Monday, April 16, 2018

The most common foot injuries after a marathon! Congrats to the Boston Marathon Runners now your feet need some TLC:)

To the brave people who have fun pushing themselves to the physical limits in a race such as The Boston Marathon we salute you!  Here at the Center for Ankle and Foot Care in sunny Florida we see our fair share of marathon runners, as Clermont is home to many professional runners and tri-athletes.  Once the race is over and the rush, thrills and endorphins wear off you may be stuck with a couple of little foot problems, if you're unlucky maybe some big foot problems.  Even with the best training and prevention efforts, sometimes stuff happens.  We are going to go over the most common foot problems we see in the runners after putting on so many miles in just one day, and of course all the training that leads up to that day, that can play a true toll on the feet!

Nail Problems
I started here because honestly this is one of the most common complaints we get from patients after they have trained for and ran a marathon.  All those repetitive miles in the shoes over the last several months training for the Boston Marathon has left you in great shape with a jacked up toenail!  The question I get all the time is "will my toenail ever look normal again?" I tell people "Maybe" , this is not a very popular answer I have discovered over the last 17 years in practice. The truth is runners usually have ugly toenails, that repetitive micro trauma plays a toll on these tiny fragile structures.  I have seen patients who have run multiple marathons over the years and during or after training for a marathon their toenails fall off.  Sometimes these nails grow back flat and smooth, but sometimes they grow back thick and lifted and much like this picture above the lifted part of the nail sets them up for a little fungus under the nail.  That is a treatable problem sometimes with a topical medicine or oral medication.

 The other type of toenail that comes into the office after a marathon is a blue toenail with blood under the nail.  I describe it to patient as a blood filled blister under the nail.  If it doesn't hurt and there are no no signs of infection we can do what I refer to as "skillful neglect", which means we just keep an eye on it.  If it continues to not hurt we just wait and watch it over the next several months until the nail is completely grown out.  You basically have to be patient and slowly see the little dry blood spot continue to advance to the end of your toe.  It is not pretty but this is usually self resolving in most people, but again the important caveat here is that there should be no pain and no signs of infection.

But when the toenail itself is actually painful after a marathon, which happens quite a lot, we sometimes have to remove part of or the whole nail. This is sometimes a very necessary evil.  The nail can be ingrown secondary to the repetitive micro trauma in combination with how your foot strikes the ground in time and space.  Like the picture to the left here, this needs medical attention, so if you just finished the Boston marathon and have a toe that looks like this, do not let it stay like this and get in to see your podiatrist! This link here to our website goes into more detail of the importance of treating an ingrown toenail and what the procedure entails.  .

Heel Pain (Plantar fasciitis or Achilles' Tendonitis)
Even in the best conditioned, rolled out, stretched out runner these injuries can happen.  The degree of pain after the marathon and time of how long it hurts usually dictates when we see these athletes.  The reality is after a marathon, these runners expect everything to hurt.  After a week if you are limping still due to a painful heel, either on the bottom like plantar fasciitis or in the back of the heel like Achilles' tendonitis you should get it checked out. These two structures are super work horses during a marathon and play a huge roll in propulsing your every step in forward progression. 

If you want to learn more about plantar fasciitis follow this ling to our website here

If your pain is more in the back of the heel/ankle then click on this link to learn the difference between instertional and non-insertional Achilles' Tendonitis.

Stress Fracture of a metatarsal bone
 The best example of a stress fracture is to grab a branch from a  LIVE shrub or tree and bend it.  You will hear a snap, but the branch will stay together.  This is what happens to bones in the foot.  If too much stress is placed on the bone it will snap, but not fall apart.  That is why stress fractures are often not seen on X-rays.  The foot will start to hurt all the same.  If you keep bending the branch back and forth, eventually it will snap in two.  Likewise, if you keep "stressing" the foot (running, jumping, walking) the foot bone may also snap in two. 

Marathons are the ultimate stress fracture maker. 26.2 miles of stressing these tiny little bones in the feet! 

We see stress fractures in the office almost weekly. They are very common and more importantly easy to treat!  The difficulty is in getting better.  Healing is 90% up to what the patient does and 10% what the patient is.  What the patient does (taking it easy) after the injury is often more important than who the patient is (healthy).  Our runners are usually very healthy but they are crazy and sometimes our most difficult patient to treat because they want to keep running, even with the broken bone in their foot.  That's right I called you crazy if you are a marathon runner but you already know you're crazy so calm down!

Marathon runners do not want to hear the treatment. The treatment is SIMPLE.  Stop stressing your foot!  I typically give the patient a fracture boot and say, "If you wear this all the time, except for sleeping and bathing, you should be healed in 1-2 months.  BUT YOU HAVE TO TAKE IT EASY!  If you get the boot and pretend your foot is not broken and run around all day long it may take 2-6 months.  If you only wear the boot "sometimes" it may never heal or get worse. Like anything when you are a  runner, if you do not convalesce an injury correctly you will suffer forever! 

Congratulations to all the men and women who participated in the Boston Marathon, it is an incredible feat but if you are having feet pain get into see your podiatrist!

Special congratulations to Desiree Linden took the women's race Monday with a time of  2 hours, 39 minutes and 53 seconds. She is the first American to win the Boston Marathon in 33 years!!!!!

Friday, April 6, 2018

Tony Finau... Ankle Dislocation! He is now my second favorite golfer!!

When Tony Finau hit the Par 3 Hole in One Contest at the Masters this week his celebration caused for jubilation for his achievement, that quickly turned into horror by the spectators and Tony himself.  The video below from ESPN shows Tony Finau discussing his phenomenal day of golf at the Masters after possibly dislocating his ankle.

As Tony's excitement for nailing this shot in one try turns into the 100 meter dash, it quickly turns bad as he turns twisting and we see his foot go one direction and his ankle go the other. Yikes! I'm a foot doctor and even I find this difficult to watch,  But what comes next in this video might be even more shocking, Tony leans over to his left side, uses the ground to push his foot back in the correct direction and stabilizes his ankle with counter pressure to pop that ankle back in place like a robot or something. What? Insane right! Then he gets up and not with the speed he made his way down the fairway but walks back toward the tee box! I have watched football and basketball players dislocate their ankles but they don't get up like this. It was incredible! They literally could use this video in podiatry and orthopedic residencies on how to relocate an ankle.

At first when I heard the news of Tony Finau's ankle dislocation but then saw he played the next day and was leading, I immediately thought he couldn't have possibly dislocated his ankle.  But then I watched the video and it looks like it to me! He apparently had a MRI that shows no structural damage he said, but it looks like his soft tissue could not have been spared. There he was there at the Masters the very next day crushing it on the golf course.

I know in my practice if we are treating an ankle dislocation conservatively, especially if the patient is a super hero and has relocated it himself and there is no associated fracture, we wouldn't recommended golfing the next day, or the next day. Our goal would be control the swelling and having the patient ice and elevate as much as humanly possible for a week or more and an anti-inflammatory by mouth for a week or two.  They would be made non weight bearing but given a pneumatic cam-walking boot for touch down with crutches or a knee walker.  This type of injury can require repair of the soft tissues affected, but even with out surgery they are usually in a cam walking boot for 6 to 8 weeks.

So to see Tony out golfing the next day really made me rub my eyes in disbelief!  Could I have imagined his injury was worse than it really was? No I watched the video again, we all saw it.  So it does beg the question of what is the doctor doing? I'm hoping for Tony's sake he is just icing, wrapped really well by a good trainer and maybe on a steroid by mouth.(again this would not be my recommended treatment regimen)  This is in no way, shape or form ideal, but maybe when you make to the big show like the Masters Golf Tournament you do whatever it takes to compete.

As we have one little golfer in the family, I explained to her what happened(I didn't want to show my 12 year old the video) and I told her to not run while golfing. She replied "Mom, I golf so I don't have to run!".  Which is even funnier because our oldest daughter is a runner and youngest a soccer player! She is my favorite golfer but now I have a second favorite golfer in Tony Finau!!

My hopes and prayers are for a fantastic rest of the Masters for Tony Finau.  I have seen a lot of things in my 44 years here on this Earth, but watching him pop that ankle back in place and then play like that... he is amazing! I also wish him a speedy recovery because he's going to need a lot of rest, ice and elevation after this!

If you would like to learn more about ankle sprains, the less serious injury that can happen when your foot rolls under the ankle follow the link here to learn more:

Michele McGowan
3190 Citrus Tower Blvd Ste A
Clermont, FL 34711

Thursday, April 5, 2018

Welcome back Dr. Michele McGowan to the Center for Ankle and Foot Care!

If you are a patient of the Center for Ankle and Foot Care, then you are aware that Dr. McGowan has been away from the practice for the last 6 months. She has returned this April to start seeing patients. If you do not know Dr. Michele McGowan let us introduce you. 

Dr. Michele McGowan is originally from Willingboro, New Jersey right outside of Philadelphia.  She grew up in South Jersey where she played competitive soccer well into her early 20's.  Dr. McGowan became a Nittany Lion and attended The Pennsylvania State University from 1992 until 1996 where she graduated with a Bachelors of Science in Biology with a Vertebrate Physiology emphasis.  While attending Penn State, Dr. McGowan took the opportunity to shadow many different medical specialties.  "I originally wanted to be a pediatrician, but after two weeks of shadowing 2 different pediatricians, it wasn't for me" Dr. McGowan explained.  "In my sophomore year at Penn State I shadowed an orthopedist and a podiatrist, and I really fell in love with the podiatry specialty! There is something so gratifying to be able to help someone, sometimes on the same day they come in feel better walking out of the office. "

After completing her 4 years at Penn State University, Dr. Michele McGowan went on to Des Moines Medical University in Des Moines, Iowa. "I knew I picked the right specialty for me, when I could spend 6 hours in a library studying a day and enjoyed it" McGowan explained.  Dr. McGowan loved being at the library so much she got a job there where she would work 6 hour shifts, so she could study and get paid! 

While attending podiatry school Dr. McGowan met Dr. Timothy Henne a fellow student at the time and now her husband of almost 18 years.  The two made a great team from the beginning, from journal clubs to jazz clubs they had fun whatever the venue was. Both Dr. McGowan and Dr. Henne were accepted after their 4 years in podiatry school in Iowa, to the prestigious and highly sought after surgical residency program at the Western Pennsylvania Hospital in Pittsburgh, PA.  "I was very excited to have the opportunity to attend the same surgical program as Tim.  The city of Pittsburgh was one of my favorite places I ever lived!"

While Dr. Henne was finishing up another year of surgical training, Dr. McGowan moved to Florida and opened their first office for podiatry in Clermont, The Center for Ankle and Foot Care.  "I did everything that first year almost entirely by myself. I answered phones, made appointments, did my own billing,developed x-rays(we have digital x-ray now), I roomed patient and checked them out by myself for at least the first 7 months" Dr. McGowan explained. "It was fun, patients thought I was crazy but they came back because I helped them, and that's what patient really care about. Now we have this fancy office and gadgets, but patients still just come back because we help them!"

Dr. McGowan and Dr. Henne live here locally in Lake county and have 3 amazing children that keep them on the go constantly. "I used to think when they were babies it would be easier when they were older, but now between 3 children we have the following activities: soccer, basketball, tennis, track, cross country, golf, robotics, cello, guitar and piano! But I would not change it for the world" explains McGowan.  The children of Dr. Henne and Dr. McGowan are a big part of their office life. " Our children have been a part of this family business from the beginning. When they were babies they would eat, sleep and play in the office. Now that they are big kids they have their own room to hang out in, but that doesn't stop our youngest Emma, who is 6, from coming out into the waiting room and trying to sell patients pictures she drew on her days off from school!" 

If you are having foot pain call the Center for Ankle and Foot Care to make an appointment with one of our great doctors!  
Office number 352-242-2502
Office address:
3190 Citrus Tower Blvd Ste A
Clermont, FL 34711