Got Burn?

You hear the news about skin cancer. You know to apply sunscreen by applying the sunscreen to your arms, legs, face, neck and even your ears….but what about your feet?

Leaving your feet unprotected out in the sun is dangerous. Often the feet are overlooked during medical exams which can lead to missed warning signs of cancerous growth.  Specifically to your feet, there are forms of cancers that are more prevalent than other forms.

Squamous Cell Carcinoma is the most common form of cancer on the skin of the feet. Often, this form of cancer is confined to the skin. However, the cancer can take on a more aggressive form and spread throughout the body. This form of cancer appears as a small scaly bump of plaque that looks inflamed with recurrent cracking or bleeding. Occasionally it begins as a hard, projecting callus-like lesion. The squamous cell cancer is painless however it can be itchy. It can look like a plantar wart, fungal infection, eczema, ulcer or other common dermatological conditions of the foot.

Malignant Melanoma is one of the deadliest skin cancers. Nonsurgical treatments are rarely effective. This type of skin cancer must be detected in early stages to ensure patient survival. Melanomas may occur on the skin of the feet and sometimes beneath a toenail. The cancer can be found on the top of bottom of the feet. The Melanoma will grow over time extending deeper into the skin spreading through the body and through the lymphatic and blood vessels. Malignant Melanoma looks like a small brown-black spot or bump with some appearing pink or red. Sometimes resembling moles, a closer look will show asymmetry, irregular borders, and alterations in color.

According to the FDA, SPF15 can provide approximately 93 percent protection from the sun whereas an SPF of 60 can provide approximately 98%.

For everyday skin protection, SPF20 would be appropriate. When you are outdoors and are involved with higher activity levels however, opt for at least SPF30 or higher. No matter what sunscreen you are wearing, reapply after two hours and don’t forget about your feet!

Tips to keep in mind to protect the skin of your feet when outdoors:
When you perspire or are in the water, even the waterproof formulas can wear off so  reapply every two hours.

Avoid stronger rays which are typically between 10am and 2pm.

Shoes do not have SPF…so apply sunscreen to your feet and reapply how often? You got it, every two hours.

Do not walk barefoot…even though it is tempting on the beach or a quick jaunt across the deck, the suns heat on surfaces can burn the bottom of your feet. Wear sandals that will allow stability as well as protection. Walking in flip flops on the beach for example will make you look like a duck trying to walk through a marshmallow pit....not so attractive and not so good for your feet muscles. 

Notice the skin on your feet not looking right or find a strange spot? Visit with your Podiatrist a.s.a.p. and inform your doctor of any recent sun burns to your feet.

So enjoy the warm weather and be smart….apply your sunscreen and apply often!  

The Road to Ironman Mont-Tremblant Goes Through New Orleans

The road to Ironman Mont-Tremblant went through New Orleans this weekend. As many of you know, that follow this blog, Janet decided to go to Galveston and I chose New Orleans for our early season half Ironman. I chose New Orleans because last year in Galveston, I had a really hard time staying upright while biking into a 30 mph head wind. I thought New Orleans would have better weather! God has a sense of humor!

New Orleans Ironman 70.3 was in a word - windy! Crazy, insane windy!! It was also only 67.1! The wind caused the race director, Bill Burke, to have to cancel the swim for the second year in a row. I actually felt bad for the guy since so many people were so upset, but when we got down to the water on Sunday morning, it was obvious that drowning was a risk given the 5 foot and higher waves!

We actually did a run-bike-run triathlon, which was much better than what they did at the Poconos 70.3 last year. At that race, after cancelling the swim, they attempted a time trial start of the bikes starting participants 3 seconds apart. This sounds good in theory, but the roads were very wet and there were crashes all over the place! In New Orleans, they were creative and wanted to keep the relay teams intact, so they made us run 2 miles to start then ride 52 miles (shortened due to road closures) and then run 13.1 miles to finish.

I met my friend Linda, from Arizona, in New Orleans and she was pretty anxious to do her first 70.3. She is attempting Ironman Arizona in November, so she needed a warm up race as well. I made a pact that I would never race without Janet again! Every time I go to a race without Janet, the weather sucks!

The best part of my race was the beginning of the 2 mile run. They started us in pair about 2 seconds apart and I was in the 5^th wave (40 and older women). This wave included all the “old” ladies. I started near the back of the wave and was just completing the first mile when I came upon a woman with an “81” on her calf.  I glanced at her and then realized it was the “Iron Nun”! Sister Madonna Buder is a Catholic nun who has completed over 400 triathlons and is an inspiration to all at The Ironman World Championships every year! I said, “Good Morning Sister!”, just to make sure it was her and then had a short conversation running along with her.  Such a positive person and it was a thrill to meet her. She is still running strong and should be an inspiration to all of us to keep moving! I told her I only hope I am still competing in 40 years!

After the short run to warm up, we jumped on our bikes to brave the wind. Crazy, insane and, at times, dangerous wind! I was trying to maintain 19-20 mph but no such luck. I worked very hard to keep 17.8 mph average into a 25mph+ head wind! It seemed like the wind was in your face no matter what direction you were going in! There were only 4 hills on the entire course, (Louisiana hills also known as overpasses ha ha) and at the top of one of them, a gust practically threw me off my bike. The bike actually felt like it went airborne for a second! I finished the bike in one piece and was happy to start running.

Then someone turned up the heat! The run was a double loop with awesome crowd support and plenty of aid stations! Thankfully lots of water and wet sponges since it was so hot! Very flat with a few small hills but overall a nice rolling course.  The casts of characters were out, just like most races. We had 3 Spidermans, guys in jester suits, and my favorite….guys running in their wetsuits with goggles and all, probably protesting the no swim!

I was happy to wave to Sister Madonna on the run and shamefully happy she was on the other side of the road about 5 miles behind me (who wants to get beaten by an 81 year old!!). I finished strong and with a smile. Legs of jelly from pushing hard on the bike made for a slow run, but overall a good day! My pesky chronic plantar fasciitis seems to have been cured by EPAT! Yippee! I have some work to do before I am ready to tackle the mountains in Quebec, but I earned my post-race beer today! Linda finished not so far behind me with a big smile!

Next up….Buffalo Springs 70.3….

Taking the right step with Golf Shoes...

Hi Everyone,

This weekend, Dr. Crane will be competing in the New Orleans 70.3. We did this race last year and weather went from nice to hot, hot, hot at the end. This course is pretty much New Orleans...flat. The swim starts in Lake Pontchartrain equalling 1.2 miles. After a quick transition, the bike course consisting of 56 miles that is smooth, flat and fast. If one good thing resulted from Hurricane Katrina, it is the beautifully paved roads. After another quick transition, a nice 13.1 mile run with a pinch of shade wraps up the event. This year I am holding out for Buffalo Springs 70.3 so other than a few fun sprints, I am in base building mode. We look forward to hearing from Dr. Crane after the race to gain insight on the 2012 race.

Last week in the store, we had an influx of golfers needing help to make their golf cleats comfortable. If you are a golfer, shopping for shoes is much like running shoes. You need to purchase the shoes that fit right on your feet. When you shop for golf shoes, make sure you have on your socks you will use in playing the game and have your feet measured. I am seeing many golf shoes too short on feet which can make playing 18 holes a long painful day to say the least. If you live in a warmer climate, consider shoes with mesh for breathability. Regardless of your playing ability, have your golf shoes replaced at least every 2-3 years. If the shoe leather is stiffer than a board, it might be time to have the shoes evaluated.

Speaking of which, your golf shoes need care as well. If you have leather shoes, condition the shoes with a leather conditioner and polish if needed. Get into the habit of spraying your shoes after each day of play with an antimicrobial spray to ward off bacteria that can form in your shoes. Allow your shoes to dry in a cool place...not sitting in the golf bag in your garage. A simple care regimen can help you play comfortably and just might stop you from flinging your 9 iron in the pond. ;)

Have a great week everyone and Good Luck Dr. Crane!

What's inside your cycling shoes?

We talked about cycling shoes in the last blog so this week; we will learn a bit more about the insoles of cycling shoes.

The factory liners are created to cover the last of the cycling shoe…that’s it. If you already wear orthotics, simply remove the factory liner and insert your orthotics. If you are shopping for new cycling shoes, make sure you have the orthotics with you when shopping as this can affect the style and size of the cycling shoe. It would be a good idea to bring your bike along as well. Many bike shops are happy to let you take sample shoes for a spin whether outdoors or on an indoor trainer. I see a lot of customers at shops try on the shoes, stand in them and then purchase. You need to actually ride in the shoes to get an idea of how the cycling shoe feels on your feet.

There are also many over the counter inserts to offer you enhanced support. At Healthy Steps, we have found success for many cyclists with the Lynco orthotic product. The orthotics are prefabricated and have a breathable top cover helping to wick away moisture whether wearing socks or sockless designed cleats. There are different styles created for different foot types and can be adjusted similar to custom orthotics.

Another route is many bike shops offer moldable inserts. The concept is to place your foot on the insert which has been heated and allow the insert to form to your feet. The trick is to ensure the inserts are created properly by proper foot placement and equal pressure. If you decide to have the inserts created at the bike shop, make sure you are aware of the adjustment and or return policy should the inserts not perform as desired. Ultimately, if you have continued foot problems, your Podiatrist may recommend customs to alleviate and prevent foot problems cyclist’s experience.

Sometimes, a bit of arch cushioning is all you need or perhaps an off load of pressure from certain areas of your feet. This can be accomplished by adding to the existing liner. I have had a few cases where adding to the arch area of the liner has done the trick for added support. As the miles add up however, the over the counter choice is a longer term fix.

So that is the skinny on insoles for your cycling shoes. So head to the shop, find the cycling shoe and insert for you and happy riding!!

Gear into the right cycling cleats

Cycling – it can be a lot of fun whether you are a casual rider, competitor or somewhere in-between. For some, “clipping in” with cycling cleats is preferred over wearing athletic shoes or hybrid options. Cycling cleats have a stiff sole which protects your feet and allows more efficient transfer of energy. So basically, you work less!

Cycling cleats vary from brand to brand just like running shoes. They vary in width, weight, color, style and may come with one, two or three straps to hold your feet in place. I recommend you research the many choices online so you will have a better idea when shopping at your local bike shop.

Which brand of cycling shoes are the best? The “best” cycling shoe is the one that fits your feet….not what your cycling buddy wears, your competition or the svelte model wearing the cleat in your favorite bike magazine. As with shopping for running shoes, I advise all of our cycling patients and customers to really take their time and shop around. This means you may have to frequent multiple cycling shops before you find “the one” pair of cycling cleats for you!

A few tips –

Define your budget. Knowing this ahead of time can help reduce your chance of overbuying.

Are the cleats for recreation or competition? Cycling cleats vary in price based on the materials and typically increase in price when geared toward longer event riding.

What is the shape of your feet? Are they bony and thin or are they fabulously fleshy or even somewhere in-between?

Do you have a high, normal or flat arch? Often times, over the counter or custom inserts are needed to allow for correct support of each foot.

Do you plan on wearing socks with your cycling cleats or sockless?

What distance do you typically ride per week? Will this distance increase i.e. training for an endurance event?

Armed with answers to the above will help you drill down to the right set of cleats. Take this information with you to the bike shop. The more information you know ahead of time and provide to the fitter, the more enjoyable your shopping experience will be for you.

Happy Cycling!

Running through the pain

At our practice, we have many athletes as patients. This unique group of patients often do not have “patience” when it comes to injuries.

For example, when a runner learns they have been diagnosed with Plantar Fasciitis also referred to as heel pain, the initial reaction is make it better and make it better now as there are runs to be run. For many, the sobering news is rest which could mean a few days or weeks. Suddenly the patient feels lost and frustrated at not being able to run.

I get it. I know what it’s like to be told you can’t do an activity you adore. Heel pain is no laughing matter. It hurts, it’s annoying and interrupts daily activities. If you “run” into this challenge, here are a few tips to consider:

Be creative and find alternative ways to exercise which will not impact your injury. An alternative such as swimming is a great way to get a cardiovascular workout without pressure to your foot injury.

Take your rest seriously. Work on that to do list of paperwork you have at home, review your written goals, visit a friend you have been meaning to contact but just can’t find the time.

Follow your Doctor’s advice and ask as many questions as you need to ensure you understand the instructions necessary to heal from the injury. Many patients are thinking so much about the diagnosis during their appointment, they do not hear the details on rehabilitation. Know what you need to do then make a plan to ensure you are doing what you are supposed to do.

Know you will get better and time is needed. This is a tough concept for many athletes. Take a deep breath and focus. It will be worth at as you cross the next finish line.

Stability and Motion Control...what's to know?

Hi Everyone,

We are receiving a lot of questions regarding the difference between motion control shoes and stability shoes so I thought I would help clear the air on the differences.

Motion control shoes also known as maximum stability are designed to provide significant support for flat-footed or severe over pronators. The shoes are suited for individuals who have severe overpronation and weigh more than 180 pounds. While many runners do not fit this category, there are walkers and runners who need maximum control. The motion control shoe provides excellent durability along with comfort for this specific foot type.

The stability shoe is a bit different. The stability category also has structural features to reduce overpronation however, the shoes have more flexibility and cushioning not found in maximum stability shoes. Within the stability category, shoe vendors have different levels of stability available.

Many footwear manufactures have increased the amount of lighter weight and less structured running shoe styles in part to the minimalist running shoe movement. Some lightweight shoes may offer some stability features with posting located on the medial side of the shoes or shanks located inside the shoe on the foot bed however; the light weight shoe tends to be less durable than traditional running shoes.

It may be appetizing for some to choose a lightweight style of shoe however, if you are a candidate for motion control shoes, the cost of the motion control shoe versus the replacement of lightweight shoes due to quick breakdown pretty much even out. Lightweight stability shoes will not offer the guidance of a motion control shoes .

Those who wear a specific category of shoe also inquire if they will always be in the same type of shoe. Genetics, weight fluctuations, orthotic use, amount of running, proper training, running surfaces are factors to name a few. Keeping up with a yearly foot exam with your Podiatrist and informing of your running habits and future plans will ensure you have the right amount of support for your feet!