Wednesday, December 18, 2019

Episode 29: Healthy Holidays! with Dr. Brian Fullem of Elite Sports Podiatry

Episode 29: Healthy Holidays! with Dr. Brian Fullem of Elite Sports Podiatry is available on most podcast apps, including Google, Anchor, Spotify and Apple

Links: Elite Sports Podiatry and his book, Runner's Guide to Healthy Feet and Ankles

Dr Fullem (interviewee,Left) and Mark Lane-Holbert (interviewer, Right)
outside his Practice in Clearwater, FL

In this episode, we dive into healthy practices, prevention and treatment of most common runners' injuries, and Dr. Fullem is a font of knowledge on most all running experience and athlete concerns from many years of practice and current research.  Dr Fullem is Board certified in Foot Surgery with specialization in tendon injuries including the use of Extracorporeal Shock Wave therapy. Dr. Fullem has experienced tremendous success using shockwave therapy for injuries such as Plantar Fasciitis, Posterior Tibial Tendon Dysfunction, Achilles Tendonosis, Medial Tibial Shin Splints and Peroneal Tendonosis.
Dr. Fullem practiced in Connecticut for over 20 years before moving to Florida in 2010 and in November, 2014 he started a solo practice, Elite Sports Podiatry.  While in CT, Dr Fullem served as the Team Podiatrist for the Yale University Track team and Sacred Heart University Athletic Department.  Dr Fullem also co-founded a running camp for HS athletes in Connecticut that is still in existence, The Running Academy.
Dr Fullem has a passion for treating athletes and frequently lectures nationally on the subject and has published several articles in peer reviewed medical journals on subjects ranging from Plantar Fascia ruptures, Navicular Stress Fractures and is co-author of a soon to be published article on the effectiveness of shock wave therapy in the Journal of Bone and Joint Surgery.  Dr Fullem has also published extensively for national running magazine Running Times. Dr Fullem has also authored chapters for two textbooks: Foot and Ankle Sports Medicine by Dr David Altcheck and International Advances in Foot and Ankle Surgery by Dr. Amol Saxena.
Show notes and details of his answers provided prior based upon Running Anthropologist's questions:
RA: Why did you choose or how did you get started on the path of podiatry?   

Dr Fullem: I entered college as a Chemistry major with the goal of doing Sports Medicine.  My Freshman year at Bucknell University I was running an indoor track 2 mile race and coming off the final turn I felt a pop in my foot.  It did not hurt at the time and I was able to sprint in and ran a big PR of 8:59.  My foot started to hurt a little on the warm down and was sore when I went to bed but the next day I fell down when I jumped out of top bunk of our dorm room due to the pain.  I went to the local Ortho and he gave me a cortisone shot and said it was Plantar Fascitis (in retrospect it was a plantar fascia tear but there was no such thing as an MRI at that time).  The shot was his only treatment and I was able to get back to running but a few months later after racing a 10K in spikes on the track my foot was just as painful. A Podiatrist that ran for Bucknell 10 years before I did was in practice in CT and my Coach sent me to him and he provided a much more detailed treatment plan including stretching exercises and custom foot orthotics.  That is when I decided Podiatry was the field I I wanted to go into.

RA: Has your own sports or running background played a role in your chosen profession, or how you approach it?  

Dr. Fullem: I know that my background helps a great deal in my treatment of patients, I hope it allows me to feel and express an empathy for my athletic patients.  I try and treat every single patient that walks in my door as if they are an athlete.  There was a great Doctor named George Sheehan, he was an MD that loved to run and he wrote books about the spiritual and mental aspects of running, I started reading his books when I was in HS.  Dr Sheehan has a lot of great quotes but my favorite is 
"Everyone is an athlete. The only difference is that some of us are in training, and some are not." A big part of sports medicine is trying to get athletes back to their sport as soon as is safely possible. I encourage all my patients to exercise even if it is just walking 30 minutes a day.

RA: Regarding the book, why did you embark upon writing this and how long did it take to put together?    

Dr. Fullem: I met Scott Douglas around 1994 or so, he had just become editor of Running Times magazine in Wilton, CT and I was practicing in Bridgeport, CT at the time.  We were introduced by mutual friends and  we ran a lot of miles together. I think he asked me to write my first article for Running Times around 1995. I am not sure I have a copy of it and I have been unable to find it on the internet but it was article focused on the fact that running shoes have too high of heel height, way before the Minimalist movement but the thought of that article was running and walking around in running shoes with a 12mm or higher heel height helps to shorten the achilles tendon which may help contribute to some injuries like Plantar Fasciitis and Achilles tendonitis.  Scott was asked by SkyHorse Publishing to do a series of books and one was on running injuries of the foot and ankle.   Scott was invaluable to the book and I hope people realize how important an Editor is to any writing process.  I was very lucky to work with great editors at RT including Gordon Bakulis and Jonathan Beverly.  They each had their own style and I loved working with all of them.  Sadly that great magazine was bought by Runners World and then folded by Rodale.

 RA: You take a very hands-on and practical approach, including pictures and exercises combined with your years of medical expertise around various conditions... Would you mind sharing what you see most often in distance runners? 

Dr. Fullem: I would say that heel pain is the number 1 injury that I see in runners and in the general population.  I think there are a number of factors that contribute to it but for runners the number 1 cause of most injuries is overuse. I am very lucky for my practice and in life that I am married to Annemarie, she is a great Physical Therapist and she contributed a huge amount to the book and sees some of my athletic patients on top of her regular job working in the Neonatal ICU at Morton Plant Hospital.  Annemarie is a very gifted artist, she drew the illustrations for my book and demonstrated most of the stretches and exercises in the book. She has taught me so much about rehabbing people that it has definitely made me a better Doctor. 

 RA: Among a few of these (achillies or plantar fasciitis, for example) what are some of the solutions that most often work for runners?  

Dr. Fullem: Most important for any injury is early intervention.  As soon as there is swelling or pain there should be some sort of intervention - icing, relative rest, a Doctor's visit.  My rule is that if you have pain during a run that is consistent then you should not be running because it is going to lead to compensation and sometimes the compensatory injury is worse than the original injury.  I have written about treatment of some of my patients with their permission for my Running Times articles. Rich Kenah, the current Director of the Atlanta Track Club won 2 bronze medals in the World Champs in the 800 and represented the US in the Olympics in 2000.  After his world champs medals in 1997 Rich developed pain in his foot, which in retrospect was a stress fracture of his Navicular, while compensating for that injury he developed a stress fracture of the 4th metatarsal. Rich had a very long lay off, he did not want surgery to fix the Navicular so he opted for conservative treatment and I think he was non weight bearing in a boot and used a bone stimulator for about 3 months.  Amazingly after not running a step for most of 1998 he was able to come back and make the Olympic team in 2000!

RA: Can you provide some tips for these common problems?
Dr. Fullem: 1. Heel pain - keep the foot supported, ice and stretch daily. I recommend rolling over a frozen water bottle and do the wall stretch for the calves. Do not hang off a step as the PF is really a ligament. KT tape is a great addition as well.
2. Achilles pain - if there is swelling then stop running! Stretching only helps a small amount.  It is important to figure out the cause and sometimes it is the Glutes not firing properly.  Also after 2 weeks a tendon is no longer inflamed but is actually degenerated.  So eccentric strengthening is important to rehab an achilles tendonopathy - eccentric means the tendon is lengthening and firing at the same time.
3. Stress Fractures - some people think that if they have a fracture they would not be able to run and that is not true.  Endorphins are powerful pain killers.  If you see swelling on top of the foot especially and the pain gets worse with activity then a stress fracture might be developing. Vitamin D is very important to supplement with for a runner IMO and the medical literature supports that. 

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