Podcast Episode #14: Foot and Ankle Health, More Nutrition Questions

Welcome to the BenGreenfieldFitness.com podcast. This is your weekly free audio exposure to cutting edge fitness, diet and wellness news. Hey, whether you're an Ironman triathlete or you're just trying to shed a few pounds, this podcast is going to present you with the latest exercise and nutrition content from the nation's top experts. My name is Ben Greenfield. I'm a personal trainer, certified nutritionist, and exercise, diet and wellness guru. Each week I'm going to be bringing you cutting edge fitness, nutrition and wellness advice. Stay tuned for this Week's podcast from BenGreenfieldFitness.com.

Hey podcast listeners, we've got a jam packed Q and A on carbohydrate depletion with some questions on last week's interview on chiropractic as well as inspection into nighttime eating patterns and some of the things that you can do to maximize the health of your nighttime eating. We're also going to have an interview about foot and ankle health, how that affects the rest of the body, common injuries, when to change your shoes. All that and more from Dr. Darren Wooley. But before we get to that content, just real quick, a couple of special announcements on Wednesday, September 24th in Spokane, Washington at Champion Sports Medicine and I'll put all the information for this on the website. I will be teaching a nutrition clinic and this nutrition clinic is going to focus on optimizing your nutrition for holistic wellness. It's going to cover supplementation, meal timing, carbohydrate, fat, protein percentages, etc. The program is slightly geared towards athletes who are in their off season, but anyone would benefit from attending this seminar and you can simply show up. There will be a lot of free handouts, free nutritional samples, free supplement handouts, things of that nature. So make sure to add that to your calendar Wednesday, September 24th at 6:30pm in Spokane, Washington. And also I wanted to draw your attention to just a little bit of publicity for BenGreenfieldFitness.com we recently featured on a local television news station and KXLY reporter came in for a lot of testing here in my lab and you can actually read more about that by visiting BenGreenfieldFitness.com clicking on the show notes for this podcast and I put a link there to the blog. It's some interesting information that you may want to look at. Very informational. So let's go ahead and move on to this week's jam packed listener Q and A from BenGreenfieldFitness.com listener Q&A Remember, if you have a question that you want featured on the BenGreenfieldFitness.com podcast, just leave a comment on one of the blog postings or you can also email me ben greenfieldfitness.com now today's first question comes from listener Steve who asks, I heard that eating a meal too close to the start of a long distance race or training session can deplete your glycogen stores faster than not eating prior to or at least three to four hours prior, he says. Is this true and if so, what causes it? Well, basically, if you're eating too close to your workout session, there's basically kind of a three step effect that occurs on your body. First of all, when you consume your pre workout meal, your blood sugar levels are going to elevate. And we've talked about this on this podcast before. One of the natural products of blood sugar level elevation is a release of insulin by your pancreas. And rapidly elevated blood sugar actually causes enough of an insulin release to where the blood sugar actually drops too quickly. And that leads to a condition called hypoglycemia, which is basically a very, very low level of glucose in the blood. And that's something that can actually happen to you if you're consuming your pre workout meal either A, just a little bit too close to your workout or B consuming it comprised primarily of the high glycemic index, very sugary carbohydrates. The only way that you can avoid that is to literally eat that high glycemic index meal just like five or ten minutes before you start your workout. And by doing that, you actually don't give the insulin enough time to send your blood sugar levels plummeting. And what you want to do is just make sure that you eat a good meal three hours beforehand and then have that high carbohydrate meal literally five to 10 minutes before and make it fairly small. We're talking about the equivalent of a gel, half a piece of fruit, half a bottle of sport drink, something of that nature. So leading on to Steve's question about glycogen depletion, basically another effect of high insulin levels is that they inhibit the amount of fat that you can use during aerobic exercise. Basically, one of the effects of the hormone insulin is it inhibits what's called lipid mobilization, which means your body's ability to take lipids or fat and mobilize them for energy. So essentially by elevating your insulin levels too close to your workout, what you do is inhibit your ability to Burn fat as a fuel. And so your body will turn more to the other fuel that it could use, which would be carbohydrate. And so, yes, when that occurs, you would be looking at a faster rate of carbohydrate depletion and less time that you would be able to work out at a high intensity. If that occurs, if those high insulin levels are allowed to circulate in the bloodstream too close to the workout. And then the last thing that would happen if you have high, high insulin levels is it actually brings blood sugar into muscle cells. And insulin is supposed to do that. But anytime you start to increase the amount of blood sugar that goes into the muscle cells, you increase the amount of blood sugar that the cells are burning or you increase basically what would be called carbohydrate methods, metabolism. So you essentially increase your metabolism temporarily and that increases the rate at which your carbohydrate or which your glycogen is depleted. So you've got quite a few different effects of increasing the body's insulin levels prior to your workout. And so what you want to do is make sure that all of this stuff happens far enough from your workout, from your race, from your training session to where it's not going to have a deleterious effect on your training session. Typically, three to four hours is about how long it's going to take for those insulin levels to stabilize. And for a lot of people, including myself, you're going to be hungry again if you eat your pre race meal, wait three to four hours, or eat your pre training meal, wait three to four hours and then work out. Now, from a practical perspective, I actually eat just a little bit closer, about two to three hours beforehand. Is that ideal? No. But I don't like to be super hungry when I toe the starting line or when I start a workout. And in addition to that, I actually take in just a bit, little, little bit of a fast release carbohydrate like the sport gel, the sport, drink something of that nature immediately, five to ten minutes prior to the workout. So I hope that answers your question. Steve, great question. Now we have another question on nutrition, but before I get to that, I want to turn to another question. And basically another listener asks, I know several athletes that utilize a chiropractor for treatment, but at what point should you question your mechanics, technique or recovery as being the issue, such as running technique, not stretching enough nutrition, dehydration, etc. And so essentially what this question is asking is, do you see a chiropractor to basically fix a problem over and over again, or do you address the underlying issue behind the problem? And I actually talk about this quite a bit in my book, Run with no Pain, and you can see that@www.runwithnopain.com. but usually, yeah, there is an underlying issue that will cause you to see a chiropractor unless you have, for instance, an anatomic abnormality or biomechanical imbalance that you were born with, such as one leg being significantly shorter than the other, or a large degree of curvature in the spine, such as scoliosis. However, if you're somewhat symmetrical and you're having to see a chiropractor over and over again, yeah, there is going to be an underlying issue that needs to be addressed. Case in point, let's look at, for instance, someone who's riding a bike a lot and going in to see a chiropractor frequently for back pain after they finish their long bike rides. A lot of times when I have someone into my biomechanics laboratory and I'm doing a bike fit, I'll notice that there are ways that that seat is set up or there are ways that the handlebars are set up that inhibits that person's ability to protect their back. For example, handlebars too low. A lot of people like their handlebars low because it looks like they're riding very aerodynamically. However, when the handlebars are too low, that closes up your hips. It decreases basically your hip flexion angle the bike, and it essentially causes your low back extensor muscles to be lengthened for long periods of time. And that can cause them to go into spasm. It can cause them to develop little micro tears as you rotate your hips side to side while you're cycling. Another issue, seat height too high. People like their seats to be real high, just like they like their handlebars to be real low. And when the seat is high, the hips have to rock from side to side. And when those hips rock from side to side, there can be a lot of pressure that develops over time in the sacroiliac joint. And so you get people, handlebars too low, seat height too high, they're going for a bike ride, they're seeing a chiropractor who fixes the problem, and then they exacerbate that problem the next week. So what you need to do is fix the problem. For example, in my book, I talk about kind of a similar issue with running. And basically the book talks about how some muscles can become short, some muscles can become long and you can develop imbalances. And while you may need the assistance of a chiropractor to address the pain and to bring the body back into balance, you need to lay down essentially like a concrete foundation to keep those adjustments in place. And usually some type of a strengthening protocol, some type of a stretching protocol, or some type of a modification of the equipment that you're using is necessary in order for that to occur. So I don't condone just going to a chiropractor over and over again blindly to fix a problem that may have underlying issues. So another great question, and the last question today is from listener Marisa who says I look forward to all the important information you give. But I do have a question. What is okay to eat before bed? Sometimes I get hungry and right before bed and I don't feel like a protein shake because I want some food. What are good foods to eat before bed that won't cause fat formation? And I know that last week I talked a lot little bit about this and essentially we talked about slow release proteins that are released over an eight to nine hour period. A specific protein called casein is especially useful for that. But yeah, it is true that sometimes a protein shake right before bed may not be your cup of tea. And so what I'd like to give you is a few of my I'd like to give you three of my top pre bed meals and each of these are based off of the concept that right before you go to bed you want to make sure that you're controlling the amount of insulin that is released. Because remember we just talked about this a little bit earlier. Insulin will inhibit the ability of your body to mobilize fat or lipids for energy. And one of the common things that will cause high insulin levels is a high degree of carbohydrate and specific specifically a high degree of the high glycemic index carbohydrate. So here is one of my top pre dinner meals or pre bed meals. Number one, you take yogurt, just regular plain fat free yogurt. Yogurt is very, very low on the glycemic index, meaning that it does not cause a significant release of blood sugar. So it's not going to cause a high, high amount of insulin release. So you take that yogurt and you actually do want to put some kind of flavoring in it. Now a vanilla or chocolate whey protein works real well. I know you don't like a protein shake before bed, but trust me, this will taste nothing like a protein shake. It's going to be a lot, a lot better than that. But you take a little bit of the vanilla or the chocolate whey protein, the equivalent of about one scoop, which is going to be anywhere from 80 to 100 calories depending on the scoop. And the amount of yogurt that you use is anywhere from 50 to 100 calories, usually about 3 to 4 tablespoons or so of yogurt. Just putting all this into a cup. So you got your yogurt, you've got your vanilla or your chocolate whey protein, and then you want to take a little bit of almond butter or peanut butter. I'm a bigger fan of almonds because peanuts, of all the types of nuts or legumes that are out there tend to be the highest in toxins, the highest in pesticides. Almonds are a lot better for you. They've got a higher degree of the good type of monounsaturated fat that your body will burn for energy. But you take the equivalent of about 50 calories of almond butter or peanut butter, that's 1 teaspoon or so, and you put that in on top of the yogurt and the whey protein, you stir that up and you put it in the freezer for about 10 to 15 minutes so it gets chilled. And even though it is considered a higher glycemic index carbohydrate, I'll usually, just to add a little bit of a crunch effect, I'll sprinkle like a quarter of a graham cracker or a tablespoon of grape nuts on top of there to give it a little bit of a crunch. And that's not going to be too much carbohydrates, not going to cause a lot of damage. We're talking about maybe 30 to 40 calories. And it's a great kind of icy frozen, chocolatey or vanilla meal. And I think it tastes great. If you're not into the sweet, you can also go for the savory. And this is something that I'll do quite a bit if I haven't had much for dinner and it's close to bedtime, you can just take some low sodium deli meat. And I recommend that you do go for the low sodium when you shop for your meat in the deli aisle because you can get high, high degrees in sodium in a lot of that meat. But you want to get turkey, which is high in tryptophan, which will help with your sleep levels. And you actually just have about two to three slices of a low sodium turkey. And you can combine that with just a little bit of cheese. So you're getting a little bit of saturated fat, a little bit of protein, a little bit of dairy, and none of those are going to significantly increase your insulin level. So again, turkey with a little bit of cheese would be another great way to get your pre bed snack in. You really don't want to do much more than about 200 calories. That should be enough to satiate the appetite. And then the last thing, of course everybody knows about the glass of warm milk and how it can be high again in tryptophan, that amino acid that helps us to fall asleep. But I've got some problems with milk. I actually rarely consume milk. Most of my dairy consumption comes from just a little bit of yogurt in the morning typically or in the evening. But milk can be high in antibiotics, it can be high in hormones and a lot of the other synthetic compounds that find their way into our dairy industry. However, something that a lot of people don't know about, but that's finding its way more and more into the commercial grocery store is almond milk. And almond milk is a great thing that you can take in. And believe it or not, almonds also have tryptophan in them. As a matter of fact, if you go to the website bite log.com, which is a great way to track the nutrient content of common foods in certain amounts. And you look at for instance, animal ounce of almonds, you've got about 0.05 for your level of tryptophan in an ounce of almonds. Well in, and that's about 0.05 grams. In about an ounce of milk you think about half of that, about 0.025 grams of tryptophan. And so not only are you getting tryptophan when you drink almond milk versus say regular milk, but you're also getting a lot more of the healthy benefit of the almonds, which are typically going to be a little bit better for you than the regular dairy milk. And you can actually warm that and it will enhance the release of tryptophan. You can mic a glass of almond milk or a cup of almond milk for about 60 seconds or so. And another great pre workout meal. So we've got turkey and cheese, glass of almond milk or the special recipe with yogurt, protein, nuts, butter and a little bit of grape nuts or graham cracker on top. So hope that answers your question, Marissa. Remember, if you have a question, you can post it on the blog or email. Ben greenfieldfitness.com and I will put a link to all the websites that I mentioned in the show notes@BenGreenfieldFitness.com.

Today's interview.

Is with Dr. Darren Wooley, podiatrist from Spokane, Washington. Stay tuned for some really cool information.

Hey podcast listeners, this is Ben Greenfield coming to you once again from BenGreenfieldFitness.com and today I'm excited because I have someone from a health profession that you may not think has much to do with your overall health, but actually probably has quite a bit more to do with it than you think. I've got Darren Wooley on the phone right now and Darren is a podiatrist specializing treatment of foot and ankle disorders. And he's got some really cool stuff to share with us today. So basically I wanted to thank you for joining us, Darren. First of all, no problem. And second of all, just tell us a little bit about yourself and how you got involved in this profession.

Certainly when I was in college, I was looking at, I always knew I wanted to go into the medical field and was looking around at different specialties. And in doing so, I came across a couple of students who were planning on going to podiatry school. And I started talking to them a little bit more about what they did and just with what they told me about how patient can walk into your office, limp into your office really, and walk out relatively pain free with just a few simple things, it really piqued my interest. I was a runner at the time, training for marathons. A couple of these guys had been to a podiatrist and had really been benefited by it. And I thought, well, there's something that I could get into. And since then, just the knowledge that I've gained and the ability to be able to help people. Not everyone walks in and walks out without any pain, but on the whole we can really do some good for athletes and their overall fitness.

Awesome. So when I'm thinking about feet and ankles, basically I kind of think about that interview that we had. It was podcast episode number eight. And you can go back and listen to any of the podcast episodes@BenGreenfieldFitness.com, but we interviewed a yoga professional, Johnny Gillespie. And when I was taking one of Johnny's classes down in la, we all had to take off our shoes and stare at our feet for what seemed like an inordinate amount of time and just look at our toes and how they were interacting with the ground and feel our feet and what parts of our feet were interacting with the ground. And Johnny kind of explained to us and talked a little bit about in the podcast how the body basically acts as this.

This chain.

And a lot of that chain originates in the foot contact with the ground. And I'd like to hear a podiatrist perspective on that. I mean, how would you say, Darren, like, the foot and the ankle actually affect what's going on everywhere else in the body?

It's a great approach to think of it as a chain. And when we're learning in podiatry schools, we're learning about biomechanics. We talk about open and closed kinetic chain motion. If you're running or doing anything on the ground, walking around, upright posture, it all starts. The only thing touching the ground is your feet and your ability to adapt to changes in terrain or be able to propel yourself. It all starts with how your foot contacts the ground. And if your heels are too inverted or everted, meaning they're too slanted, one way or another, that can set up the way the rest of your foot is positioned on the ground, then that then is transferred. That malposition can be transferred right up the leg into the knee. So if your foot's moving too much in any one direction, that can put a torque or a force on the knee that the knee is not really able to handle, and that can start causing knee pain. If you're torquing the leg too much one direction, that can affect the way that the hip is moving, and that can start irritating the hip. And if the hips shifted or changing positions, and that can start. That can irritate the way the spine is positioned. So it really all starts with the way the foot strikes the ground and its ability to accommodate to changes in the terrain and then be able to propel yourself forward. You get too much one direction or another with that position of the foot, and that can cause problems all the way up. So it's definitely the basis of a good starting point. It's a good stance on the ground.

Exactly. I'm sure that you've. You've probably come into this in your profession. But, for instance, I've gotten over the counter orthotics before, and whereas they fix problems or pains that I was having in my feet during exercise, what I found was, eventually I developed problems in my lower back, and all it was was exactly what you say. It basically inverted my foot just a little bit and increased the amount of external rotation in my knee. It moved straight up the hips and ended up basically causing me to have a rotation problem in my low back. And what I really want the audience to be aware of is that these.

Tiny little things that are going on.

In our feet and our ankle, it's crazy how it can affect the hips and the low back.

I've had that experience myself. One of my biomechanical professors in school said, if you want to know what 2 degrees can do to someone, put a little piece of felt underneath the outside of my heel so that my calcaneus, my heel bone, hit the ground just 2 degrees more everted than normal. I went running for a mile and by the end of the mile I had such significant pain going up the side of my leg and into my thigh that I couldn't stand it anymore. And it took me a day or two to get used to it. So if we put the wrong correction in a device or you get an over the counter device that isn't right for you, it could really cause an issue.

Yeah. You know, when we're talking about specificity of injuries, a lot of the listeners on this show, they engage in running and cycling, and sometimes that's just on a recreational basis in the gym for weight loss. And some of the listeners are a little bit more competitive, like triathletes. But if we talk about cycling for a second, when you get a cyclist in who's having foot or ankle problems or what's the most common injury that you see in the cyclist?

In the cyclist, the number one injury would be neuromas in the forefoot. Basically what that is, Ben, is the nerves that run from the leg down into the bottom of the foot end up going out to the toes to provide sensation in the tips of the toes. And as those nerves course down, they run between the long bones of the foot called the metatarsals. As they cross over the the metatarsals can go out into the toes. They can often get squished in between those metatarsals. We call them heads of the metatarsal, these flares at the end that make up the knuckle bone, the knuckle joint. What happens often in cyclists is you've got constant pressure on the ball of your foot, right where those nerves are. And if a cycling shoe doesn't allow for enough spreading of the metatarsals with pressure. So if the shoe is really, really tight, that compression of knuckles together on the nerve with that constant pressure on the ball of the foot can cause a nerve to become really inflamed. And so you get a feeling like you've Got a wad of sock underneath the ball of the foot or you're stepping on a pebble. Somehow a pebble made its way into your cycling shoe. Generally, that pain causes numbness, burning or tingling into the toes. Often taking off the shoe and letting the foot expand a little bit and massaging the area relieves the pain. So the number one thing that I've seen in cyclists is that neuroma. Other things that can happen are ingrown toenails from ill fitting shoes that just compress the nail into the meat or the flush of the toe and causes ingrown toenails. Those are some pretty common injuries with cyclists.

Now you talked about Morton's neuroma and just relieving the pressure on the foot. Is there anything else that you do to address that injury in cyclists?

Yeah, try to look at the shoe itself and see if we can get a wider shoe to help it spread out. And also we can place Padma in the shoe or use an orthotic that will help redistribute some of the weight off of the knuckles and off of the nerve right there and help get a little more relief. There's also some other medical treatments. Using some injection therapy can also be beneficial. And some physical therapy modalities are also beneficial in treating neuromus.

Yeah, and I'm aware, actually, I think it's Dr. Andy Pruitt out of the Boulder College of Sports Medicine. He helped specialize develop their body geometry orthotic. And I know that that particular orthotic actually has what's called a metatarsal button in it that helps spread apart those nerves in the feet. So, you know, I think that those are really only like 30 or $40, you know, kind of a, kind of a fix for probably a lot of the neuromas that you see out there.

Yeah, it's definitely a great first step is to feel like you got that burning or numbness. You can get a pair of those and see how it feels.

So shifting focus, how about for running? And you know, what I'd like to hear is because there's different types of runners out there, there's the people that are running marathons and there's the people that are running up and down the court for basketball. But in your typical kind of recreational athlete, weekend warrior type of person, what are you seeing in terms of running related injuries?

I break it down really into two categories. The first category is like an acute injury. You got sprains and breaks, things that happen. I twisted my ankle and I came down off the rebound and fell on someone, or I was out running on a trail and I tripped over a rock. So aside from those acute injuries, the other injuries really fall into the category of these generally overuse injuries. If you think of the bones, the ligaments, the muscles, tendons, everything working together, and you think of that as a chain of things working together, doing too much, too soon, too fast, too high an intensity will cause the weakest link in that chain to break. And so someone will come in if they have too much pronation in their hind foot, their foot flattens out too much and they're not wearing a shoe that helps address that, they start getting strained along the plantar ligament along the bottom of the foot called the plantar fascia. They get plantar fasciitis or heel spur syndrome. Oftentimes I've seen high mileage trainers or people doing a lot of high mileage training will get stress fractures in the metatarsals, those long bones in the front of the foot, just behind the toes. So you get a stress fracture. This achy pain doesn't seem to go away worse when you run. It doesn't get better with rest. Then there's common injuries too, where everybody's done it, who's trained for marathons. You start losing toenails, you just get so much pressure and stress on the front toes, toenails pop off. Those are some common injuries. Stress fractures, ligament problems, tendinitis. Those are some pretty common injuries with those long distance trainers, people who are out there running.

Yeah, I'm an ironman triathlete and my.

Wife will attest to the fact that.

I have some of the ugliest feet you've ever seen. I mean, half the toenails are missing and there's scars all over the place.

And calluses and blisters.

But basically a lot of these running injuries. I think that from what I find among the athletes that I coach and people that I work with, some people just think time off is going to completely heal the injury. But I'd like to hear from you about ways that people can can speed up healing of some of these common running related injuries.

Certainly if you're getting a running related injury because of, say, poor training technique, then getting in with a coach or trainer who can help find where you're breaking down in your training, where you're doing too much, you're not addressing particular issues that can be helpful. The second eye is to kind of help you step back and evaluate. Maybe the intensity is just not the right thing for you. If there's a problem with the biomechanics involved, then getting into someone who's got training, training and identifying abnormal motion or position of joints can help. And then use in running, use an orthotic in the shoe that can help address that. If you take time offgo ahead, then I'm sorry.

Well, I was going to ask about physical therapy modalities. From something as simple as ice to ultrasound to electrostimulation. Do you do a lot of those for the foot or are those more things you would use for the knees and the hips?

You know, I've seen them used mostly for the knee and the hip. But that's not to say that it can't be done in the foot. Generally, by the time someone gets to my office and they're in bad shape, a lot of times there needs to be a little bit of rest involved or at least modification in the training. But yes, ultrasound can certainly be used in the foot. I'm a big proponent of using ice. And generally the rule of thumb, I like to tell people, is anytime you have a meal during the day and you have a nagging injury, just ice it during your meal. It doesn't have to interrupt your whole lifestyle, but just slap some ice on it. I think deep tissue massage, different massage techniques can be very helpful. Then if you've got an injury that's caused by, say, abnormal motion and you get the right type of orthotic in there, you can actually train through that injury because you're not going to be stressing the joint the same way you can get that foot repositioned so that stress is not there on those ligaments or the tendons can function easier. You can actually get yourself out of that injury even as you're training through it? In certain cases, yeah.

It's a pretty common sight in our household for there to be a pool of water underneath the kitchen table at breakfast, lunch and dinner. Because I'm always icing something. That's funny you should say that. So when people are taking care of their own injuries, you know, last week I interviewed a chiropractor and he was talking about how one of the most common mistakes that people make when treating their back pain is that they put heat on it. Are there common mistakes that you find that people make when treating their foot pain?

I guess the classic doctor answer is it depends. I think sometimes when I would say this, when there is a. Let's take Achilles tendonitis, for example. Anytime that you've got pain in your Achilles tendon, it's difficult to Ignore because you feel it every step. Some people want to be able to transfer it. Oh, if I just run, it'll get better. As soon as you start seeing swelling or changes in thickness of that tendon, it's time to go see someone about it. You don't want to try to train what that swelling, what that change. Sometimes the tendon can swell up. So it has like, call it a fusiform shape or has a football shape swelling to it. Once you get those changes, then there's real damage being done to the tendon itself. It's no longer the outside, the tendon sheath, or the covering that's involved. Once that starts to happen, then you're at really high. You increase your risk of having a tendon rupture. I think what some people do, we get Augut 8 contained, try to treat it on our own. But I think when you start seeing physical changes in what's going on, trying to train through that or treat it on your own, that's taking it a little too far. I think at that point, you need to go see a physician.

So, in other words, when your foot or your ankle is giving you trouble and what you want to pay attention to is the transition from something that's like a nagging ache or pain to something that you look at your foot and look at your ankle and you can actually see that there's some sort.

Of change occurring in the anatomy.

Yeah, exactly. And that's not to say that when you first have that nagging ache or pain, you shouldn't go in to see the doc, try to treat it on your own. Yeah, I wouldn't let it go long, especially when there's changes there.

Right. You've mentioned orthotics a couple of times on the show. And I personally use a custom orthotic that was casted to my foot. I use a custom orthotic for running, and then I also use a special casting of my foot and a custom orthotic for cycling. And they're two different orthotics. The cycling orthotic is more for the forefoot because you really don't use your.

Heel that much when you ride, whereas.

The running orthotic goes a little bit farther back on the foot. But what are the primary differences between, for instance, an over a counter or an over the counter and a custom? When would someone want to make that leap from just getting, say, a super feet pair of orthotics and go into, like, a custom?

A lot of that. When to go to a custom from an over the Counter. It depends on what types of symptoms, what we're trying to treat with the orthotic. I'm a big believer in having a diagnosis and a problem that I'm trying to fix with my orthotic. And so I have a pathology specific diagnosis and treatment plan in mind. And I think in switching it's always nice, it's cost effective, especially for people who are always already spending a lot of money on gear and equipment. Start with something over the counter. Some of the differences, an over the counter orthopedic, if you're a manufacturer, you need to make a device that's going to fit most people and so you can't make the arch too high because those with a low arch are actually going to find that it's quite irritating to their arch. And you can't correct, you're not really looking to correct one specific pathology. You can build some things into that over the counter device that are going to help most people, but not all. And so if someone has tried an over the counter device and they just don't feel like they're getting support and the problem that they were getting the device for isn't going away, or they have a really, really tall arch and again they don't feel any support, then it's time to think about getting a custom device and that can be made specifically to fit their foot and to correct the specific problem that they've got.

Yeah, you know, I put in a lot of volume on my shoes and a lot of times the athletes that I coach or the people that I coach that are just in there running shoes or their training shoes day after day after day, sometimes I'll tell them that it might be worth their money to throw down 300 or $400 on a casting and an orthotic. Whereas if people are running, you take like my wife for instance, she runs a couple times a week for maybe two or three miles and she uses an orthotic, but she has one like the over the counter oven molded orthotics and that actually fixed knee pain that she was having. So I think it seems that volume is a little bit of a consideration and that actually leads into something I did want to ask you.

How often should people change out their shoes?

It's an excellent question. It depends on the runner. If you have a 300 pound, 6 foot 5 inch tall guy who's trying to run 8 miles a day, his shoes are going to get pounded flat a lot sooner than someone who say 115 pounds and running the same amount of distance. My goal is this. There's no one rule of thumb. Some people say, well every 500 miles, but it depends. If I weigh 500 pounds and run 500 miles, it's going to wear out sooner. I have my patients do this if they're really serious about going.

If you're £500 and you run 500 miles, you have some serious respect from me.

What I tell people is this. Generally people who are running do a long run maybe once a week. So I tell people, go out and buy. If you find a pair of shoes you like, buy two pair. Wear one pair free on the weekend when you do your long run, or whenever you do your long run, wear the other pair during the week. As soon as that shoe during the week doesn't feel as comfortable as that shoe you wear for your long run, move your long run shoe to your weekday shoe and buy a new pair of shoes to willer for your long run. Because I think most people don't realize how pounded flat the midsole of the shoe, the shock absorbed portion of the shoe, how flat that's getting and how much resiliency it's losing until it's too late all of a sudden. Oh yeah, they're not feeling as good that way. It keeps them fresh. You're going to go through them a little bit sooner, but you're going to keep yourself from a lot of overuse injuries by changing your shoes more frequently.

Yeah, and one of the things I do is I have three different pairs of shoes.

I have kind of a high stability.

Shoe, then I have kind of a lighter mid stability shoe that I'll even use for like racing a marathon. And then I have a racing flat for really quick, you know, sprint or Olympic distance triathlon events, things like that. And most of the time I use that high stability shoe. And then for a few of my workouts I'll use that medium stability shoe so that my body gets used to running. And for instance, the shoe that I'm going to run the marathon in and then the racing flats, I use those.

Maybe one time in the week before.

The race just to make sure that.

My feet are used to running with that light, light amount of support.

So I guess it's probably dependent on.

How many different pairs of shoes you're.

Training with too, because I know some people use one shoe, some people use two, some people use three. I was going to ask you though, what's the best self help resource for someone who's experiencing foot or ankle pain? Is there any good books or any good websites out there that you're aware of?

There's a couple of websites that can be pretty beneficial. A good place to start with foot pain is the American Podiatric Medical Association's website apma.org and from there.

They'Ve got.

A lot of resources available. Also our medical foot center, we developed a website and it's got a 120 page library available with common foot problems and some common treatments that people can do at home. It's@medicalfootcenter.net medicalfoot center.net is that your personal.

Website or your medical foot center?

Yeah, you can also get there from drwully.net as well. D rwully w o o l l.

E y dot net so doctorwooley.net or medicalfootcenter.net that's right. Okay, perfect. So one final question, Darren. What's your shoe brand of choice for training?

I got hooked on Asics when I was early on in running and I've been happy with them. But there's no one brand for one person. There's no one brand that's going to fit everybody. I should say. It's a personal feel, it's a personal decision. I think all the good running shoe lines and good models that can be very good depending on if you're a heavy striker, you need extra cushioning or you got over pronation. But I just run Asics because I got hooked on them and I really like them. I run in a 21:30 I think I've got right now.

Yeah, yeah, the ASICS 2130 and 2140 series, those are both good shoes. I ran an Asics for probably two or three years, then last year switched up to Avia who's starting to put out some actually really good shoes. When I was talking about like a high stability mid stability racing flat shoe, they have a really, really cool series of shoes. So I'm an Avia man myself now. But Asics is also a cool brand.

Hey, we can still be friends, right?

Well, probably we probably just can't together because that might not look good if.

Our shoes don't match.

Hey, thanks for coming on the show today. I'm excited to get this news out and I'll put links to your websites in the show notes so that people can go check those out and maybe I'll even put a link to a via.

I don't know about Asics but I'll.

Put a link to a via in the show notes and yeah, just thank you so much Darren for coming on the show today and sharing that information with us. I really appreciate it.

My pleasure.

Okay, I'll talk to you later. Thanks for listening to today's podcast, episode number 14.

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