April 2010 Newsletter

Blue Ridge Foot and Ankle Clinic has been an integral part of the Charlottesville and Waynesboro communities for over 20 years.  In addition to offering you the best possible care when you come into one of our practices, our goal is also to educate our patients and future patients on foot and ankle related issues.

Our monthly newsletter will include articles of interest to the wide variety of patients that we treat.  This months articles are 'Run With Style' and 'In Women's Shoes, Pain Does Not Equal Gain.' Please visit our Website, Blog or Facebook page for a wealth of additional information.

If you have foot and ankle concerns that you would like to address, please CONTACT US at anytime.  We thank you for making us your foot care provider of choice.

Dr. Kevin Murray, DPM
Dr. Stewart Chang, DPM

P.S.  If you have family and friends who would benefit from our newsletter, please forward it to them by using the link at the bottom of the page.
Charlottesville Marathon
The Charlottesville Marathon is on Saturday, April 17th! Runners will find tips on common running injuries and when to replace athletic shoes from Dr. Murray and Dr. Chang in their race packets.  Thank you to Charlottesville Running Company and Bad to the Bone for including us!

A preview of our new running flyer-

Running Card

Run with Style
It's that time of year again when many of you are trading time at the gym for time in the Spring sunshine! As you lace up your running shoes and head outside, keep in mind these tips for staying injury free! 

If you are experiencing foot and ankle pain, we offer custom orthotics that may help.  And, did you know that the average life of orthotics fitted by Dr. Murray or Dr. Chang is TEN years?  Enjoy your Run!

Running Style

by Stephen M. Pribut, D.P.M.
Director, Executive Board AAPSM 2002

Bill Bowerman, in his coaching days at the University of Oregon, would say "Run Tall". This sums up the style of many of the recent and current greats in long distance running. You should run standing up fairly straight, not leaning forward, twisted to one side, or tilting backwards. You should be looking ahead at where you are going, not staring at your feet or the ground. Of course on a trail run, you might be checking out the ground and what is coming up next, if you value your ankles.

Starting with the foot: Where should you contact

Some say to run on the ball of your foot, others say contact the ground with the heel. I take a middle of the road approach. Studies have shown that good long distance runners usually contact with the midfoot. Slower runners contact between the midfoot and the heel, faster runners a bit further forward. Only sprinters or short to middle distance runners should contact the ground with their forefoot or the ball of the foot. While there may be exceptions to the rule, this is a good way for most beginning and intermediate runners to start out. It allows for better shock absorption, less stress on the calf muscle and Achilles tendon, and better rolling forward onto the next stride. Your muscles will then be used in a manner that is similar to how you walk, and this is the pattern of muscle firing and contact pattern which the muscles are accustomed to.

Hips & Head

This part is hard to think about: Where are your hips when your foot hits the ground. Some people have suggested that your foot should be under the center of gravity of your body when it strikes the ground. A line from your head through your hips should end up at your foot. Keep the head fairly straight and look ahead. Turns to the side should be done carefully and usually mostly from the neck up to avoid twisting your body and making you unstable in your forward progression.

Arm Carriage

This is what you use when you haven't obtained a jogging baby stroller. Actually, it is where you allow your arms to swing. First, and most importantly, don't tense up and carry them stiffly with your hands balled up into a fist and your elbows completely bent. Relax. Carry your arms at your side somewhere between your waist and your chest. Make sure they are not too high or too low. One arm swings forward while the other one goes backwards. This occurs opposite to the foot and leg motion. Sprinters on the track move their arms in a straight forward-backward motion. Most longer distance runners use a slight arc as they swing their arms, but the better ones don't waste motion by moving too much from side-to-side. In other words, they don't swing their arms excessively in front of their body.


The knees do not have to come up very high for long distance runners. Only sprinters or those of us chugging up a hill have to left our legs high.

Stride Length

One of the biggest problems of form in long distance running is overstriding. Make sure that you don't do this, it can lead to a host of problems including Achilles tendonitis, ITB pain, and iliopsoas muscle pain.


While some like to tell you how to count your breathing in seconds both in and out, we will just tell you to keep breathing, deep and regular. In most cases your breathing will take care of itself, as you run faster, you'll breathe faster. And yes, most runners are mouth breathers or at least nose and mouth breathers. It would be impossible to take in adequate oxygen just breathing through your nose.

Uphills and Downhills

Slow up a bit on the uphills. In general it is a bad idea to try going faster. Move your arms a bit more to help you imagine that you are cranking your way or pulling yourself up hill. Shorten your stride and chug on up. You can think of the little train that could and repeat "I think I can" on the way up a big hill.

On the downhill, be careful. Go slow. The biggest risk, is to your knees. Your quadriceps do the bulk of the braking and be overworked without you being aware of it. If you are racing, then you may lean forward a bit and fly down the hill in a short race, but certainly be more careful in training. In fact many runners who use hills as part of their training will walk down the hill while recovering to run up the hill once more. This is a good way to rest and recover while avoiding the excessive knee stress that downhill running can cause.

In Women's Shoes, Pain Does Not Equal Gain
 Each season a new line of 'must have' shoes show up in stores and most of the time the latest fashion also means a very high heel.  Don't worry , we aren't saying that you can't EVER wear heels but there are precautions that you can take to avoid foot and ankle problems in the future.
High heeled shoes can cause pain, deformities and damage to the feet that can last a lifetime. But doctors say there are steps women can take to reduce high heel-related foot problems.
  1. Avoid shoes with pointed toes.
  2. Avoid heels taller than two inches.
  3. Recognize foot pain is a warning sign.

High heeled shoes crowd the toes, force the body's weight onto the ball of the foot and disrupt the body's alignment. They can lead to a laundry list of problems for women and their feet:


High heels do not cause bunions. Most women who develop bunions can blame their ancestors for passing down a faulty foot structure. But over time, wearing pointed-toe high heels can make bunions worse. Only surgery can correct this often painful deformity.


Hammertoe1High heeled shoes that crowd the toes together can contribute to hammertoes. This deformity occurs when the second, third, fourth or fifth toes become bent, like a claw. This can cause constant shoe friction, leading to painful corns. Severe hammertoes may require surgery to relieve pain.


Corns usually form from repeated pressure on the skin. Women with foot deformities, such as hammertoes, often suffer from corns because the tops of the bent toes rub against the tops or sides of shoes.

Haglund's deformity, or "pump bump"

HaglundPump-style shoes often cause significant pain by irritating a bony deformity some women have on the back of their heel, called a "pump bump." This problem is common in young women who wear high heels almost every day. In many cases it can lead to blisters, bursitis or Achilles tendonitis.


Pointed-toe and high heeled shoes are the most common reasons women develop painful neuromas. High heeled shoes can cause the toes to be forced into the toe box, which can compress and swell nerves in the foot, especially between the third and fourth toes. Neuroma symptoms appear gradually and include tingling, burning, numbness or pain. Without treatment, a neuroma can lead to permanent nerve damage, making it difficult to walk without severe, shooting pain.

Ankle sprains

High heels increase the risk for ankle sprains. Sprains occur when ligaments that connect bones together are stretched or torn. Left untreated, sprains can lead to chronic ankle instability and potential arthritis.

Back pain

High heels force women to stand and walk unnaturally, affecting the alignment of the ankles, knees, hips and lower back.

Foot and ankle surgeons say the majority of their patients are women. But not all foot problems related to wearing high heels require surgery. Luckily, many of these conditions can be treated non-surgically with changes in shoe wear, padding, orthotic (shoe inserts), pain medications and other measures.

Women's high heeled shoes aren't going out of style anytime soon. But by recognizing pain as a warning sign, wearing high heels in moderation and seeking medical care when problems are in their early stages, women can stay fabulous on their feet. 

Athlete's Corner
Blue Ridge Foot and Ankle Clinic specializes in sports related foot and ankle  injuries so each month we plan to share a favorite sports related website, article or upcoming event with our athletes through this newsletter.

Running Insight is a digital magazine that is published each month.
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Foot Facts 
Did You Know...
The skin on your feet is 20 times thicker than on any other part of your body.
The pressure on your feet when running can be as much as 4 times your body weight.

The average person takes 8,000-10,000 steps in a day