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Before stepping out to train, check out these tips.

By Rich Griset
Henrico Monthly
November 2014

With the Nov. 15 Anthem Richmond Marathon fast approaching, now is the time when the Richmond area sees an uptick in foot and ankle injuries.

To discuss the problems caused by running and hiking, we reached out to Tim Zimmer, MD, an orthopedic surgeon with Commonwealth Orthopedic Specialist Inc. in Stony Point. Dr. Zimmer came to the area after earning his medical degree at the University of Cincinnati and orthopedic surgery training at the Mayo Clinic. Dr. Zimmer exclusively treats injuries of the foot and ankle.

According to Dr. Zimmer, problems caused by training lead to many of the injuries he sees.

“Runners don’t train slowly enough,” Dr. Zimmer says. “They try to train too quickly and they end up with all sorts of bone and tendon problems and plantar fasciitis.”

Commonly known as jogger’s foot, plantar fasciitis causes pain in the bottom of the heel and/or arch.

“It’s probably the most common problem I treat,” he says. “The plantar fascia is a ligament that runs through the arch of the foot. It attaches up near the toes and the bottom of the heel and kind of bowstrings through the arch.”

The condition is caused by repetitive stress on the arch, and can be tempered by alternating running surfaces. Concrete and asphalt cause more stress on the body than more forgiving surfaces such as grass or a treadmill.

Dr. Zimmer says most patients can recover fully from the injury with stretching, anti-inflammatory medicines and ankle splinting. Sometimes, he immobilizes his patients’ ankle using a removable walking boot. Cortisone injections are also an option. On rare occasions, Dr. Zimmer will recommend surgery.

Stress fractures – another repetitive loading injury – are also common.

“If you take a paper clip and bend it too many times, it gets hot,” he says. “If you keep bending it, it breaks, and that’s what a stress fracture is.”

Dr. Zimmer sees many stress fractures in the fall as people train for the Anthem Richmond Marathon, as well as in February and March as people train for the Ukrop’s Monument Avenue 10K. Dr. Zimmer advises those whose stress fractures are caught early enough to switch to biking or swimming so they can continue to train and still be ready to run the races. Once the bone is broken, the only course of treatment is to have the patient stop training and put him or her in a boot.

For people who wish to run in the marathon for the first time, Dr. Zimmer advises beginning training about a year in advance. Running distance should be increased a maximum of 10 percent a week.

“There are a lot of groups in town that coach people who want to run in those events,” Dr. Zimmer says. “I think that’s far more effective than someone who has a running co-worker or friend.”

Muscle pulls are caused by either not stretching or stretching incorrectly. Overtraining can also cause pulls.

“These runners who have a deadline realize they have to get their mileage up to be able to participate and that’s where they run into problems,” he says. “To run 26 miles, they build up their mileage over months and normally combine short runs with periodic long runs.”

Achilles tendonitis is another common problem for runner and hikers.

“Most people think it will just go away if they rest it,” he says. “It’s usually an overuse problem. Most often I’ll see it after someone starts a new sport. They aren’t stretched out, they’re too tight.”

Dr. Zimmer also sees patella tendonitis, or runner’s knee.

“That can be a very hard problem to get rid of because it’s used all the time,” he says. “That’s part of the quadriceps muscle. They use that muscle every time they’re getting out of a chair. All you can do with that is stretch it and rest it.”

Shin splints also afflict runners.

“People that try to train too fast can cause a lot of inflammation where the muscles attach to the backside of the tibia,” he says. “Stretching helps some, anti-inflammatories, rest, backing off mileage and speed – but sometimes they just have to quit until it resolves.”

Regarding ice or heat, Dr. Zimmer says that ice will reduce inflammation but heat is good for back spasms and pain. Ice tends to tighten muscles while heat tends to loosen them.

To avoid foot and ankle problems, Dr. Zimmer recommends getting fitted for running shoes at a specialty store, adding that runners often don’t change their footwear frequently enough.

“I get the question a lot: ‘What’s the best shoe to wear?’” Dr. Zimmer says. “The answer is the shoe that best fits your foot. Every foot is different and you just have to try on enough shoes until you get a good fit.”

Dr. Zimmer recommends wearing socks with wicking action in the summer months. Like with shoes, he says, it’s important to get rid of worn-out socks.

With proper stretching, good footwear and gradually ramping up training, many injuries can be avoided when running and hiking.

Dr. Tim Zimmer is a graduate of the University of Cincinnati College of Medicine and received five years of intensive training in orthopedic surgery at the Mayo Clinic in Rochester, Minn. He founded Commonwealth Orthopedic Specialist in 1999. He is board certified and recertified by the American Board of Orthopaedic Surgeons.