone.  This can be a simple stress fracture with incomplete seperation of the bone, a complete fracture with both cortexes (edges of bone) broken, or an avulsion where the piece of bone is pulled from the area and has significant seperation from the remainder of the bone.  Any of these can be a problem, but the greater the seperation the more difficult the treatment for an athlete.

If you have pain to the side of the foot that hurts with twisting of the foot or ankle, I recommend evaluation by a foot or ankle specialist.  If you sprained your ankle severely and now have pain on the side of the foot, again get the foot evaluated.  Although the treatment may preclude you from running for a period of time, the longer you wait the less treatment options that are available.

Possible treatments may include bracing (even a simple ankle brace) if very mild, a boot or cast if more complex (this will stop your running) or surgical correction if it is severe or fails to heal.  This area is notorious for not healing and may require surgery in some cases.  Severe ankle sprains should be treated early and surgery for this condition may be unnecessary. 

Although I hope no runner sees this condition in their running, early treatment will keep you running and allow you to perform at your top level.  As I continue to run, I think of these type of injuries as I step over holes on the side of the road, or get mild twists from stepping off the side of the asphalt into dirt.  Let's stay injury free and keep running...


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

The Truth About Leg Length Differences In Running...

As I stated in a seperate blog, the development process causes each half of the body to develop independently, including foot size and leg length. As a runner, it is imperative that you understand these differences and adjust your equipment and training to accomodate the differences.

1. Based on which foot is larger, you should fit your shoes to minimize injuries from loss of toenails, to ingrown toenails, to blisters and even stress fractures.

2. Leg length difference can be a bigger issue:
-If the leg length difference is only minor, you will often not notice any difference and can continue to run without difficulty. No training adjustments will be required.
- For a significant difference, the following training modifications should be considered:

A heel lift or orthotic (with heel lift integrated) should be considered to allow modification of length to make the legs function closer to the same. This minor modification of equipment will preclude major changes in training.

If you typically run on a treadmill, the heel lift/orthotic are imperative, because there is no training adjustment that can be done to fix the additional stress on the bones, ligaments and tendons or aggressive pronation of the shorter leg that will occur irrespective of the shoe utilized.

If you typically run on a road, modify your running such that the longer leg is on the downside of the road. For example if your left leg is longer, running against traffic is good. The opposite is the case for a longer right leg. This is because most roads are canted to allow runoff during rain storms to the sides of the road.

So before you get more expensive shoes, run long distances or get injured from poor functioning of your feet from a simple leg length difference, make the necessary adjustments to improve your running gait pattern. 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