Know if the Shoe Fits: Top Footwear Tips for Runners

**By Jeffrey R. Pentek, DPM**

Whether you occasionally jog, run a couple of days each week or regularly race competitively, a key to enjoying – and enduring – the sport is establishing and maintaining foot health practices, which include periodic shoe-fitting and proper selection.

As a podiatrist and avid runner, I’m very aware of the importance of this often overlooked aspect of the sport and its role in helping people enjoy and benefit from it long term.

I hope the basic information in this article inspires you to invest a little time, energy and money into keeping your feet healthy and happy. Trust me, you won’t regret it.

What to look for

Although it’s not rocket science, there are a few important things to look for when selecting a good pair of supportive running shoes.

  • When you bend a running shoe from front to back, it should only bend at the ball of the foot. The midfoot and hindfoot should be firm.
  • Heel counters on the back of running shoes should also be firm to prevent ankles from rolling in or out.
  • Twisting running shoes with your hands should not allow for a lot of bending. You do not want very flexible shoes since this tends to put greater stress on feet.

In addition to these “kick the tires” tips, here are other things to keep in mind when looking for the best shoe for you.

  • Well-constructed running shoes typically last for about 500 miles of use before they should be replaced.
  • Minimalist shoes, including road racing shoes, often last between 250 and 300 miles.
  • People with high foot arches tend to do better with cushioned “neutral” shoes, and people with flatter foot arches tend to do better in running shoes designed for extra stability.
  • Also, specific running shoe characteristics should be considered for people’s individual foot pathology. For example, wide toe boxes are helpful for bunions and hammertoes, and running shoes with a stiff forefoot rocker (a feature that provides additional stress reduction by facilitating a smooth gait) are helpful for people experiencing arthritis or other pain issues in the forefoot.
Running shoe aids

Beyond taking time to research and find a supportive and appropriate running shoe to suit your individual needs, some people – especially runners dealing with chronic foot pain due to anatomic issues or injury – can benefit from the use of orthotics.

These over-the-counter or customized devices, which are placed in the foot bed of running shoes, are sometimes used to modify the structural and functional characteristics of feet by providing extra motion control and stability.

Additional resources

If you are a runner who experiences foot pain on a regular basis, I encourage you to speak with your primary care provider about it so your feet can be properly examined and appropriate care can be prescribed, which may include a referral to a podiatrist for a more thorough evaluation if needed.

A final thought

As a former competitive runner who makes it part of my active lifestyle today, I could not agree more with something that Oprah Winfrey said: “Running is the greatest metaphor for life, because you get out of it what you put into it.”

For more information about the Podiatry program at Virginia Mason, call 206-341-3000 and visit:

Pentek_JeffreyJeffrey R. Pentek, DPM, specializes in podiatry, orthopedics, sports medicine, foot and ankle surgery and podiatric surgery. His practice is located at >Virginia Mason Bainbridge Island Medical Center.

Make Stretching Your Fitness Strategy: Tips from Tyler Lockett and David Belfie, MD

When is the best time to stretch, before or after exercise? What types of stretches have the most benefit? Why does stretching become more important as we age? These are just a few of the questions Tyler Lockett of the Seattle Seahawks and orthopedic surgeon David Belfie, MD, answered for viewers of King 5’s Take 5 show last week. Watch the video, then discover your own favorite stretch.

Sports Physicals for Teens Matter. Here’s Why.

**By Michael Dudas, MD, FAAP**

Soccerball in netPlaying on a community or school sports team is a great way for kids to stay in shape, learn teamwork, commit to a healthy pursuit and have fun. This is probably why more than 38 million American children and teens play at least one organized sport.

No matter which sport your child plays, there is always a risk of getting hurt. Teen sports injuries range from minor sprained ankles and repetitive strains to heat stroke. Some kids experience medical conditions such as exercise-induced asthma or allergic reactions to bees and other stinging insects found around athletic fields.

To avoid getting hurt or sick while competing, teens need to be ready. Preparation begins with seeing a health care provider for a sports physical to ensure their bodies are ready for the season and that there is not a family or individual medical history that requires further attention.

Even if your child’s school district or recreational league does not require a sports physical, it is a good idea for every teen who plays a sport to make sure they are healthy enough to safely participate.

What is a sports physical?

A sports physical is a checkup to assess a teen’s health and fitness as it relates to a sport. It is not the same as a regular physical, but sometimes can be done together during the same visit. During a sports physical, the health care provider looks for any diseases or injuries that could make it unsafe to participate in sports and reviews the family’s medical history to ensure additional tests are performed, if necessary.

Where and when is a sports physical done?

Pediatricians, primary care doctors, physician assistants and nurse practitioners can perform sports physicals and sign the required forms. While sports physicals are offered at other clinics, such as those inside some drug-store chains, they should not take the place of an annual physical exam by your teen’s pediatrician, where other important health issues are also addressed.

Ideally, you should try to have the exam done about six to eight weeks before sports season starts. That way, if the health care provider wants to treat a condition, refer you to a specialist, or do a followup exam, there will be enough time before the sport begins to be cleared to play.

What to expect during a sports physical

Your teen’s sports physical should start with a thorough medical history. The health care provider will ask about any history of illness, hospitalizations or injuries that might prevent them from playing or limit the amount of activity they can handle. Your teen should be asked to complete a health history form, as well as a questionnaire that asks about daily habits and lifestyle choices.

The medical history will be followed by a physical exam, where the health care provider will:

  • Measure height and weight
  • Take pulse rate and blood pressure
  • Check heart and lungs
  • Check neurological function
  • Test vision and hearing
  • Check ears, nose and throat
  • Look at joint flexibility, mobility, spinal alignment and posture
  • Screen for hernias in males

Girls may also be asked about their period, and whether it is regular. Additional tests such as bloodwork, an X-ray or electrocardiogram may be ordered based on the analysis.

Will my teen be able to play?

At the end of a sports physical, the health care provider will decide whether it is safe for your teen to play. The decision is based on several factors, including:

  • Type of sport and how strenuous it is
  • Position played
  • Level of competition
  • Size of the athlete
  • Use and type of protective equipment
  • Ability to modify the sport to make it safer

If everything checks out, the health care provider will provide an OK to play without restrictions. Or, the health care provider may recommend modifications, like using special protective equipment, carrying an epinephrine injector (“EpiPen”) for severe insect allergies, or using an inhaler if your teen has asthma.

It is rare for teens not to be allowed to play. Most health conditions will not prevent kids from participating in sports, but sometimes they will need treatment and a follow-up exam first.

Even if your teen has a sports physical every season, it is not a complete physical exam. They should still receive a comprehensive health exam each year.

Schedule sports physicals early

Since individual school districts have different timing requirements about when student athletes need to show proof of a recent sports physical to try out and play, I encourage parents to schedule them as early as possible since demand often exceeds availability. Some school districts require that student athletes trying out for fall sports show proof of a sports physical as early as Aug. 1 since that is when tryouts and practices sometimes begin.

Walk-In Sports Physical Mini Camp at Virginia Mason Issaquah Aug. 11

Virginia Mason Issaquah (100 N.E. Gilman Blvd., Issaquah, WA 98027) is offering a Walk-In Sports Physical Mini Camp Saturday, Aug. 11, from 9 a.m. to 2 p.m. This convenient, drop-in opportunity will allow athletes between ages 5-21 to receive the required preparticipation exam and important information about concussions and sports nutrition. Healthy snacks will also be available, and student athletes can participate in Nutrition and Fitness for Life (N.F.L.) challenges. For more information, or to schedule an appointment on another date, call 425-557-8000 or visit

Dr Michael Dudas_2017Michael Dudas, MD, FAAP is a board certified pediatrician who practices at Virginia Mason University Village Medical Center. His specialties include Pediatrics and Primary Care. He has been chief of Pediatrics at Virginia Mason since 2007.
A version of this article previously appeared in 425 Magazine

Chronic Ankle Pain? You May be a Candidate for Replacement

**By Eric Heit, DPM**

More than 30 years ago, Michael Diorio fell from a palm tree while trimming fronds at a San Diego apartment. The three-story fall crushed his left heel and fractured his right ankle. Over the years he’s had seven surgeries on his feet and suffered pain on a regular basis.

Michael Diorio_Total ankle replacement patientv2

Michael Diorio

After moving to the Pacific Northwest three years ago, Diorio, 56, was referred to a podiatrist with Virginia Mason Orthopedics and Sports Medicine. Diorio soon learned he was a candidate for a relatively new procedure – total ankle arthroplasty, also known as total ankle replacement. 

Last December Diorio underwent the three-hour outpatient surgery on his right ankle at Virginia Mason Hospital and Seattle Medical Center. He was able to return to full-time work in March, where he spends several hours a day on his feet.

“I used to limp and regularly experience pain,” says Diorio.  “Now I walk almost as well as I did before my injury and without any discomfort. I’m glad I was a candidate for total ankle replacement and have been very satisfied with the experience and outcome.”

The procedure

Total ankle replacement is similar to hip and knee replacements – patients receive a new ankle joint made of precisely engineered metal and plastic parts that replace the old ankle joint.

The surgery is typically performed without the need for an overnight hospital stay and patients usually go home the same day. Patients should expect a period of limited weight-bearing, followed by a gradual return to daily activity as their ankle heals. Most patients will have physical therapy after the procedure to help regain mobility.

The benefits — and some risks

Total ankle replacement relieves discomfort in the joint that older adults sometimes experience during weight-bearing activities. It might also ease occasional ankle pain when not moving the joint.

However, like every surgery, there are risks such as infection and wound healing problems, although this risk is low, occurring in less than 2 to 3 percent of cases.

The American Orthopaedic Foot & Ankle Society recommends people try non-surgical options for pain relief before considering total ankle replacement. Some patients get relief through treatments such as bracing, cortisone or steroid injections and changing to non-weight bearing or low-impact activities.

sr.coupleIf non-surgical approaches do not provide relief, total ankle replacement might be appropriate.

Getting the green light
Your physician will consider a few things before recommending surgery, such as:

  • Age
  • Activity level
  • Other potential medical complications
  • Severity of arthritis in your ankle
  • The potential for arthritis in other foot joints

In general, surgeons recommend total ankle replacement for people 55 or older. The thinking is that older adults will likely not stress the ankle as much as a younger patient, extending the life of the implant. Runners, or people who do other high-impact activities, are not good candidates for the surgery.

A person’s overall wellness before total ankle replacement is important. People should see their primary care physician before surgery to help ensure they are in optimal health.

Even if someone doesn’t think they’re a candidate for total ankle replacement, they  should get a referral from their primary care provider to consult with a foot surgeon. This is important because even if someone isn’t a candidate for the procedure, the specialist can discuss other treatment options that might help.

If you have health issues

Certain conditions can increase the risks associated with surgery and recovery, such as:

  • No ankle movement
  • Poor ankle-bone quality
  • Unstable ankle ligaments
  • Significant ankle alignment problem
  • Infection, especially in an ankle

If you have diabetes, your doctor will want to make sure you have good circulation and healthy blood-sugar levels before surgery. If your condition is not well-controlled, it increases the chance of complications, including infection.


According to the American Orthopaedic Foot & Ankle Society, there is a 90 to 95 percent chance that total ankle replacement will be successful and without complications.

Based on our experience at Virginia Mason, most people are doing well within about three months after surgery, and full recovery usually takes six months to a year.

Dr. Eric Heit

Eric Heit, DPM, is a board-certified podiatrist with Virginia Mason Orthopedics and Sports Medicine. His specialties include podiatry, foot and ankle surgery, podiatric surgery and sports medicine. He practices at Virginia Mason Hospital and Seattle Medical Center

You Zigged But Your Knee Zagged: How to Treat Mild Sprains and Strains

Tyler Lockett of the Seattle Seahawks

Seattle Seahawks Player Tyler Lockett

If playing sports will be part of your spring – whether on a team, tennis court or tossing a Frisbee around the local park – sprains and strains can result. What’s the difference between a sprain and a strain? While both injuries have similar signs and symptoms, they affect different parts of the body.

Sprains involve the stretching or tearing of ligaments, the fibrous tissue that connects bones in your joints. Strains are injuries to muscles or tendons, the cords of tissue that connect muscle to bone. Both injuries can cause pain, swelling and limited ability to move the affected area. The good news is mild sprains and strains can be treated at home.

One of Tyler’s Tips for Virginia Mason, from Tyler Lockett of the Seattle Seahawks, breaks down what every athlete (or weekend warrior) should keep in mind for treating mild sprains and strains:

“As an NFL player, I know firsthand — and first tibia and fibula — that injuries can happen to anyone. When it comes to recovery, RICE is an easy way to remember how to treat minor injuries.

“R” stands for Rest. When you get injured, the first thing to do is stop the activity that is causing pain. Resting gives your body time to recover.

“I” is for Ice. Applying an ice or cold pack will prevent or reduce swelling. Apply for 10 to 20 minutes, three or more times a day.

“C” means Compression. Wrapping the injured or sore area with an elastic bandage is another way to reduce swelling. But remember, don’t wrap it too tight or you could cause swelling below the bandage.

“E” stands for Elevation. Elevate the injured area while applying ice or when you are sitting or lying down. Try to keep the injury at or above the level of your heart to reduce swelling.

Remember that RICE is only for minor injuries that you can treat yourself at home. For more serious injuries, talk with your doctor.”

How do you know when it’s time to get medical attention for a strain or sprain? Watch out for these symptoms, which could indicate a more serious injury:

  • Difficulty walking more than a few steps without significant pain
  • Inability to move the affected joint
  • Numbness in any part of the injured area

Virginia Mason Orthopedics and Sports Medicine Services has cared for thousands of sports enthusiasts, from world-class athletes to “weekend warriors.” Board-certified experts work together from diagnosis through rehabilitation to help patients return to their favorite activities, feeling stronger and safer than before their injury. Get inspired by reading orthopedics comeback stories or meet our providers.

Staying a Lifelong Runner: Tony’s Story

Tony6178“Always running.” That’s what Tony Williams, 50, is always doing and it’s also the name of his company, Always Running, where he helps people safely reach their fitness goals. “We stress taking care of your body first,” says Tony, and he often suggests Virginia Mason to clients when they have concerns or get injured.

About 15 years ago, Tony was out for a run and had so much pain in his leg he had to stop after a quarter mile. At Virginia Mason, dead cartilage was found behind Tony’s kneecap, probably from an injury he had sustained 10 years earlier when his knee took the brunt of a collision with a light pole. The dead cartilage was cut away and holes drilled into the bone to create “trauma,” allowing scar tissue to form so the knee would essentially repair itself.

Tony was told that when the knee was fully healed, it would be as good as new. “Today the only way I can tell which knee had the problem is to look for the scar,” he says.

As a trainer, Tony found that many of his clients returned to training too soon following surgery, either because they were ignoring or hadn’t fully comprehended their doctor’s instructions. He began to go to appointments with his clients so he could hear the instructions they were given and could work with them more effectively.

When he sat in on the appointments, he says the medical people at Virginia Mason never had the attitude of ‘you’re just a coach.’ “They’ve always welcomed me, and we’ve had a lot of great outcomes because we’re all working together to help the patient,” he adds, “I like that they are very straightforward. They say, ‘this is what the problem is, this is what you need to do and this will be the outcome.'”

Tony is well known in the fitness community and says he gets calls every week from people asking where they should go when they’re having a physical problem. “I always tell them Virginia Mason,” says Tony. “They’re the best.”

This story originally appeared on Meet other patients who got back to the activities they enjoy with the help of an expert medical team from Virginia Mason Orthopedics and Sports Medicine.