Monday, August 22, 2011

Bay Area Excursions: Podiatry Edition

When I worked in Redwood City, taking care of business on the Peninsula was relatively simple. Most things were either on the way to or from work, or, on occasion, not too terribly farther south that the R-Dubs. These days, though, Peninsula business requires a special trip, so I try to save up those errands when I can and take care of them all in one fell sweep.

pep boysTake maintenance on my car, for example. I have a very special six-year relationship with the Pep Boys in San Carlos, and don’t think for a moment that just because I moved 30 miles away that I’m about to go through the torturous process of finding a new auto mechanic in the city. (It does help that my car only requires service every 10,000 miles, and that since moving to SF, I only drive it about 20 miles a week.)

Now, that doesn’t mean I’m going out of my way to make a special trip. Nope; just add it to the pile of Peninsula business to be taken care of the next time it’s convenient.

Somewhat unfortunately, I haven’t had to be on the Peninsula for anything specifically scheduled in a while. About three weeks ago, though, you may recall that I made an appointment with a sports medicine podiatrist in Palo Alto, so this morning I packed all my errands into my service-needing car and left the cold, nasty drizzle of SF for some Peninsula sunshine.

sf to pa

I traveled to the Palo Alto Medical Foundation to see Dr. Amol Saxena. Like my beloved Pep Boys, Dr. Saxena is a good 30 miles away from me. Surely there are perfectly adequate sports podiatrists in San Francisco, you may ask? Well--yes. But after spending countless hours with doctors and physical therapists, one of the biggest things I've learned is that finding the right person to treat you (particularly for a running issue) is everything, and doctors are certainly NOT all created equal. You've got to do your research. So I did mine.

Here are a few of the reasons why I waited three weeks and drove 30 miles to see Dr. Saxena:

    pr bunion
  • He is a runner / duathlete with 13 marathons, several Bostons, and multiple World Duathlon Championships under his belt.
  • He went into podiatry because of his experiences being treated for running injuries in high school and college.
  • He is affiliated professionally with the San Francisco Marathon, Stanford University, Palo Alto Run Club, USA Track & Field, Runner's World, and the Nike Oregon Project.
  • He has / had numerous elite & Olympic runners as patients, including Alan Webb, Paula Radcliffe, Shalane Flanagan, and Alberto Salazar. (I figure if he's good enough for them, he's good enough for me, right? Heh.)

(By the way, those are Paula Radcliffe's bunions, up there. That's what Dr. Saxena fixed for her.)

So yeah. 3 weeks and 30 miles seemed like a small price to pay.

After getting vaguely lost in the small city-state that is Palo Alto Medical Foundation (I always leave ridiculously early for doctor appointments for the same reason I leave ridiculously early for races; it is a sad fact of my existence that if it’s possible to get lost, I will get lost), I finally made it to Dr. Saxena’s exam room, which is hung with race bibs and autographed photos and copies of running magazines picturing athletes he's treated.

When I made the appointment, the receptionist requested that I bring my running shoes and inserts; having recently changed shoes and suspecting that my old shoes might have had something to do with my shin splint flare-up a couple of months ago, I brought my old Kayanos in addition to my new Brooks (also my Mizuno flats, but those didn’t come up much).

A few fun facts about Dr. Saxena:

  • Dr. Saxena can identify the make and model of a running shoe with a sidelong glance.
  • Dr. Saxena can identify your foot / running shoe type by watching you march in place for approximately three seconds and then stand on your tiptoes for approximately two seconds. No fancy pressure pads or treadmill videos for him!
  • Dr. Saxena knows the approximate dates and course profiles of every major road race in the area (and probably a bunch that aren't).
  • Dr. Saxena makes no bones about his opinions of different running shoes.

I’d been telling him about how my shin splints come and go, and how they’d gotten particularly bad in the weeks prior to my changing shoes. I told him about how my Kayanos had sort of felt worn out, even though they’d only had about 380 miles on them.

This kind of made Dr. Saxena laugh a little. As a general rule, he’d told me, Asics last about 250 miles. “They’re comfortable,” he admitted, “but it’s all marketing.” (Dr. Saxena intimated later that he personally could not run more than about 3 miles in a pair of Asics.) The Brooks, on the other hand, he told me, should last 350-400 miles. I find this kind of hilarious, given that the Kayanos generally cost ~40% more than the Brooks Adrenalines.

Dr. Saxena did not have strong feelings about my orthotics except to say that the reason I’ve been feeling as if I have stone bruises on the balls of my feet could be that they are slightly too long in the heel, causing the orthotic to ride slightly forward in my shoe relative to the part of my foot that it’s been molded to. That means that the very front part of the arch is essentially pressing up on the ball of my foot (where there is apparently a cluster of rather temperamental nerves). Dr. Saxena advised taking the orthotics back to Roadrunner Sports and asking them to trim up the heels a little.

Like everyone else who’s ever looked at my feet and legs, Dr. Saxena seemed pretty positive that my shin splints were caused by moderate pronation and the tiny muscles in my lower legs not being strong enough to pull them back into alignment completely with each stride. For this, he recommended strengthening exercises with a Theraband. For the pain, he recommended regular icing (which is my usual approach anyway). We did talk briefly about ibuprofen, and it seems that Dr. Saxena agrees with my best buddy K-Starr on that point: Ibuprofen is known to interfere with the healing and strengthening process, and the relative benefits (barring a significant injury like a sprained joint) are minimal.

For the next three weeks, I am to continue running normally & increasing my mileage, do my daily Theraband exercises (sidenote: I wonder what percentage of my life I’ve spent doing Theraband exercises?), and ice for pain. On Sept. 12, I am to see Dr. Saxena again for a follow-up. He seemed to think that my particular case is a fairly mild one, if chronic, and that the Theraband work should take care of things. On the off chance that it doesn’t, he described to me a few more options that are sometimes necessary in more severe cases:

  • Fully custom orthotics (~$400; The Footbalance ones that Roadrunner Sports will do in-house for you are more semi-custom, according to Dr. S., but if they work, they work.)
  • Aircast ankle braces
  • Shockwave therapy (to break down scar tissue in the tib med area)


After my visit with Dr. Saxena, I went to Pep Boys and had my car serviced, then popped over to Roadrunner Sports (just a few blocks over) to explain about my inserts. To my great pleasure, they did better than just trim it up; they replaced the too-long-in-the-heel inserts with a brand spankin' new set in a smaller size. Thanks, guys! After that, a few more errands on the Peninsula, then back home (where, thankfully, it was no longer drizzly and nasty).

So we'll see how the Theraband exercises go. They are yet new and different from any other shin splints exercises anyone has ever prescribed for me, so I'm willing to try them for a few weeks (hey, it's Dr. Saxena, after all!). I'll keep you updated on how it goes. In the mean time, if you're local and find yourself in the market for a podiatrist who gets runners, you might consider heading over to PAMF.

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