Shin Splints Prevalent as the Fall Marathon Training Season is in Full Swing

Many popular marathons take place in the Fall, making late summer "crunch time" for marathon training.  Shin splints are the most common ailment below the knee to cause leg pain in runners.

While all runners are at risk for developing shin splints, some runners are more susceptible to injury than others. For example, females are twice as likely to develop a shin splint injury, as are runners who run on uneven surfaces such as gravel or sand. Intrinsic factors such as hormone levels, bone density, structural and biomechanical abnormalities, nutritional status and a previous running injury can also lead to shin splints.
The old adage of "too much too soon" is often the cause of these injuries. "The highest incidence of injury occurs two to four weeks after the start of training," says Dr. Rachoy. He offers several tips for how to avoid shin splints:
1. Follow a structured training program based on your performance and fitness level.
2. Run on a uniform, flat surface that is moderately firm.
3. Wear well fitting, supportive shoes and change them every 250-300 miles.
4. Follow an aggressive stretching program.
5. Wear custom foot orthotics (specially fitted shoe inserts that provide foot support) inside the shoe to address biomechanical and functional abnormalities, if medically necessary.
6. Consult with a medical doctor prior to training to address any intrinsic risk factors such as hormonal and nutritional factors.
Runners who do develop shin splints typically experience the pain at the beginning of the activity but will diminish during running, only to have the pain return after completion. Pain may progress to the point of impaired performance and the inability to sustain a regular run. Treatment may be as few as three to six weeks or as long as sixteen weeks depending on the severity of the injury. To minimize the severity of the injury, Dr. Rachoy recommends seeking treatment at the onset of shin splint pain. The cornerstone of shin splint treatment is rest. Other treatments such as ice, anti-inflammatory medication, immobilization and physical therapy are also sometimes recommended.

Vibram FiveFingers: The barefoot runner's shoe

If you have heard about or seen people walking around in this strange footwear and would like to learn more click here.

Barefoot-simulating Footwear Associated With Metatarsal Stress Injury in 2 Runners

Abstract

Stress-related changes and fractures in the foot are frequent in runners. However, the causative factors, including anatomic and kinematic variables, are not well defined. Footwear choice has also been implicated in contributing to injury patterns with changes in force transmission and gait analyses reported in the biomechanical literature. Despite the benefits of footwear, there has been increased interest among the running community in barefoot running with proposed benefits including a decreased rate of injury. We report 2 cases of metatarsal stress fracture in experienced runners whose only regimen change was the adoption of barefoot-simulating footwear. One was a 19-year-old runner who developed a second metatarsal stress reaction along the entire diaphysis. The second case was a 35-year-old ultra-marathon runner who developed a fracture in the second metatarsal diaphysis after 6 weeks of use of the same footwear. While both stress injuries healed without long-term effects, these injuries are alarming in that they occurred in experienced male runners without any other risk factors for stress injury to bone. The suspected cause for stress injury in these 2 patients is the change to barefoot-simulating footwear. Runners using these shoes should be cautioned on the potential need for gait alterations from a heel-strike to a midfoot-striking pattern, as well as cautioned on the symptoms of stress injury.

Drs Giuliani, Masini, Alitz, and Owens are from Keller Army Hospital, West Point, New York.
Drs Giuliani, Masini, Alitz, and Owens have no relevant financial relationships to disclose.

The views and opinions expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or United States government.
Correspondence should be addressed to: Brett D. Owens, MD, Keller Army Hospital, 900 Washington Rd, West Point, NY 10996 (b.owens@us.army.mil).

Posted Online: July 07, 2011

Foot and ankle injuries associated with running, including stress-related changes and fractures, occur frequently. However, causative factors, including anatomic and kinematic variables, are not well-defined. ¹ Footwear choice also has been implicated in contributing to injury patterns with changes in force transmission and gait analyses reported in the biomechanical literature. These studies also report conflicting data, particularly in the realm of the benefit of the padded cushioned heel, which typifies modern high-performance distance running shoes. ^2–6
Despite the benefits of footwear, interest in barefoot running has increased among the running community, with proposed benefits including a decreased injury rate. Advocates tout the evolutionary success of man as a barefoot bipedal runner. There is also speculation that the development of modern footwear and the associated altered running gait patterns (including a hindfoot strike versus the forefoot or midfoot strike typical of unshod runners) have contributed to injuries seen in runners. However, there is little prospective data to support these claims.
As a response to the rising popularity of barefoot running, several product lines of barefoot-simulating footwear have been developed to allow the proposed benefits of barefoot running while providing protection to the sole from the environment and giving the flexibility and natural feel of barefoot running. Runners with longstanding hindfoot striking gait patterns who have transitioned to footwear developed for a forefoot or midfoot strike may be without specific training or practice in this altered running pattern. This scenario represents a possible risk for repetitive stress injury to the foot or ankle as there is a mismatch between the running style and the footwear design. This article presents 2 cases of experienced runners who sustained metatarsal stress injuries as the result of running in barefoot-simulating footwear.

Case Reports

Patient 1

A 19-year-old man who ran 3 to 4 times weekly for an average of 20 to 30 miles per week presented with left foot pain and dorsal swelling of 3 to 4 weeks’ duration. The onset of the pain correlated with new footwear (FiveFingers; Vibram, Concord, Massachusetts) the patient was wearing while running.
The patient reported making no changes to his daily routine, mileage, or terrain. He noted pain with weight bearing, but he continued with full weight bearing and had a mildly antalgic gait.
Physical examination revealed no obvious deformity of the left foot; hindfoot alignment and ankle range of motion were normal with no evidence of tendo-Achilles tightness. Dorsomedial soft tissue swelling was noted over the second and third metatarsal shafts. There was no ecchymosis or crepitus; however, the patient had significant tenderness to palpation at the dorsal and plantar aspect of the second metatarsal.
Radiographs of the left foot demonstrated no signs of fracture or dislocation. Magnetic resonance imaging (MRI) was consistent with stress reaction of the entire second metatarsal with adjacent soft tissue edema (Figure ).

Figure 1:. T1-weighted axial fat-suppressed MRI of the left foot is consistent with stress reaction changes of the second metatarsal.

The patient was treated with crutch-assisted weight bearing until he no longer ambulated with an antalgic gait. He then was advised to avoid impact aerobics for an additional 8 to 10 weeks and to modify his activity to low-impact aerobic exercise.

Patient 2

A 35-year-old ultra-marathon runner who ran 3 to 4 times weekly for an average of 30 to 40 miles per week presented to the emergency department with sudden-onset left foot pain after running 3 miles. The patient reported making no changes to his training mileage, frequency, or terrain. The only recent change to his training was the incorporation of new footwear (FiveFingers) approximately 6 weeks prior to injury.
The pain was associated with difficulty ambulating, and radiographs were interpreted as negative for fracture at that time. The patient was instructed to stop running and was referred to the orthopedic clinic for follow-up.
On presentation to the orthopedic clinic 1 month later, the patient was weight bearing with normal footwear and had a mild antalgic gait. Physical examination revealed no obvious deformity of the left foot; hindfoot alignment and ankle range of motion were normal with no evidence of tendo-Achilles tightness. Dorsal soft tissue swelling of the foot was noted. There was no ecchymosis in the area or crepitus to palpation; however, the patient had significant tenderness to palpation over the dorsal and plantar aspect of the second metatarsal shaft.
A repeat radiograph obtained at the clinic demonstrated a periosteal reaction and callus formation of the second metatarsal diaphysis, although no fracture lucency was visualized (Figure ). T2-weighted MRI of the foot demonstrated increased signal within the second metatarsal shaft consistent with stress fracture (Figure ). The patient was instructed to avoid impact aerobics for an additional 6 weeks and to modify his activity to low-impact aerobic exercise.

Figure 2:. AP radiograph of the left foot 1 month after injury shows evidence of a healing second metatarsal diaphysis stress fracture.

Figure 3:. T2-weighted sagittal fat-suppressed MRI shows increased signal and cortical thickening consistent with stress fracture of the second metatarsal.

Discussion

The transition to cushioned-heel running footwear is a relatively recent phenomenon, with the advent of the modern running shoe only dating to the 1970s. ⁷ Barefoot running is a modality that by anatomic study dates to early man, and the characteristic gait of native unshod runners has borne the test of time as a successful means of locomotion. ⁸
The resurgence in popularity of barefoot running as an alternative to the wearing of modern footwear has been based in part on the theory that there is reduced risk of injury; however, there is an absence of data supporting this. ⁸ The need for cushioned soles has been questioned with the launch of several product lines of footwear that simulate barefoot running while offering some protection to runners’ feet. Among these is the shoe that was worn by both patients in this case series. The purpose of this footwear is to facilitate the barefoot running experience while protecting the foot from modern-day elements such as pavement, broken glass, or other hazards that would be directly injurious.
Although the superiority of one footwear style over another is outside the scope of this article, it is relevant to discuss the possibility that there is an association with the transition from modern cushioned-heel footwear to barefoot-simulating footwear with the metatarsal stress injuries described in these 2 cases. Stress injuries to the metatarsals are common in the recreational running population and may be associated with changes in a training routine such as distance, intensity, or frequency. ¹
Stress fractures in the foot are also common in military populations. March fracture is the name given to stress fractures of the second and third metatarsals commonly seen in military recruits after long marches. The second and third metatarsals are rigid while marching and are common sites of injury. The majority (75%) of march fractures occur in the distal or middle one-third of the metatarsal shaft. ⁹
The location of the fractures in our 2 cases was more proximal in the metatarsal shaft than the typical march fracture. Our patients had long-standing running routines prior to presenting with a metatarsal stress fracture in a location not commonly seen in overuse metatarsal stress fractures. For these 2 runners, a common factor appears to be the transition from a cushioned-heel modern running shoe to barefoot-simulating footwear.
The kinematics and biomechanics of shod and barefoot runners has been described in the literature. One notable difference between the 2 styles is the foot-strike pattern typical of each. In a landmark study, Lieberman et al ⁷ reported on these differences in a comparison of shod and unshod runners that included an evaluation of runners from the Rift Valley region of Africa who have never worn shoes. Runners who regularly wear or who have grown up wearing cushioned-heel footwear primarily have a hindfoot strike gait pattern. Lieberman et al ⁷ found that this strike persisted when these same runners were tested in an unshod condition. In runners who grew up barefoot running or who have transitioned to barefoot running, a forefoot or midfoot strike predominates. ⁷
Both of our patients grew up and typically trained wearing cushioned-heel footwear. They can be presumed to have a hindfoot strike typical of this general running population. ¹⁰ They also likely continued running with a hindfoot strike as they transitioned to barefoot-simulating footwear consistent with the findings of Lieberman et al. ⁷
The advantage of the forefoot strike gait in barefoot running is a flatter foot position at impact, which limits the local pressures underneath the heel. Barefoot runners typically adopt a gait pattern with shorter stride length and increased stride frequency. These adaptations facilitate the altered touchdown foot position. ^11,12 They also serve to decrease the vertical forces transmitted to the limb, which may have further implications in injury prevention. ¹³ An additional advantage is gained with the finding of decreased energy expenditure in barefoot versus shod running. ¹⁴
In another study evaluating adaptations of stride mechanics in shod and unshod running trials on a treadmill, no in-trial limb position adaptations were noted in barefoot trials whereas shod runners made multiple adjustments in running mechanics during the course of the trial. ¹³ The authors postulated that this may be due to a natural state of barefoot running that needs no alteration to find the biomechanically efficient gait pattern. However, this also seems to be a risk factor predisposing a runner to repetitive stress injury.
With a transition to barefoot running from cushioned-heel footwear, Lieberman et al ⁷ described a persistence of a hindfoot strike gait. If a runner of this type does not make gait adaptations, as described by Divert et al, ¹³ there is potential for perpetuation of a gait that does not provide the efficiency and force reduction expected with barefoot running. An overuse stress injury is the predictable result and may be what was experienced by our 2 patients.
This article presents 2 runners who transitioned from a modern cushioned-heel running shoe to a barefoot-simulating shoe without alteration to their running routine or any specific gait training. Both runners developed a stress injury to their second metatarsal shaft. We propose that the alteration from a cushioned-heel shoe to barefoot-simulating footwear without specific gait training may have contributed to their injuries.

Ankle Sprains: Risk factors and prevention

Ankle sprains account for 10-20 percent of all single sport injuries.  Click here to understand and anticipate the epidemiology of the ankle sprain and the risk factors that you dont have control over.

FGCU Eagle Valor 5K Road Race and 5K Trail Run

Start: Saturday, April 09, 2011 @ 7:15 AM

Florida Gulf Coast University
10501 FGCU Blvd. S.   Ft. Myers, FL

Date

Saturday, April 09, 2011 @ 7:15 AM

Address

Florida Gulf Coast University
10501 FGCU Blvd. S.

Fees

$18-$30

 

Brief Description

This is the 5th edition of this outstanding race, held entirely on the beautiful FGCU campus. Races open to participants of all ages and abilities. Proceeds from this race go to benefit the Lee County Emergency Workers Charitable Fund.

 

 

Additional Information

FOR REGISTRATION...go to WWW.FTMYERSTRACKCLUB.COM or email jdavis@fgcu.edu for more info!!!

 

Beach Bum 5K

Start: Saturday, March 26, 2011 @ 7:30 AM

Lowdermilk Park Beach, Naples
1301 Gulfshore Blvd N   Naples, FL

Date

Saturday, March 26, 2011 @ 7:30 AM

Address

Lowdermilk Park Beach, Naples
1301 Gulfshore Blvd N

 

Registration Closing Date

Friday, March 25, 2011 @ 3:00 PM

 

Brief Description

5K ON the beach in Naples, FL? It doesn't get any better than that!

 

2011 Hope, Love & Faith MS 5K Run/Walk

Come see us and support a great cause.  Gulfcoast Foot and Ankle will have a medical and informational tent.

Start: Saturday, March 05, 2011 @ 8:00 AM

Philharmonic Center for the Arts
5833 Pelican Bay Blvd   Naples, FL

Ankle sprains hit male athletes hardest

By Anne Harding

NEW YORK | Mon Feb 14, 2011 12:20pm EST

(Reuters Health) - A new study in West Point cadets sheds a bit more light on risk factors for two relatively rare, but severe, types of ankle sprain.

So-called "high" and "inner" ankle sprains account for 10 to 15 percent of all ankle sprains, Dr. Brett D. Owens of Keller Army Hospital in West Point, New York, and his colleagues note in the American Journal of Sports Medicine.

Both types of sprain result in longer time lost due to injury and greater disability than more common sprains.

Ankle sprains usually involve the ligaments linking the lower leg to the heel, and typically occur when the foot twists inward. But high ankle sprains, technically known as syndesmotic sprains, affect the ligament holding together the two long bones of the lower leg, Owens explained in an interview.

Inner, or medial, sprains are even rarer and occur when the foot is twisted outward.

To better understand how common these types of ankle sprains are and what puts people at risk for them, Owens and his team looked at data on all ankle injuries among U.S. Military Academy cadets between 2005 and 2009.

Over the five years, 1,206 cadets sprained an ankle, with seven percent of those injuries being high sprains and five percent inner sprains.

In the entire cadet population during that period, the overall risk of experiencing a high ankle sprain was about half a percent for both men and women. For inner ankle sprains, the annual risk for male and female cadets was also less than one in 100, at 0.39 percent and 0.12 percent, respectively.

Eighty percent of the high sprains that occurred happened during athletics, as did 64 percent of the inner sprains. High-contact, high-impact sports accounted for most injuries, with top offenders for high sprains in men being sprint football, men's team handball, soccer, and basketball; for women, the highest-risk sports for high sprains were intercollegiate volleyball, followed by basketball and soccer. Inner sprains occurred most frequently during men's rugby, gymnastics, and soccer.

Men playing at the intercollegiate level were 3.5 times as likely as women playing intercollegiate sports to have inner ankle sprains, but there was no gender difference in the risk of high sprains. Athletes playing intercollegiate sports had 2.4 times the risk of high sprains compared to athletes playing intramurally.

Bulk also played a role in who was most at risk. The average body mass index (BMI, a measure of weight in relation to height that is used to gauge obesity but can also indicate high muscle mass) was higher for people who sustained either inner or high sprains. The BMI of those who were injured averaged about 26, versus 24 for people who were not hurt. A BMI between 18.5 and 24.9 is considered normal for most of the population.

Time lost to play averaged about two weeks for high sprains, and while data on inner sprains wasn't complete, time lost to sport was higher than seen in previous studies of these injuries. By comparison, a past study by Owens and his colleagues in the same group of cadets found they lost an average of eight days due to lateral sprains, the most common type of ankle sprain.

Inner sprains were probably more common for men because men were more likely to engage in high-impact play, Owens noted.

While efforts to prevent inner and high ankle sprains wouldn't differ much from efforts to prevent more common sprains, such as the use of special braces, Owens said, the findings do help to identify which individuals face the greatest risk, and where these interventions should be targeted. "It's the contact sports that are most problematic, football, rugby...gymnastics, which is not surprising, given the amount of energy that goes into a jump landing," he said.

SOURCE: bit.ly/g6I0cd The American Journal of Sports Medicine, online February 2, 2011.

Susan G. Komen Race for the Cure at Coconut Point Mall

Komen Southwest Florida Race for the Cure®
March 12, 2011 at 8 a.m.
Coconut Point Mall, Estero, FL
U.S. Hwy. 41 and Coconut Road - click here for directions

GENERAL INFORMATION
Q: When is the Race?A: Saturday, March 12, 2011.  This event will occur rain or shine.  We reserve the right to cancel in extreme circumstances.  In that event, there will be no refunds, rather, your entry fee will be used as a donation to the Komen Southwest Florida Race for the Cure.

Q: Where should I park on Race day?
A: Click here to view a parking map.  Plan to arrive an hour prior to the Race Start to allow plenty of time to park.  We ask that you also carpool with others.  Parking is available throughout Coconut Point Mall on a first come, first served basis.  Additional parking is available north of Sun Trust Bank off U.S. Hwy. 41 & Vandenberg Way (directly across from Coconut Point). A parking map will be available after Jan. 1.  A special parking area will be reserved for registered breast cancer survivors.  Starting at 9 p.m. on 3/11/10, Fashion Drive will be blocked for parking due to Race for the Cure festivities.
Q: What is the Race route?
A: Click here to view the 2011 Race route.  The Race course is a 5K or about 3.1 miles.  The 5K Race is sanctioned and certified by USAT&F, FL-10001EBM.

Q: Are strollers allowed at the Race?A: We strongly urge participants with strollers/baby joggers to join in the Non-Competitive 5K or the 1 Mile Fun Run/Walk rather than the Competitive 5K. We ask those with strollers to line up towards the back so that the other participants can enter the course first. EVERY participant on the Race Course must be registered!

Q: Are pets, rollerblades, skateboards or bikes allowed at the Race?
A: For the safety of all participants, rollerblades and pets are discouraged from participating in this event.  Thank you for your cooperation. Those with guide dogs, we ask that you please stay at the back of the crowd on the Non-Competitive 5K and 1 Mile Fun Walk.
REGISTRATION INFORMATION
Q: How much does it cost to register?A:  Registration fees through Feb. 25, 5 p.m. EST:
     Adult 5K Run/1 Mile Fun Walk - $32
    Youth 5K Run/1 Mile Fun Walk - $10
    Adult 5K Chip-timed Run - $35
    Youth 5K Chip-timed Run - $15

Q: What are the deadlines to register?

• Register between Oct. 1 - Feb. 25 (by 5 p.m.*), your packet will be mailed to you.   
• Register between Feb. 25 (5 p.m.*) - March 3 (by 5 p.m.*), your packet will only be available at a
  Packet Pick Up Site (see T-shirt Information below for locations) or on Race Day. 
• Register after March 3 (5 p.m.*) - March 10 (by 5 p.m.*), your packet will be available Race Day only.
   *Eastern Standard Time

Q: Why do I need to log in prior to registering?A: By first logging into your Participant Center, the registration process will be a breeze for you!  Also, any contacts and donation history will also be available from last year to help make setting up your Personal and/or Team Page easier!  Click here for directions on how to make changes to your Participant Center.

Q: What portion of my registration fee is tax-deductible?
A: The IRS does not allow deductions when you receive items of value for the entry fee.  However, all additional donations are tax deductible to the full extent allowed by law.
Q: What does it mean if I register as a Chip-Timed Runner?A:  By registering as a Chip-Timed Runner you will be participating in the Competitive Timed Event, which starts at 8 a.m.  This year we will be using the ChronoTrack B-Tag with a Chip start and capture the “chip times”. All awards will be based on gun time, which is in accordance with USA Track and Field.  Your bib must be clearly visible on the front of the torso, unaltered and unmodified (do not fold or wrinkle), pinned in all four corners and not covered by jackets, runner belts, water bottles, etc.

Q: Can I register Race morning?A: Race Day registration fees will increase for all participants.  On Race day, the Registration Tent opens at 6:30 a.m.  The Registration and Chip Tents will be located behind Hollywood Theaters.  If you want to register for the 5K Run/Walk & 1 Mile Fun Walk go to the Registration Tent marked with red balloons.  If you want to register for the 5K Chip-timed Run go to the Chip Tent marked with blue balloons.

Q: Are there Race awards for the Competitive Chip-Timed Runners?A: All competitive chip-timed runners must be registered as a 5K Chip-Timed Runner and wear the ChronoTrack B-Tag bib to be eligible for awards.  The following places will be awarded Race day:Top three overall breast cancer survivorsTop three overall participants for males and femalesTop Master, Grand Master and Senior Grand Master for survivors, males and female
FUNDRAISING INFORMATION
Q: Where does my money go?A: We maintain the philosophy of “what is raised here stays here” with 75 percent of net proceeds being used for local programs, and 25 percent used to fund breast cancer research nationally. The Komen Southwest Florida Affiliate serves Charlotte, Collier, Glades, Hendry and Lee Counties.
Q:  Do I have to collect donations to participate in the Race?A: We do encourage all participants to fundraise above the entry fee. Just imagine the IMPACT - If every Race participant raises just $100 in addition to their registration fee, we would bring in an additional $1,000,000 to support local screening, treatment and educational programs in our community!

Q: Are there fundraising incentives/awards?
A: Yes!  The Affiliate must receive all donations by March 9, 2011 to be eligible for fundraising incentives. Prizes will be available for pick up on Race day only at the Incentive Tent on Fashion Drive. Incentives will not be mailed.

• $100+:  Komen ribbon car magnet
• $250 - $499:  One Southwest Florida Ford Dealers oil change for any make/model/vehicle
• $500+:  One Hollywood Theaters movie ticket, one Southwest Florida Ford Dealers oil change for any make/model/vehicle and a pink Komen ball cap.

Rare ankle replacement allows long walks to resume

CHRIS SEGAL / News Herald Writer

PANAMA CITY — Daily walks were put on hold in 2009 when retired Army Sgt. Maj. Mike Mead could no longer suppress the pain in his left ankle.

A total ankle replacement, one of the first done in Bay County in the past decade, has given the career solider relief from the pain and a return to his walks.

Mead took three one-mile walks a day with his dog, at least until this time last year when the pain kept him off the walking paths. He is slowly building up his strength to return to his longer walks. He currently can walk about a mile a day.

Dr. Shayne Jensen of Gulf Coast Podiatry Foot and Ankle Surgery Center, who performed the ankle replacement, said Mead’s pain was caused by a lack of cartilage in his ankle joint, likely caused by osteoarthritis. In July 2010, Mead was implanted with the INBONE Total Ankle Replacement from Wright Medical.

“We have total knee and total hip replacements — why can’t we have total ankle replacements?” Jensen said.

The “second generation” ankle replacements have been around for about 10 years but Jensen waited for the research before performing a total ankle replacement. The research is showing that with the right candidate 10 years out, there is a 70 percent success rate, Jensen said.

“It went really well,” Mead said. “Before the surgery I could not put weight on my left foot. I think the dog got frustrated with me on our walks. I thought I could handle the pain but I finally went to see my doctor.”

Jensen performs 10 to 15 ankle fusions a year, which he said is still the “gold standard” for treating ankle problems. An ankle fusion uses pins and plates to fuse the ankle joint, and patients lose range of motion in the ankle joint.

The total ankle replacement uses an artificial prosthesis to offer patients better mobility.

“It looks good, it healed well and it works,” Jensen said.

For Mead to qualify as an ideal patient for the total ankle replacement he had to give up smoking cold turkey. Jensen explained with replacements there is a higher rate of failure with smokers and he would not consider the total ankle replacement on a smoker.

“It is important to use the right indicators for your patients,” Jensen said. “This is another modality.”

If a patient is obese, diabetic or has several misalignments, the ankle fusion is still the better option, Jensen said.

Mead’s recovery included two weeks when he could not put weight on his ankle and three months of physical therapy. Mead, who has also had a knee replaced, said the ankle replacement was less painful but the recovery took longer. Mead, Jensen and others on the walking path are impressed by the progress made following the total ankle replacement.

Early surgery for ankle fractures may improve outcomes, reduce costs

Sukeik M. Injury Extra. 2010;41:133-134. doi:10.1016/j.injury.2010.07.419.

United Kingdom investigators suggest that hospitals establish a policy of early surgical intervention for ankle fractures, which would improve outcomes and reduce the costs associated with this injury.
Ankle fractures are one of the most common orthopedic injuries, according to Mohamed Sukeik, MD, MRCS, and colleagues at the Cumberland Infirmary, in the United Kingdom. The swelling associated with these fractures causes operative delays. However, a surgical delay of more than 24 hours after injury is linked to longer hospitals stays, which increases costs.
In this retrospective study, the investigators followed 145 consecutive patients who were treated for ankle fractures between January 2008 and December 2008. They excluded patients with talar and pilon fractures. There were 62 men and 83 women. The patients had a mean age of 49 years. To determine surgical delay, the investigators noted the time of emergency department presentation and the time of anesthetic. They reviewed patient notes for inpatient stay and postoperative complications.

The early group included 117 patients who were operated on within 24 hours of presentation. The delayed group included 28 patients operated more than 24 hours after presentation.
The mean inpatient stay for the early group was 3.79 days vs. 8.57 for the delayed group. In 57% of the delayed surgery group cases, swelling caused the delay. Surgery was also delayed because of a lack of operating room time and a lack of fitness for surgery.
Five patients (4.27%) in the early group had wound infections, and one patient had a chest infection (0.85%). In the delayed group, four patients (14.28%) had wound infections; all had ankle swelling.

5th Annual Run for the Paws Walk / Run

5th Annual Run for the Paws Walk / Run
Saturday, January 29th, 2011
Race starts promptly at 8:00 a.m.


Race Info

• PANCAKE BREAKFAST!!!!  This year in addition to the usual bagels and Gatorade, the Civil Air Patrol will be holding a fundraiser pancake breakfast on-site!  For a $5 contribution to the CAP you will get pancakes, sausage, eggs, OJ, and coffee!  Plus, they are hosting the award ceremony in the hangar and giving tours. 
• Pets are allowed to participate with their guardians, but must be up to date with their vaccinations, be able to complete the distance of the event, and must be on a non-retractable leash at all times.  The retractable leashes are not permitted due to tripping concerns that we have experienced in previous years.
• Please arrive early to allow yourself time to park, register, pick up your timing chip, and get to the start line.  Day-of registration WILL CLOSE AT 7:45 a.m. TO MAKE SURE EVERYONE HAS TIME TO GET THEIR CHIP AND GET TO THE START.  If you arrive after 7:45, there is no guarantee that you will be timed and included in the event results!
• We encourage participants to bring items for the pets at the Humane Society Naples, items that they are always in need of are cat litter, laundry detergent, bath towels, paper towels, hand sanitizer, canned dog food, and dryer fabric softener sheets.  They do not need dry food. 

Bay to Breakers: 100 Years and Running

Countdown begins as "The World's Most Unique Footrace" turns 100; get ready to run on Sunday, May 15, 2011; race limit of 50,000

From Ryan Lamppa, Running USA

SAN FRANCISCO - (January 6, 2011) - With five months until race day, runners from all over the world, of all shapes and sizes, and of all intensities are readying themselves for what is known as the most unique footrace in the world. The100th running of Bay to Breakers will take place on Sunday, May 15, 2011, and up to 50,000 runners will participate in this quintessentially San Francisco event.

"Looking back at the past 100 years of Bay to Breakers, the only thing that comes to mind is the word 'iconic,'" saidAngela Fang, general manager of the race. "Bay to Breakers is an all encompassing event that unites best-in-class athletes with enthusiastic fans and creates the spirit that is San Francisco."

Originally known as the Cross City Race, Bay to Breakers was first held on January 1, 1912. In its first year, 186 runners started the race at Embarcadero and Market streets, and only 121 runners completed the race. The winner of the first race was Robert Jackson "Bobby" Vlught, who won with a time of 44 minutes, 10 seconds. Since then Bay to Breakers has grown to be one of the largest footraces in the world with more than 50,000 participants and close to 100,000 spectators annually. The 12K race, also home of the world records (33:31 and 38:07), has grown to be a celebration for everyone and exemplifies The City's irrepressible color and its affection for eclectic traditions.

At Expo this year, a race retrospective exhibit of Bay to Breakers will be held on May 13-14, 2011. The retrospective will include photos, rare memorabilia and a historical timeline from 1912-2011. This historical display will kick-off the weekend's festivities and will begin to generate the excitement as runners build towards race day.

On Sunday, May 15, 50,000 runners, including Bobby Vlught's grandson, will be propelled into the 100th running of Bay to Breakers. At the finish line, runners will receive a race t-shirt, and for the first time in race history, all registered finishers will receive a commemorative medal representing the 100th running of the race. In this year's race, men who beat Vlught's 1912 winning time of 44:10 and women who beat the 50:45 winning time of the first female winner, Dr. Frances Conley from 1971, will have their race numbers retired.

Along the USA Track & Field certified 12K (7.46 miles) course, Bay to Breakers will host entertainment from the past 10 decades, offering a fun and lively atmosphere for participants and spectators alike. At 7:00am runners will start at the base of the San Francisco Bay, and progress to the City's famousHayes Street Hill. Around the 2.5-mile mark runners climb an 11.15 percent grade between Fillmore and Steiner streets, bringing them to the highest point in the race, approximately 215 feet above sea level. The remainder of the course gradually flows alongside the Panhandle and through Golden Gate Park and ends at the Pacific Ocean.

Alcohol and floats are not allowed at the 100th running of the Bay to Breakers. Neighborhood associations, city officials, police and race organizers have determined alcohol and floats create a threat to public safety. At the 100th running, additional police and private security will be added to enforce applicable laws. There will be multiple checkpoints on the race route to remove any floats and alcohol. Only registered participants will be allowed on the course.

This change was made to ensure everyone has a safe, fun and challenging 100th celebration race. These new regulations will not be reversed.

The completion of Bay to Breakers and the celebration of the centennial will be commemorated at Footstock this year. The merriment will move from its former location at the Polo Fields to the soccer fields for the 2011 race and will feature food booths, entertainment and exciting festivities as a celebration of the incredible 100 years Bay to Breakers has had, and 100 more to come.

For more information, go to: www.baytobreakers.com