P1070534Q: I switched to minimalist shoes some time ago, and in the beginning they really helped. Recovery time after long runs shortened, and constant issues I had with my IT band simply disappeared. Unfortunately something has gone badly wrong lately,and for whatever reason I’m getting constant problems with my Achilles tendon. I did a lot of reading about natural running, watched several videos about it, tried to follow their approach, but the issues with my tendons are always present, to the point I may give up running. I recently saw a sports doctor because of this problem, and he told me all this “natural running thing” is just a fad, that the heel was designed to absorb impacts, and since I overpronate, I should be buying structured shoes to help correct the problem. I am really confused.What should I do?

SD: The heel absorbs impact? That’s news to me. Actually it’s proper pronation of the foot and natural and essential lengthening of the Achilles which deal with much of the impact force. When a person’s body is used to wearing traditional shoes with an elevated heel for so long, their Achilles tendon shortens. If that person switches to a minimalist-type shoe faster than their body can adapt (and their Achilles can lengthen), then a problem in the tendon can result. There are two things you can do to help this problem you’re having. One is to try just a bit more shoe to see if that lessens some of the Achilles tendon pain. So if you’re in a zero-drop shoe, try a 4mm drop. If you’re in a 4mm drop, try a 6-7mm for a bit, but only if it helps while the tendon heals. The other thing you can do is look for trigger points to massage out with deep pressure in the calf muscles, especially lower in the calf (soleus) just above where the Achilles tendon starts and 2-4″ higher up in the lower leg. Stay off the Achilles tendon and look for points in the calves instead, massaging any sore spots out for 30 or so seconds. You might also find compression socks to benefit you as you heal up – making it three things you can try!


Q: I currently wear arch orthotics in my running shoes. But after reading some of the articles on this website, I now want to switch out of the orthotics and transition from a elevated-heel running shoe to a transition shoe. Should I switch out of the orthotics first and transition to the transition shoe later or switch from the elevated heel with orthotics to the transition shoe without orthotics completely? Either way, should I still transition 10% mileage per run? Or is this too difficult to recommend without seeing the condition of my feet?

SD: The transitional phase is different for each individual. Typically in my office I have my patients get rid of their orthotics immediately so their foot is no longer in a dysfunctional-supported state. I’ll have them remain in their same shoes for some time during this period unless the footwear they are currently wearing is hindering their movement (think women’s high heals or very thick and stiff shoes for both men and women). During this transitional period I have my patients walk and move barefoot in their house and at work as much as they comfortably can. Once they’re able to remain barefoot without any problems for an extended period of time, I’ll have them move into a transitional shoe. The only exception to this is if the current footwear is limiting their ability to go barefoot more often. I always recommend moving to less shoe as quickly and as comfortably as possible. Since this is different for everyone, I personally don’t use the 10% rule as some can progress much faster, and some much slower, than any set number.


Q:Is there a long-term risk in taking either Advil or Tylenol on a regular basis? It just seems that whenever I up my weekly mileage to include runs over 10 or12 miles, I get a sharp pain just below my left knee. So I pop a pill  or two when I get home.  The next morning, most of the pain has seemingly vanished, though the area still feels stiff and not quite right. But after two days of rest, except for some walking of a few miles, my leg feels fine. I want to do an ultra some day. Please advise, Sock Doc!

SD: Absolutely there is a long-term risk particularly with NSAIDs (nonsteroidal anti-inflammatory drugs such as aspirin, naproxen, and ibuprofen). Some of the risks include gastrointestinal, (they have found fecal bacterial in the blood of ultra-marathoners taking NSAIDs), cardiovascular, musculoskeletal, and renal (kidney) side-effects and complications. NSAIDs require sulfur  to be properly detoxified by the liver. Sulfur is needed to make glucosamine sulfate and chondroitin sulfate which helps facilitate cartilage repair. The amino acid L-cysteine is very high in sulfur and can sometimes be of great benefit as a supplement, and it’s also high in protein-rich foods like eggs and whey protein.  Sulfates are high in foods such as broccoli, cauliflower, garlic, cabbage, onions, radishes, and mustard. Proper levels of magnesium, vitamin B12, vitamin B6, (in its active form of pyrodixal-5-phosphate), and folic acid, (also typically in its active form of 5-MTHF), are also needed for proper sulfation.

If you’re having a knee problem you very well may be creating more problems in that joint (and others) the longer you take these meds. Sulfation is also how you detoxify cortisol, a common stress hormone that your body makes to help balance your blood sugar and deal with inflammation. I always tell my patients that if you ever feel better from taking any anti-inflammatory then it’s a sure sign that you’re suffering from an inflammatory condition, otherwise you’d see no effect taking the drug. So look to your diet, lifestyle, and training as sources of too much stress and inflammation because if you keep on the path you’re on now,  it’s only a matter of time before you become seriously injured and can’t run at all.


Sock Doc is Dr. Steve Gangemi. His site Sock-Doc.com is a great resource for injury treatment and prevention.