Posts for: February, 2014

Running Shoes: Hazardous to Your Joints?

By Kathleen Doheny
WebMD Health News

Jan. 7, 2010 -- Compared to running barefoot, running in conventional running shoes increases stress on the knee joints up to 38%, according to a new study.

"There is an increase in joint torque that may be detrimental," says D. Casey Kerrigan, MD, the lead author of the study, published in PM&R: The Journal of Injury, Function and Rehabilitation.

Joint torque is a measure of how much a force causes the joint to rotate.

But Kerrigan is not advocating that runners take up barefoot running -- just that her findings may be a reason to redesign running shoes. Kerrigan, formerly chairwoman and professor of physical medicine and rehabilitation at the University of Virginia, Charlottesville, now heads JKM Technologies and is designing a running shoe.

At least one podiatric specialist calls the study finding "much ado about nothing."

Running Shoes Study: Details

Kerrigan's team evaluated 68 runners -- 37 women, average age 31, and 31 men, average age 36 -- who ran at least 15 miles a week. None had any history of musculoskeletal injury.

Participants ran barefoot on a treadmill and then in a running shoe: the Brooks Adrenaline.

Kerrigan's team observed how each condition, barefoot and shod, affected the joints of the hip, knee, and ankle.

Compared to running barefoot, the researchers found running in running shoes increased stress on the lower extremities. They found a 54% increase in the hip internal rotation torque and a 36% to 38% increase in knee torque. Is that increase mild, moderate, worrisome? "We don't know," Kerrigan tells WebMD. "We just know it's an increase."

She attributes the increased stress to the characteristic design of the majority of running shoes, including an elevated heel and increased material in the midsole arch.

Providing this cushioning in the heel, she suspects, counteracts the body's natural response to compensate for the torque associated with impact.

The increases found in her current study are higher than when she compared barefoot walking to walking in high heels. The high-heel shoes increased knee joint torque by 20% to 26%, she says.

Running Shoes Study: Analysis

Some torque on the knee is normal, of course. "What we are saying is, there is an increase over what would be experienced just walking around," Kerrigan says.

Her concern is that the excess stress may contribute to knee osteoarthritis, although the study did not look at a link between running shoes and injury or running shoes and the development of arthritis.

She isn't suggesting barefoot running -- a trend that's picked up steam in the past year or so -- is necessarily better than running in athletic shoes, she says.

Running Shoes Study: Other Opinions

"It's much ado about nothing," says Bruce Williams, DPM, past president of the American Academy of Podiatric Sports Medicine and a spokesman for the American Podiatric Medical Association, of the study results.

"She showed there was an increase in joint forces, but that's it," says Williams, a podiatrist in Valparaiso, Ind., and a runner. There was no link shown between running shoes and running injuries, nor with development of arthritis -- both beyond the scope of the study.

The bulk of research studies have found that runners don't have a higher incidence of knee osteoarthritis than the general population, Williams tells WebMD.

In one study, for instance, German researchers evaluated 20 former elite marathon runners and compared them to the general population, looking for arthritis. They found that knee osteoarthritis was rare in the former marathoners, publishing the result in the journal Orthopade.

Ideally, Kerrigan's team should have looked at many different shoe types, says Joseph Hamill, PhD, professor of kinesiology and director of the Biomechanics Laboratory at the University of Massachusetts, Amherst, who has researched the biomechanics of running shoes. "For example, a racing flat has very little in the way of cushioning and is almost like running barefoot," Hamill says.

Running Shoes Study: Industry Input

In an email response, Tiffany Herman, a spokeswoman for Brooks Sports, which makes running shoes, says: "We value the results of this study and are in active research and development on many unique performance running footwear solutions at Brooks."

"This includes styles that enhance the natural motion of the foot and body while offering protection from weather conditions, road debris, and individual biomechanical variances."

Running Shoes: What to Buy?

So what's a runner to wear -- or not wear? "Nobody should take the message that being barefoot is better than wearing any type of shoe whatsoever," says Williams of the new study.

Kerrigan, too, says her research isn't a vote for the barefoot running trend -- nor for giving up running.

"If you are happy with your running shoes, you don't necessarily have to change them," Williams says. But if you have an injury, he suggests consulting a sports podiatrist and getting advice about the best shoe features for you.

"I would suggest runners try a number of different types of shoes until they find one that they like," Hamill says. "Also, buy two or three pairs of shoes and rotate them each day."

Your Running Shoes Don’t Matter


If you’ve read Born to Run or you’ve found that your injuries disappear when you put on Hokas, you’d be forgiven for thinking the science of running shoes was more settled.

In fact, no large-scale studies have uncovered a strong link between running shoe type and running injuries, and there’s no evidence that anything other than weight will affect your ability to run fast, as long as you remember that lighter is almost always better.

Still, there is lots of suggestive evidence that minimalist shoes might influence footstrike, and further evidence that certain kinds of footstrikes (landing on the forefoot, in particular) lead to softer landing patterns, and, perhaps, fewer injuries. But there are big caveats, and the evidence linking loading rates to injuries is mixed.

Testimonials from people running in, and loving, max-cushioned shoes such as the Hoka are hard to ignore, but so far they’re just testimonials. A five-month-long randomized, controlled study of 247 runners published this fall in the British Journal of Sports Medicine uncovered no difference in injury rates between runners who wore soft-soled shoes and those who wore firm-soled shoes. (The researchers did, however, find that body weight and training intensity affected injury rates.) Nor have researchers ever found a strong link between pronation and injury, so it's no surprise that stability shoes don't seem to help people who have been diagnosed as "over pronators." One 2009 paper concluded, famously, that prescribing cushioned, motion-controlled shoes to distance runners was “not evidence-based.”

Likewise for Vibrams and other minimalist shoes. There’s no reason to doubt testimonials of dedicated wearers (I’m one), but it’s important to remember what we know about cushioning: adding or subtracting it just doesn’t significantly affect impact forces or running economy.

How is that possible? Biomechanists have long known that runners automatically “tune” their legs, adjusting muscle tension and knee flexion to keep impact forces within a neurologically determined range. In simple terms, that means people who run in Hokas will land a little harder than they would in less cushioned shoes, and people who run in Vibrams will land a little softer.

Overall, form may matter a lot less than you think it does. In early 2011, I spoke with Dathan Ritzenhein for an article about running form. Ritzenhein, then a three-time Olympian and former American record holder at 5,000 meters, had started rebuilding his form under coach Alberto Salazar. (The experiment was even the subject of an interesting article in The New Yorker.)

Surprisingly, when we spoke, Ritzenhein said that his form was never a huge priority for him, at least not compared to all the other stuff he did with Salazar on a daily basis. "For a year, it was maybe in the top five," he said. "But we always ran 100, 120 miles a week. We lifted. We did intervals. We did long tempo runs. Those were the key things."  

So why do we care so much about shoes and form? In part, I think many runners assume that running shoes are like other kinds of gear, and that running technique is like other kinds of athletic technique. If you don’t have a bike, skis, or a surfboard, you can’t go biking, skiing, or surfing. Nor can you do any of those sports very well without the right movement patterns.

But you don’t need shoes to go running, and some of the best runners in history have had terrible form. Overwhelmingly, it seems, success in running is a function of fitness. If biomechanics play a role, it’s probably not a very big role.

That isn’t to say that you shouldn’t be enamored with your shoes or work on your technique. It’s more an argument for perspective: unless you’re dealing with a chronic injury that you’re sure isn’t the result of training errors, your time is better spent crafting the right balance between mileage and intensity, on eating and sleeping well, on strength training and mental toughness. There’s simply not much evidence that you need to worry about shoes.

By: Peter Vigneron

February 24, 2014
Category: Uncategorized
Tags: Untagged

Diabetic gangreneConsider the following facts:

  • About one in three diabetic individuals will surely develop a foot ulcer during their lifetime, which if left untreated may develop into diabetic foot gangrene.
  • About 85 percent of all limb amputations in diabetic individuals are followed by foot ulcers.
  • Every 30 seconds, a lower limb amputation is carried out due to diabetes throughout the world.
  • The mortality rate due to diabetic foot gangrene is just next to cancer death rate.

How do diabetics develop foot infections?

Diabetes predisposes an individual to several changes in the body and causes known problems such as heart disease, stroke, blindness, kidney problems and nerve dysfunction. Nerve dysfunction is one of the reasons of foot ulcers in diabetic individuals. It is often painless and may cause numbness in the feet which signals danger because the sensation of pain is essential to protect the body from injuries. Numb feet are more exposed to damage while walking barefoot or stepping on sharp objects that can cause injury. Exertion of additional pressure on the inflamed area while walking leads to the development of callus (hard and thickened areas) which develops into a deep blister. Inflamed blisters gradually break into a wound.

A foot ulcer or a wound is nothing but a rupture in the skin that exposes the underneath tissue. Since diabetic individuals are more prone to infection due to suppressed immune system, the developed wound serves as a site of entry for bacteria which multiply rapidly and enter into deeper tissues.

Diabetes also hampers normal blood circulation of the body which weakens its wound-healing ability. With poor circulation, infected wounds grow deeper exposing the underlying muscle, tendon or bone. The deeper the wound gets, the more difficult it is to heal. Read more about Diabetic foot

What is diabetic gangrene?

Gangrene is a condition characterized by obstructed blood supply that causes death of the tissue. It can occur in any part of the body but typically starts in the extremities like feet, fingers and hands. Diabetics are more prone to gangrene because they are exposed to several other problems as well.

Diabetes by itself or in combination with hypertension (high BP) and high cholesterol can cause significant damage to the arteries. Large arteries are narrowed by partial or complete obstruction. This reduces blood pressure and normal flow of blood to the extremities. Smaller arteries along with capillaries get thickened and can totally prevent oxygen supply to the affected areas. If blood flow is decreased below a threshold level, gangrene can occur.

Gangrene can be either dry or wet. Wet gangrene is caused by infection and necessitates emergency care and treatment. Diabetic individuals are more prone to dry gangrene, involving restricted blood supply, and the initiation site is often the toes of the feet.

What are the symptoms of diabetic gangrene?

Lack of awareness and negligence is the major contributing factor for worsening cases of diabetic foot in developing countries like India. Diabetic foot is one of the most costly complications of diabetes and is the main cause of hospitalization for people with diabetes. Without appropriate treatment at the right time, tissue death may spread progressively and may require amputation of the limb. Therefore, initial signs and symptoms of gangrene should not be ignored.

Symptoms of diabetic gangrene:

  • Pain in the affected area
  • The affected area turns cold
  • Change in colour of the affected area from pale or red to brown or black
  • Development of blisters on the foot
  • Loss of sensation or numbness in the affected region
  • Sometimes, the affected region may be extremely painful as gangrene advances
  • Discharge of foul odor from the blisters

Treatment of diabetic gangrene:

Gangrene can be treated only if the signs and symptoms are recognized at an early stage, before it progresses to complete death of tissue.

  • Vascular surgery:

Dry gangrene is often treated by restoring the blood flow to the affected area. The surgery involves repairing obstructed blood flow by placing a tiny balloon in the blood vessel to open it up. A tiny metal tube, called as a stent, may also be placed into the artery to keep it open.

  •  Bypass surgery:

In this surgery the blood flow is redirected to a healthy artery by connecting or grafting one of the body’s healthy veins to it. This allows blood flow to bypass the blockage and reach the affected area. Read about 

  • Nutritional Revascularization:

It involves use of natural and essential nutritional supplements in specified amounts to correct deficiencies and nutritional imbalances known to cause circulatory problems. Gangrene Clear-G Formula, developed in Canada, is one of the effective methods used to treat dry foot gangrene all over the world; however, very less is known about its use in India. It contains 120 nutrients and phytonutrients (plant nutrients) that keep the blood flow in check.

  • Debridement:

Since tissue death cannot be reversed, surgical removal of the affected tissue (debridement) or amputation of the limb is the only treatment option left when gangrene has advanced. So debridement is paramount and needs to be done weekly by your chiropodist.

  • Amputation:

Worldwide more than 70 percent of limb amputation takes place due to diabetes. Amputation is the last resort for treating gangrene when it has progressed beyond repair.

Post Gangrene Treatment:

There are a lot of things that should be taken care of after the treatment of gangrene:

  • The affected area should be kept clean and dry
  • Antibiotic treatment should be continues as prescribed
  • Physical activity should be reduced
  • If an amputation is performed, recovery may take a while
  • off-loading of the wound with specialty foot gear or orthotics

Advances in treatment of diabetic gangrene that can avoid limb amputation

  • Hyperbaric oxygen therapy (HBOT):

In January 2013, a diabetic patient was successfully treated with hyperbaric oxygen therapy (HBOT), a therapy that involves healing of diabetic wounds with supply of oxygen to dead tissues, in India. Although the doctor had to amputate the patient’s gangrenous toe at first, further spread was prevented by fast wound healing using oxygen breathing at high atmospheric pressure. Studies have shown that HBO treatment can drastically reduce the risk of leg amputations in diabetic patients suffering from wounds.

  • Diabetic Foot Care:

It is estimated that amputation rates can be reduced to 45-85 percent with the adoption of proper diabetic foot care. Foot problems in diabetics are complex and they do not have simple solutions. Therefore, diabetes education and understanding the nature of foot complications is essential for diabetics. Diabetic individuals should be aware of self management of diabetes to further reduce the risk of complications. They should also visit their chiropodist regularly for treatment and monitoring.

Self care tips for diabetic foot:

  • Inspect your feet daily to check for cuts, sores, wounds or change in colour
  • Keep the feet clean and trim your toe nails regularly
  • Wear loosely fitting socks and comfortable shoes to avoid risk of blisters
  • Follow a healthy lifestyle and keep your sugar levels under control
  • With the discovery of any concerns, call your chiropodist for a follow-up

Tips for avoiding injuries when running during winter

By Lauren La Rose | January 9, 2014.

Even as the temperatures nosedive, there has been no dip in productivity for Al Garlinski, who continues to log between around 80 and 97 kilometres a week as part of his running routine – with some adjustments.

“You have to be more aware of your surroundings,” said Garlinski, a member of the Manitoba Runners’ Association.

“In the summertime, you’re just sort of in the lockdown mode and you just focus on running ahead. With the winter, you’re so cautious about your footing, you’re taking shorter strides, you’re wearing ice grips on your runners, which a lot of runners will do for safety’s sake.”

The Winnipeg running enthusiast said he prefers to use ice grips on his shoes for “peace of mind,” but still demonstrates extra care. If Garlinski approaches an icy patch while out running, he’ll simply stop and walk around it. And when temperatures drop to around -25 C, he’ll run indoors, usually joining friends for laps around different tracks in the city.

Still, Garlinski’s first choice is take his strides outside – even when it’s chilly.

“It’s still an exhilarating experience. You’ve got the fresh air in your lungs, even though it’s cold, but you feel better after the run,” said the 50-year-old.

“In a controlled environment, when you’ve got the room temperature and you’re running on the track with that boredom, it’s still not the same.”

Running on ice-slickened sidewalks, paths and trails has the potential to cause injury unless key modifications are made.

“When the snow falls or when it gets icy out, the natural thing for a runner to do is to increase their stride width – so they run with their feet a little further apart – and they decrease their stride length. They take more steps per kilometre, they take shorter, choppier steps,” said Reed Ferber, director of the Running Injury Clinic at the University of Calgary.

In order to reduce their injury risk, Ferber said they tell runners that they need to run in that manner to retain stability in slippery conditions.

“They need to reduce their mileage, reduce their intensity and get stronger and more flexible because of that biomechanical pattern.”

Research has shown that hip strength – specifically in the gluteus medius, the muscle on the side of the hip – is critical in terms of maintaining balance, Ferber said.

“All of the other muscles in your legs – your quads, your hamstrings, your glutes, your calf muscles – they are responsible for energy absorption when your foot lands on the ground, and they’re responsible for energy generation to propel you forward.

“The only muscle that controls your side-to-side balance is your gluteus medius. If you’re running in slippery conditions, you’re in an unstable situation. Strength of that muscle is critical in order to improve your balance.”

He recommended doing strengthening exercises daily and anytime after a run to avoid causing fatigue beforehand. The Running Injury Clinic’s websitefeatures videos of some common muscle strengthening exercises aimed at preventing and treating running injuries, several of which require use of a resistance band.

“Stretching is also important because when you decrease your stride length, you’re taking shorter, choppier steps, you’re going to be using your hip flexors – the muscles in the front of your hip – and you’re going to be using your hamstrings and your glutes – the muscles in the back of your hip and your leg – a lot more,” Ferber said.

What about people who don’t modify their approach and continue to run as quickly as they normally would?

“The risk is that you’re going to slip,” Ferber said. “If you take a big long stride, you’re going to land on your heel most likely. Ninety-five per cent of runners strike the ground with their heel first, and by doing that, your foot is going to slip out from underneath you.”

Bruce Raymer laced up in ultra-chilly conditions while living in Saskatchewan and remembered what he described as one of his most “savage” runs in Regina.

“It was -40 with the wind chill, and it was so cold that your eyelashes would start sticking together,” recalled Raymer, a Canadian marathon champion and former member of the national team.

As a run coach and personal trainer serving the Greater Toronto Area and Ontario’s Durham Region, Raymer said he usually tells clients to get shoes with an “aggressive” tread; but for the most part on really bad days, most will run indoors on a track or treadmill – himself included.

“If it comes down to footing or temperature, they’ll take footing any day because they just want to get out there and get the run in,” he said.

If weather is consistently bad, some clients like to cross-train to give running a break, Raymer said.

“They’ll just view it as a chance to do something else, maybe hit the weight room and do some strength stuff and do some core, do some stuff that maybe they don’t pay as close attention to when they’re running all the time.”

In addition to stretching and muscle strengthening, building core strength is also key, Ferber noted.

“We see a lot of people that undertake yoga, Pilates, they do a lot of core (work), but they still neglect the hip and pelvis musculature. All of it is one functional unit.”

As for ice traction devices, Ferber said the decision to use them is entirely individual.

“We completely leave it up to the runner. And there’s zero evidence to support or refute they’re injury-protective or injury-causative properties,” he said.

“For the simple fact that it’s going to grip the ice and it’s going to give you better traction, that’s great. But if it changes your biomechanics, if it changes the fundamental way that you run enough that it causes a different type of injury, maybe that means that that person shouldn’t run in those devices.”

Ferber said they always ask runners to be reasonable and listen to their bodies, which includes staying in if they simply find conditions too chilly.

“If your goal was to run 5Ks, for example, but your body is telling you that either it’s too cold out or you’re starting to get injured, there’s no reason why you can’t shorten that to a 2K or 3K run,” he said. “We want runners to listen to their bodies and they can make good decisions based on that.”

© The Canadian Press, 2014

Testing whether vitamin D delays onset of diabetes

By Maria Paul

Northwestern Medicine is looking for volunteers to take part in the first definitive, large-scale clinical trial to investigate if a vitamin D supplement helps to delay or prevent the onset of type 2 diabetes in adults who have prediabetes and are at high risk for type 2. Funded by the National Institutes of Health (NIH), the study is taking place at about 20 study sites across the United States.


The Vitamin D and Type 2 Diabetes (D2d) study will include about 2,500 people. Its goal is to learn if vitamin D—specifically D3 (cholecalciferol)—will delay the onset of type 2  in adults age 30 or older with prediabetes. People with prediabetes have  that are higher than normal but not high enough to be called diabetes.

D2d is the first study to directly examine whether a daily dose of 4,000 International Units (IUs) of vitamin D—greater than a typical adult intake of 600-800 IUs a day but within limits deemed appropriate for clinical research by the Institute of Medicine—helps keep people with prediabetes from getting type 2 diabetes. Based on observations from earlier studies, researchers speculate that vitamin D could delay the onset of diabetes in 25 percent of prediabetic subjects. The study will also examine if sex, age or race affect the potential of vitamin D to reduce .

"Millions of Americans are at risk for diabetes, a serious condition that can lead to heart disease, kidney disease and blindness," said Lisa Neff, M.D., assistant professor of medicine at Northwestern University Feinberg School of Medicine and an endocrinologist at Northwestern Memorial Hospital. "Evidence from preliminary studies suggests there may be a link between vitamin D and diabetes risk. The D2d trial will help us determine whether vitamin D can delay the onset of diabetes in people at risk for the disease."

Half of the study participants will receive vitamin D. The other half will receive a placebo. Participants will have check-ups for the study twice a year.

The study will be double-blinded, so neither participants nor the study's clinical staff will know who is receiving vitamin D and who is receiving the placebo. The study will continue until enough people have developed type 2 diabetes to be able to make a scientifically valid comparison between diabetes development in the two groups, likely about four years.

D2d builds on previous NIH-funded studies of methods to delay or prevent type 2 diabetes, including the Diabetes Prevention Program, which showed that, separately, lifestyle changes to lose a modest amount of weight and the drug metformin are both effective in slowing development of type 2 diabetes in people with prediabetes. However, additional safe and effective preventative strategies are needed to stem the increasing numbers of people developing .


Provided by Northwestern University

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