One-Day Foot Care Clinics?

August 14, 2016 by · 1 Comment
Filed under: blister care, Foot Care, Foot Care Products, Health, Sports 

Since the 6th edition of Fixing Your Feet came out and I worked Western States 100 and Badwater for another year, I’ve been thinking about putting on a few one-day foot care clinics in 2017.

Fixing Your Feet Foot Care Clinic

Fixing Your Feet Foot Care Clinic

I‘d like to do these around the U.S. – in Northern California, Southern California, Florida, maybe Texas and Oregon, and elsewhere if there is enough interest. If it were just me, I could teach 10 people. If I had a knowledgeable helper, we could teach 20 people. If there were enough in one area, we could do it twice in two days.

My preferred audience would be athletes who want to learn the finer points of patching feet, taping, blister care, shoe modification, and more. I envision different sections: the basics, hot spots and blisters, toes, general taping, specialized taping, post event care, and more. This would be full hands-on training. Ideally attendees would like to learn and then share the skills with others – medical people, runners’ crews, those with a keen interested to learn but without the opportunities to learn.

Attendees would received full instruction, watch and do the skills, get hands-on with the tools and tapes, handouts, copies of the presentations on CD, and a bunch of goodies I’d try to get from companies with relevant foot care products.

My plan is to hold these in a location easily accessible to those in the area – a hall or community center, a hotel meeting room or something similar. I realize some people would have to travel and would work to arrange nearby accomodations.

I have the outline of the day completed and it would run from 9am until 5pm. The clinic would cost participants to cover the meeting location, supplies, lunch and breaks, and associated miscellaneous expenses.

I had originally wanted to do the clinics on a Friday and then have participants work aid stations at a local 100-mile race the following day – but the logistics of that are too complex.

If you are interested in this kind of foot care clinic, please send me an email and tell me where you are located. I’ll collect names and locations, and if there is enough interest, will get back to everyone in future emails.

What To Do About Calluses

Anyone who knows me has heard me talk about calluses.

I don’t like calluses – period. They indicate repeated pressure over time, generally from poor fitting footwear.

But the most important thing to know is that if or when you get a blister under a callus, it will be painful. No matter how small or how little fluid is inside the covered and hidden blister. You know it’s there. I know it’s there. But finding the exact location and depth of the blister in order to drain the fluid is very, very, very difficult. It can be painful too because it take a series of punctures with a needle to try and find the blister sac.

So for that reason, I prefer nice soft skin instead of calluses. I’ll accept a little bit of callus – but very little. I have spent too much time at aid stations and medical checkpoints trying to help athletes with thick calluses that have negatively affected their forward movement.

Your job is to reduce your existing calluses and then try to keep the skin soft. It’s not easy but in today’s blog post, I have a link to a Moo.Review webpage that goes into great detail about callus tools. Manual tools, battery operated tools, gels and creams, the list is long and the pros and cons are shown.

I encourage you to check out the webpage and even get one or several of the tools to work on reducing your calluses. Here’s the link to Moo.Reviews Callus Remover page.

Fixing Your Feet 6th Edition Available

After 14 months of revising and updating, editing and then editing again, and issues with the cover, the 6th edition of Fixing Your Feet is available.

While it has been available for pre-order in Amazon, they now have the print version in stock and ready to ship. Amazon currently has the 6th edition priced at $13.64, well below the retail price of $19.95 – a great buy. Here’s a link if you want to order a copy.

The Kindle ebook version will be released in about two weeks.

As I meet runners and crews at races, I find many have an older edition. I encourage you to bite the bullet and get the 6th edition. It’s well worth it.

Every new edition has all products and URLs verified. In addition, the text has been tightened up to eliminate redundancy of topics, and remove out-dated information. Many topics have expanded and new information. Every chapter has been reviewed and some degree of change made.

The chapter on Extreme Conditions and Multiday Events includes new information on the growing problem with maceration, as well as new information on trench foot, chilblains, and frostbite, all possible in the adventures we participate in.

A new chapter is Blister Prevention – The New Paradigm. The chapter revises the thinking that moisture, friction, and heat are the causes of blisters. After much study by experts in the field, I introduce the concept of shear as the underlying cause of blister formation. Several charts show the relationship of moisture, friction, and heat to shear, and how new things like bone movement, skin resilience, and pressure; along with the usual things like fit, socks, insoles, lubricants, and more, influence blister formation. The chapter also stresses the value of ENGO Blister Prevention Patches.

Fixing Your Feet, 6th Edition

Fixing Your Feet, 6th Edition

I would be remiss if I didn’t comment on the new cover. The first cover mock-up had an image of an athlete trying to patch her feet, but it did not capture my view of doing foot care and blister patching well. I arranged a photo shoot with a local photographer and Tonya Olson, a physical therapist and well-trained foot-patching expert as our model. Thanks Tonya. I’ll let you be the judge, but I like the cover and the design.

If you have an older edition, you will benefit from the new edition. Even if you have the 5th edition, you’ll find value in the new 6th edition. Order the 6th edition through Amazon.

Once you have the new edition, I’d be appreciative of a review in Amazon when you have time. Reviews are important and help other buyers make informed decisions.

Note: The links above are my Amazon affiliate link.

Don’t Do This to Your Feet!

July 17, 2016 by · Leave a Comment
Filed under: blister care, Foot Care, Footcare, Footwear, Health, Sports 

Over the next few days, over 90 ultra runners will test themselves at the Badwater Ultramarathon in California’s Death Vally. 135 miles. Extreme heat, scorching roads, sand, wind, hot winds, and then at the finish line – much colder temperatures. I’ll be there to help with runner’s foot care issues, working with Denise Jones.

I decided to rerun this blog post from 2010. It describes an issue that can harm a runner, and can happen when time is not taken to repair small blisters before they become large, and then huge.

Here’s the post from July 2010.

This was a good week. Badwater in Death Valley always is. Fit runners, great crews, fantastic scenery through the harsh reality of Death Valley – and for me, lots of feet needing care.

For the most part, things were pretty normal. Blisters and more blisters. A great case of severe capillaritis (heat rash) on one runner’s ankles. Ugly toenails. Stinky feet. And more. Lots to like for someone who does foot care.

At the closing ceremony, I noticed Monica, a runner from Brazil, was favoring her right heel. I had met her several years earlier at a previous Badwater when I patched her feet at the 40-mile mark. This year, she finished her 2nd Badwater and that was important. However, she had not come in for help.

She should have.

After the awards ceremony, Denise Jones came and told me I had to see this blister. She talked as if it was really a great find. Denise, as the Badwater Blister Queen, has seen everything and it takes quite a bit to faze her. This blister did. And yes, it was good.

What started as a small blister, one that could have been treated to prevent it from getting bigger, was now an enormous blood blister. The image shows you the size.

An enormous blood blister

An enormous blood blister

There were several issues we had to consider. First and foremost, Monica is a diabetic. This makes foot care a huge issue because any foot infection suddenly becomes a huge health issue. Secondly, the size of this blister, filled with blood, would make it difficult to patch. As always, blood-filled blisters must be managed with care.

We debated the issues and gave Monica advice on how to take care of the blister for her trip home. We advised frequent soaks in warm/hot water with Epson salts and sticking to sandals or other open heel footwear.

What I want to emphasize here is that this never should have reached the size it was and worse yet, filled with blood. For those wondering, a blood blister is bad because, once opened or torn, it can introduce infection into the circularity system if not kept clean.

I wish Monica had taken care of this earlier. She may have never mentioned it to her crew. At any rate, what could have been easily treated now became a huge issue.

It’s a good lesson on not allowing small problems to become large problems. In other words, “Don’t do this to your feet.”

Thru-Hikers Feet – an Update

July 13, 2016 by · Leave a Comment
Filed under: blister care, Foot Care, Footcare, Health 

This is an update to my blog post of May 28, A Thru-Hikers Story About Feet. The thru-hiker is Tami and she is still hiking the PCT.

When possible I love to share people’s before and after stories with their feet.

Her story was interesting because she was having huge issues with her feet. I shared three pictures that she sent me, which shows the damage to her skin. I’d suggest going back to read the first part of her story and seeing the pictures. It’s important because it put today’s blog post update in a real-life perspective.

Tami wrote:

“I just wanted to drop you a follow up line and let you know that my feet have never been better thanks to you! I just walked 600 miles (trudging over 20 miles per day in the High Sierra on rough rock during dehydrating heat spells carrying an extremely heavy pack complete with bear canister…yes this is a run-on sentence but I can’t help myself) using your preemptive taping methods and tincture of benzoin for toughening and I didn’t get one single blister! This is a huge breakthrough for me and I’m giving acknowledgements to your book and your suggestions everywhere I can- you truly are helping me hike the Pacific Crest Trail.

“Yes, I’m still hiking and super in tune with these feet. Every tiny hot spot or slight discomfort makes me stop and evaluate everything. Thanks for the reminder to not get complacent, it seems like my feet are tough, but it wasn’t too long ago that I was disabled to due horrible blisters.

“I thought my foot issues would be putting the cabosh on my plans, but here I am with happy feet! I met a girl on a bus who was limping around with blister pain and pulled out my foot kit for her to look at. She took notes, jotting everything down including your book title. These are hard lessons learned, but then again, I never seem to do anything the easy way. Thanks so much.”

So what do we learn here? We see that there is hope. It shows that athletes can survive and find help and solutions for their foot issues. Whether you are a thru-hiker, like Tami, an ultramarathoner, marathoner, walker, adventure racer, or anything else, you don’t have to quit because of your feet. Tami was smart and reached out for help – and was willing to put in the effort to learn what to do and what her feet needed.

You can do the same thing.

Consequences of Maceration

Macerated feet at the finish line of Western States

Macerated feet at the finish line of Western States

At Western States we saw a lot of negative results from wet feet. Even though we tried to spread the word, many runners did not protect their feet. Runners had poured water over their heads, which went into their shoes, and they sat in streams. Runners were complaining of blisters on the feet, mainly the balls of the feet but it was maceration. In reality, almost everyone had one or more skin folds common to their feet being wet for long periods of time. These might be in the center of the mid-foot or at the ball of the foot near the toes. Some did fine by warming their feet, applying powder, changing socks and shoe when possible, and maybe sitting a bit – and continued on and ran well. Others did not stop at aid stations or get crew help, and ran on with wet feet. Then they reach a pain point at which they cannot continue, or they reach the finish line – and they want help with their feet.

There is no quick fix to maceration. The more severe it is, the longer it takes to return to normal. Maceration can be painful – and yes, feel like one’s feet are burning. The skin is so soft and tender that every step is painful. Many times the skin has folded over on itself or has lifted to form deep creases, which can split open. I have seen maceration go through several stages:

  1. First, the skin begins to soften and becomes tender.
  2. Second, the pruning starts as the exposure continues. The skin wrinkles and softens even more.
  3. The third stage is when the skin can form creases and folds over onto itself. The creases may be shallow or deep, but are painful.
  4. The fourth stage is the most severe. The folds split open and/or the skin may tear.

If there are blisters, they must be drained and covered with a waterproof dressing to help keep tissue swelling under control. Tissue swelling leads to cold and damp skin, swollen and difficult to patch.

There are ways to deal with maceration, but it’s even more important to take steps upfront to prevent it. For instance, change into dry shoes and socks whenever possible, change socks as often as possible. When getting crew aid or at aid stations, remove your shoes and socks to allow your feet to dry, sprinkle with powder and rub it in, warm your feet with light massage, let them see some sunshine, and use one of the moisture control agents.

For moisture control, RunGoo from Foot Kinetics is one of the best. Its thick white paste works wonders on the skin and helps keep moisture at bay and it last a long time. FootKinetics.com has created a great product that works. Other excellent products include Trail Toes, ChafeX. SportsSlick, and Desitin Maximum Strength Original Paste. One thing to look for in these products is how long they last and do they come small packages or could they be packaged small enough to be carried in a hydration pack. My preference for applying any of these is to use them liberally. Then bunch your socks and roll them over your feet. Avoid just pulling your socks on, which can thin the product around your toes and forefoot.

Applying a coating of Hipoglos

Applying a coating of Hipoglos

Having severely macerated feet is not a badge of courage. It’s a sign that you could have made better earlier choices in foot care. Some of the worst feet I have seen have been because of severe maceration.

For 20% off your purchase of RunGoo from Foot Kinetics, use the coupon code “tfk20john.” I’m even using it as a chamois cream when road bike riding. It does last.

In a future post, I’ll talk about treating feet and maceration at a race finish line.

A Thru-Hikers Story About Bad Feet

May 28, 2016 by · 3 Comments
Filed under: blister care, Foot Care, Footcare, Health 

Today’s post is a thru-hiker’s story about her experiences with her feet. It’s one that make you grimace when you hear the details and see the pictures. I share the story because there are lessons to be learned. Here’s her story.

“This past April, I started the Pacific Crest Trail intending to thru-hike northern-bound to the Oregon/Washington border. I’m an experienced long distance thru-hiker and frequently hike 20-25 miles without issue.

Taped feet with gauze and white athletic tape.

Taped feet with gauze and white athletic tape.

“Rarely do I get blisters, and I have no calluses. The day I started at Campo, California, I hiked a 20-mile day and was shocked to find my toe pads laden with deep blisters at the end of the day and a couple smaller surface blisters on my little toes. This is how the trip started! I did my best triage but wasn’t very familiar with how to treat such ailments, and so continued hiking.

“By the time I’d reached mile 350 on the trail, my feet were an absolute mess. Blisters had become wounds, wounds became infected, toenails were falling off and each foot was severely compromised. At one point I sat on the edge of the trail so frustrated I was in tears! What was wrong with my feet?

Healing left foot

Healing left foot

“Only after my feet got good and angry did I switch to a larger size shoe in hopes of accompanying the swelling. I think one of my mistakes early on was that I used gauze and Neosporin along with athletic tape and made mummies of the feet. Add to this 90-degree heat through the desert and my feet looked like big balloons, which barely fit in shoes. They were so painful that one day while walking, I took my socks off to give my feet more room. That caused heel blisters. But aside from cutting the sides out of my shoes, I had no other choice. I was in a remote area hardly able to walk despite taking NSAIDS.

Healing right foot

Healing right foot

“After I hit Big Bear Lake, I rested for 4.5 days in hopes of curing my issues. When I set back out on the trail I switched to Altra Olympus 2.0, in a half size larger than normal (for swelling issues) since they offered more cushion. I hiked for two days, but my feet were not healed all the way and I suffered terribly during that timeframe. Blisters popped up in places they’d never been, likely because my gait was compromised and I was still in pain. I was finally able to hobble down to a highway and hitchhike to a town where I put on flip-flops, rented a car and flew home.

“I’d never had these issues before in all my years of long treks. When I got home, I started researching foot care online and came across your book, which I downloaded. I read it cover to cover and feel it’s the part of the puzzle that I never knew I needed and also, the solution moving forward. I’m following your advice with the tapes and have been practicing with bandaging as you suggest, including the betadine prep and a dab of zinc oxide on the new recovering skin. I also purchased some powders and lubes and will take the whole shooting match with me when I get back out on the trail.

“I’m also trying Injinji liners to see if that helps, although my feet aren’t particularly sweaty. I believe that the deep blisters in my toe pads were due to the heavy water weight I had to carry through the desert, which was different than how I trained since I underestimated how much water I’d need in such a harsh environment. I did wear trail gaiters, but my shoes were Altra Lone Peak 2.5’s and they allowed dirt to come in. There was a lot of abrasive mica in the desert soils and it’s hard to keep feet clean with little water available. I used wet wipes but it was still hard to get the grit out. My pack’s base weight is very low at 14 pounds, so I’m doing everything I can to keep the pack as light as possible and have lots of experience with backpacking. Nothing else hurts – no hip, knee or ankle pain – just these silly feet.

“I did not make any changes to my shoe or sock choices before starting. I used the same combination I’ve used for years without problems. Things I did not do which I probably should have: take more breaks, start out slower and not push huge days, wipe my feet off several times a day with wet wipes, change socks more frequently, stop more for hot spots, listen to my body, and take preventative measures to not get blisters.”

I initially asked the thru-hiker my usual questions. Did you change footwear, socks, conditioning, etc? Were you wearing good socks? Was the weather a factor? Do you wear gaiters? Do your shoes/boots have a mesh upper that allows grit and dirt inside? It sounds like your feet rebelled at what you wanted them to do. We traded emails several time with her providing answers and my giving suggestions.

The lessons I mentioned at the start of the post? Here are a few that pertain to thru-hikers, hikers in general, runners, ultrarunners, and adventure racers.

  • Know your event. Carrying extra water, food, and other supplies in a weighted fannypack, hydration pack or backpack can put extra stresses on your feet.
  • Know any possible weather issues. Heat, rain, and humidity can all cause problems.
  • Know any possible trail/road issues: water, stream crossings, desert sand, grit, and rocks.
  • Know about any special accommodations necessary for like swelling feet, and grit or sand getting into your shoes’ mesh uppers.
  • Know what to do when you have problems with your feet and have the supplies to fix them. Practice ahead of time to refine your skills.
  • Know how to get your blistered feet back into hiking/running condition.

Providing Foot Care for Athletes

April 22, 2016 by · Leave a Comment
Filed under: blister care, Foot Care, Health, Sports 

Providing foot care for athletes at ultramarathons and multi-day events is a huge responsibility. Their feet are what keep them going, and if you are known for providing foot care, the athletes will be appreciative of whatever you can do. If you are simply helping one runner, you might be a bit more casual. But if you will be part of a foot-care team, you need to be prepared.

In 2015 race directors of several multi-day ultramarathons in Europe were overwhelmed by shear volume of runners seeking medical attention for blisters. They said it took upwards of 30 minutes per foot to treat most of the runners, which caused a significant drain on the ability of the medical team to look after more serious problems. Beginning in 2016, these races are introducing a triage system for medical care. Patients will be assessed prior to treatment with the most needy being treated first, regardless of how long others have been waiting. If the assessment indicates “minor” blisters, advice will be given and runners will be expected to treat their own feet. All runners must have their own blister treatment kit as part of their mandatory gear kit. They candidly state that foot care is easily divided into several phases, what they call the 6Ps: “Proper Preparation Prevents Piss-Poor Performance” and provide a thorough list of preparation, prevention, assessment, and treatment suggestions. “Proper Prevention” means in the months before the event, “Prevents” means during the race, and “Piss-Poor Performance” is what happens if you fail to follow the first three Ps.

Rebecca Rushton, an Australian podiatrist and owner of blisterprevention.com.au, and I agree that foot care at multiday events is vital. I consider a 100-mile ultramarathon a multi-day event. The problem is that many runners have become dependent and expectant that events will have medical personnel providing even the most basic foot care. Participants have come to treat foot care services at events as a perk of the event. While it’s nice to have, it’s not practical and sustainable long term. Race directors need volunteers with the time and expertise in foot care techniques, and the budget for supplies and equipment. The larger and longer the event, the more volunteers are needed and the more costly it becomes.

I wrote in a blog post that, “… at some events participants will move along the trail from aid station to aid station, and at each one, require some degree of foot care. What was patched at an earlier aid station didn’t work or didn’t hold up and they want someone at the next aid station to redo their feet. That’s a lot of work and supplies.” Many athletes also fail to take care of their feet and fail to plan, and in many cases fail to take common sense action (reduce calluses, trim toenails, do self-care, etc) that could have prevented or reduced the problem. Rebecca and I support what we call assisted self-management. In the aid station, provide a table and a few chairs, and basic foot care supplies. Medical personnel will be available to give advice and tend to more serious treatment. It could even be that runners are shown how to patch the first blister and then they manage the rest. It’s a workable model and builds on today’s popular DIY (do-it-yourself) method of learning new skills.

Credit: Oxfam TrailWalker Melbourne and Rebecca Rushton

An example of self-assisted foot care. Credit to Oxfam TrailWalker Melbourne and Rebecca Rushton

This leads to a new mindset among many medical professionals that manage medical direction at races and multiday events that is worth considering. An article in the April 2014 Sports Medicine summarized it well. “Although participants in ultra-endurance events should be educated and prepared to prevent and treat their own blisters and chafing, blister care will likely be the most frequent use of medical resources during ultra-endurance foot races.” The mindset is that participants need to shoulder some of the responsibility for managing their feet. Medical staff at aid stations can quickly become overwhelmed even to the point of running out of supplies. We can help promote and support this new mindset in several ways:

  • Give participants tips to prepare their feet in advance of the event. (Refer to “Foot Care in Multiday Events” in chapter 16.)
  • Give participants tips on the best footwear selections for the event (types of shoes, gaiters, oversocks, camp shoes, and so on).
  • Give participants a list of foot-care gear they must carry. A section on mandatory foot-care gear can be found at the end of this chapter. Even runners in a 100-mile race can carry a small Zip-lok bag pinned to their bib number or in their hydration pack.
  • Advise participants whether or not foot care services will be provided and if so, to what degree. This includes no foot care and supplies, limited self-management, or full service.
  • Provide a self-service table of supplies for runners to use in DIY patching of their feet. This can speed up their in and out times at aid stations.
  • Stress the importance of knowing how to work on one’s feet (by reading this book or through other sources, or workshops).
  • Stress the importance of runner’s having crews knowledgeable in foot-care work and prepared with a well-stocked foot-care kit.

How you implement the principles of self-management or whether you decide to provide full service foot care services depends on several factors: The number of participants, the difficulty, the remoteness, the number of medical volunteers, the availability of supplies (and being able to absorb the cost) and the number of aid stations and how far apart they are. It should be a well-thought out and joint decision between the race director and the event’s medical director.

Please comment how you feel about foot care services at the races you run or help with, or as a race director. We’d love to hear your thoughts.

Science of Ultra Interview

A while back I was interviewed about foot care by Shawn Bearden of Science of Ultra website and podcast. Here’s the link to the Science of Ultra website.

Shawn asked great questions and got deeper into foot care than any other interview I have done. We talked about the essential components of good foot care, from shoe fitting to blister care. Then we wrap it up by defining the essential features of a good minimalist foot care kit for your next run or adventure. The whole episode is about an hour and 22 minutes.

I encourage you to listen to the interview on the Science of Ultra website and then check out his website and other interviews. Podcasts can be subscribed to in iTunes and Stitcher Radio. By subscribing, you’ll received shows on your device (smart phone or tablet) as they are released.

Science of Ultra

Science of Ultra

 

Professional Foot Care Help

February 26, 2016 by · Leave a Comment
Filed under: Foot Care, Footcare, Health 

Never ignore an injury. Pushing through an injury or returning to your sport too soon after being injured can lead to additional injuries. You do not want to turn a temporary injury into a permanent disability. Too often athletes rely on self-diagnosis rather than consulting with a medical specialist. If during or after running or hiking you have persistent foot problems or recurring pain that you cannot resolve, seek medical treatment from a medical specialist who can provide his or her medical expertise for your problem.

Primary Medical Specialists for Feet

Orthopedists are orthopedic surgeons, experts of the joints, muscles, and bones. This includes upper and lower extremities and the spine. Look for an orthopedist that specializes in the foot and ankle. The American Academy of Orthopaedic Surgeons and the American Orthopaedic Foot and Ankle Society can provide referrals. There are also Orthopedic Clinical Specialists (OCS).

Podiatrists are doctors of podiatric medicine (DPM) that work on the feet up to and including the ankles. They specialize in human movement, and medical and surgical problems including foot diseases, deformities, and injuries, such as nail, skin, bone, tendon, and diabetic disorders. Podiatrists treat such disorders with surgery, custom-made orthotics (shoe inserts), physical therapy, injections, casting and braces, prescription medication, and medicated creams and ointments. The American Podiatric Medical Association and the American Academy of Podiatric Sports Medicine can provide referrals.

If you have chronic foot problems, or you are uncertain what your feet are trying to tell you through their pain, consider consulting a podiatrist or orthopedic surgeon. Listen to your whole body and especially your feet. Be attentive to when the pain begins and what makes it hurt more or less. Then be prepared to tell the specialist about the problem, its history, what you have done to correct it, and whether it worked or got worse.

There is a wide range of skill overlap between orthopedists and podiatrists. Each can treat most of the same foot problems. When searching for a medical specialist for your feet, talk to doctors about their training, experience, and whether they have a specialty field. Each of the two specialist fields has doctors who specialize in sports medicine, and these would be my first choice. Weigh this information when making a decision about who to turn to for help. Additionally, a variety of other specialists can provide assistance in strengthening, alignment, rehabilitation, and footwear design and fit.

Foot Specialists

Pedorthists work with the design, manufacture, fit, and modification of shoes, boots, and other footwear. Pedorthists are board certified (C.Ped) to provide prescription footwear and related devices. They will evaluate, fit, and modify all types of footwear. A C. Ped. can help find a shoe built on a last (the form over which a shoe is constructed) that best matches a person’s feet, and then construct a custom orthotic that meets his or her particular biomechanical needs and interfaces with the shoe in a way that improves its fit and performance. The American Orthotics and Prosthetics Association and the Pedorthic Footwear Association can provide information and referrals.

Sports Medicine Doctors specialize in sports-related injuries. They are typically doctors of internal medicine with additional training in sports medicine. When treating athletes with lower-extremity injuries that do not improve with their initial treatment, they may refer the athlete to a podiatrist or orthopedist. Most are members of the American College of Sports Medicine (which does not provide referral services).

Physical therapists (PT) are licensed to help with restoring function after illness and injury. Most work closely with medical specialists. Physical therapists use a variety of rehabilitation methods to restore function and relieve pain: massage, cold and heat therapy, ultrasound and electrical stimulation, and stretching and strengthening exercises.There are also Masters of Physical Therapy (MPT) and Doctor of Physical Therapy (DPT). The American Physical Therapy Association can provide referrals.

Athletic trainers are licensed to work specifically on sports-related injuries. Rehabilitation methods may be similar to physical therapy but can additionally focus on maintaining cardiovascular fitness while injuries heal. The National Athletic Trainers’ Association can provide referrals.

Massage therapists work with athletes in reducing pain and tightness in muscles, tendons, and ligaments—the body’s soft tissues. The American Massage Therapy Association can provide referrals. Look for either Licensed Massage Therapists (LMT) or Board Certified in Therapeutic Massage and Bodywork (BCTMB).

Chiropractors are doctors of chiropractic (DC) medicine who specialize in the alignment of the body’s musculoskeletal system. Pelvis, back, and neck pain and muscle imbalances are often treated by a chiropractor. Some may specialize in sports injuries. There are also Certified Chiropractic Sports Physicians CCSP). Two organizations, the American Chiropractors Association and the International Chiropractic Association, can provide referrals.

When the time comes to seek medical attention, ask others in your sport for referrals, ask at your local running or outdoors store, look in the Yellow Pages, or search online. If you have a choice, choose a sports medicine specialist over a general doctor.

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