THE CLINIC

Avoid Running with a Foot Drop

I am a 46-year-old male, 5' 11" and 170 lbs. I have been running 23 years and run one or two marathons a year for a lifetime total of 26 marathon. The most recent was two months ago. In the last month, I have developed “right foot drop” after running only two miles. As I run, I develop fatigue and soreness in the lower front leg and the have difficulty with pulling the toes toward the front of the leg. I can walk normally minutes after I complete the run.

Since the marathon, I have soreness on the top of the foot around the first two toes and on the side of the ankle. This occurs when I first get out of bed, but it dissipates after walking a few minutes. Are there any conservative stretegies I can try at home prior to seeing a professional for the foot drop?

Bill Weimer
Torrington, CT

You may be developing a foot drop caused by an abnormality in your lower back. The region of your soreness is with the "L5" disk. I would seek out a physiatrist that deals with runners and a physical therapist or chiropractor as needed. Do not run with a foot drop, as you could fall and injure other things.

Amol Saxena, DPM
Palo Alto, CA

I would strongly recommend you not try to manage drop foot yourself. Drop foot can be caused by peroneal nerve injury and/or nerve root compression originating in the lumbar level of the back.  It is a condition that needs to be addressed by a physician before permanent nerve damage occurs.  Please see a physician at your earliest
convenience.

Paul Langer, DPM
Minneapolis, MN

Knee Pain from Nowhere

I'm 6' 2", 200 lbs. I had been running 10 to 15 miles a week when one day I felt a sharp pain under the lower front part of my knee. It’s now been eight months, and I still have a little pain in my knee when I walk. I can actually hear a kind of slipping and popping in the knee socket when my left heel touches the ground. If I walk a lot and then sit, the knee gets stiff and sore. What can I do to get through this and back to running?

Ed Kopchik
Hollywood, FL

Instability of the fibular head is possible, but is usually caused by significant trauma, for example, a car accident; and there are usually other ligament injuries as well. A simple exam by an orthopedic surgeon can determine whether the head is subluxing (slipping). One treatment for this consists of fusing the head of the fibula to the adjacent tibia. This is a relatively short and predictable operation and should allow you to return to running. That said, I don't quite have a good explanation for why this has occurred in the first place, so upon examination you may find yourself with an altogether different diagnosis.

Klaud Miller, MD
Evanston, IL

Cramping and Nausea During Ironman Events

I'm a 33-year-old female weighing about 118 pound. My recent Ironman competition went well for the first two legs, but by mile six of the run my stomach began cramping and that continued for the next hour and a half. I vomited during miles 19 through 24.

I've been running for almost 20 years, but when participating in endurance events, I often have trouble with my stomach. At about the three-hour mark during a marathon, I am no longer able to ingest a gel or other food without feeling nauseated. What can I do to alleviate this problem?

Karen Oldsweld
Bayport, NY

The fact that these symptoms occur well into these extended events suggests that dehydration or electrolyte imbalance is affecting peristalsis. When peristalsis, the muscle contractions that propel food along the digestive tract, is interrupted, nausea and vomiting can result. There is a normal reduction of blood flow to the digestive tract during exercise, but this occurs early and remains so throughout the exercise, so it would not be the cause of a problem this late in the event.

You should prehydrate with sports drink containing sodium, and continue to hydrate throughout the exercise period. Peristalsis is very sensitive to salt and water imbalance in the intestinal tract. Many runners restrict their nutrient intake late in the race to fluid-only. Be sure to experiment on long training runs with various foods—your intestinal tract needs to be trained for an endurance event in the same way your other muscles and organs do.

Dennis D. Daly, MD
Camillus, NY

Spike in Sugar Level Only After Intense Workouts

I'm diabetic, 62 years old, 4' 10", and weigh 95 lbs. For three years without medication I’ve been able to consistently keep my morning blood sugar readings below 110. I've noticed after high-intensity tennis or running, though, that my blood sugar count is often in the 200 range. An hour or so later, the level is back down to around 120.

My tennis games are very competitive, and I play four or five times a week. Am I harming my body? In addition to tennis, I try to speedwalk or jog 20 miles a week, and I've noticed my blood sugar level does not spike on days when I just speedwalk. By comparison, my last run was a 5K at 9:15 mile pace, and my blood sugar level was 240 ten minutes after the race. My diet consists mainly of vegetables, oil and protein.

Ellen Lamontagne
Philadelphia, PA

Exercise typically lowers blood sugar level in type 2 diabetics during the event and for one to two days following, which is one reason why exercise is recommended for diabetics. Therefore, I suspect you are not as well controlled as you think you are. Check your glycohemoglobin with your doctor. This is a measure of long-term blood glucose control. It is reflective of the last three months of blood sugar levels, and more meaningful than individual blood sugars. I think you may need some type of once-a-day medicine that will make you more sensitive to the insulin your body makes. Another consideration is how much glucose loading you are doing in the meals before (and during) exercise. On a side note, I recommend having a stress test or heart scan, since diabetes is a major risk factor for coronary artery disease, which is often asymptomatic.

Peter Mendel, MD
Woodbridge, VA

I have type 1 diabetes and have managed it with an insulin pump for 14 years. I've completed seven marathons since being diagnosed in 1991. I emphatically urge you to continue your exercise regimen—the benefits, both physical and psychological, are just too great to give up. That said, please know that it is very common for diabetics to progress over time from managing their disease with diet and exercise, then to taking one or more oral medications, and finally to insulin.

It's good that you test regularly. I would keep your doctor informed about your blood glucose response to the vigorous workouts, as he/she may one day feel the need to prescribe medication to help you manage; this is not a bad thing. You should continue your workouts. Your body's response to them is not unusual, and may be related to catecholamine release. This is a stress hormone that causes the liver to produce glucose. You seem to follow a low-carb diet. Your age at diagnosis suggests that you may have overt type 2 diabetes, which is well controlled with diet and exercise. Remember, however, that diabetes can be a progressive disease and so medications may become necessary down the line.

Kevin Foley, MS
Dayton, OH

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