The Clinic.

RETINA REPAIR AND RUNNING

I recently had surgery to repair a detached retina. I have not been running for six weeks during the recovery. My. surgeon is concerned that my running could cause the other retina to detach (most other activities are okay). Is it likely that running is a risk factor for me?

Barbara Pike

Concord, MA

Several years ago the American Retina Society members were polled with two questions. One, do you think running causes retinal detachments? The answer was overwhelmingly-no. Two, do you allow your patients to return to running after retinal detachment surgery? The answer was overwhelmingly-yes.

Running does not cause retinal detachments. Usually they are due to weak spots, holes, or tears in the retina. These in turn are usually caused by traction from the jelly-like substance in the back of the eye. Runners do not have retinal detachments more than non-runners do. And, as the number of runners has increased in the last two decades, the number of retinal detachments has gotten much smaller, not larger.

Discuss your concerns with your present ophthalmologist. If there are areas in your other eye he is concerned about, these can usually be bolstered or strengthened by laser treatment or freezing (cryopexy). If your doctor remains adamant then seek a second opinion with another retinal specialist. I would try to find a doctor who believes in the value of exercise.

Having a detached retina in one eye dramatically raises the risk of a detached retina in the other eye. The risk in everyone-runners and non-runners-is 10% to 15%. However, running in my opinion, and in the opinion of the majority of retina surgeons, is not a significant risk factor.

John Hagan, M.D.

North Kansas City, MO

STRANGE SYMPTOMS CAUSING CONCERN

I am a 38-year-old male, 5'9", 170 pounds. I have been an endurance athlete for 18 years. Until about two months ago, I trained about five to ten hours a week. I ran 15 to 20 miles per week and cycled 50 to 100 miles a week.

Something is creating strange symptoms in my left leg. A physician-friend told me it has something to do with sympathetic nerves. I have numbness on the surface of my leg, coupled with pain, arbitrary temperature change in the surface of my leg and occasional burning sensations. It is better in the morning, and worse at night. It's worse after sitting for a long time, and there are occasional sharp, needle-like pains. Despite a steady regimen of chiropractic care, stretching and anti-inflammatory medication, there has been no improvement. Please help!

Bradley Stern

Sacramento, CA

The symptoms that you complain of may be secondary to a pinched nerve in your back or your leg. A condition called reflex sympathetic dystrophy (a problem of the sympathetic nervous system) may be causing the skin temperature changes you are experiencing.

Another cause could be spinal problems such as arthritis or disc herniation, which can irritate nerves that cause numbness and weakness in the affected extremity. (A leg fracture or sprain can also irritate or damage nerves causing the same symptoms, but you haven't mentioned any acute injuries.) Realistically, reflex sympathetic dystrophy can be caused by many types of nerve problems, and also by problems that I doubt you have like stroke and diabetes.

What you really need is a good clinical exam, appropriate x-rays, and a nerve test called an EMG. Most problems that may be causing your trouble are self-limited and ultimately resolve with appropriate care including medication, rest, and physical therapy. Please find a board-certified physiatrist, neurologist or orthopedist and get to the bottom of this, and then begin an appropriate treatment plan. Work with your physician to get your health back. Sports medicine isn't always straight forward, so be persistent in your diagnosis and therapy.

Daniel S. Rosenberg, M.D.

Trenton, NJ

FOOT MISERY AT MIDNIGHT

I have recently developed quite severe cramping of my left instep. The cramps hit when I'm asleep and are severe enough to wake me several times a night. I try pulling my toes back but this only partially relieves the cramping. The pain seems very deep and localized. I've been running for 25 years (now about 20 miles per week) and have never experienced this problem. Also I can't think of anything I have done differently lately to cause a new problem like this. My shoes are in their "mid-life" and I've been wearing the same type of insoles for years. Please help.

Rob O'Connor

Hudson, OH

One possibility is that as you age, ligaments, tendons, and fascia lose their elasticity. The foot tends to widen and the longitudinal arch on the instep of your foot tends to flatten. Running increases the stress on your ligaments and muscles that support the arches of the foot.

Cramping can be the result of muscle overload in their attempt to maintain the normal biomechanical foot function. This overload will produce an involuntary muscle contraction that can occur when the fatigued muscle is at rest.

Massage and gentle prolonged stretching will usually alleviate the immediate symptoms or spasms. Strengthen the muscles supporting the arches with exercises such as towel-rolling and marble pick-ups with your toes. Resistive sand exercises are also good. Special taping for the longitudinal arch (done by a physical therapist or podiatrist) may be of benefit to give additional support. Orthotics or shoe inserts to restore the normal biomechanics of the foot and prevent over-pronation may also be helpful.

Carol Hamilton, M.S., P.T., O.C.S.

Frederick, MD

Nighttime foot cramping can be due to several conditions relating to muscle, nerve or metabolic problems. One of the most common explanations for muscle cramps is relative dehydration. Many runners are chronically dehydrated, not consuming the 12 to 16 glasses of water per day suggested for the moderate runner. Further, self-imposed salt restricted diets may not allow adequate absorption of the water we do ingest. More liberal use of salt is probably okay if there are no medical contraindications such as hypertension.

A neurological problem occurring in the foot or ankle, and even from the lumbar spine, may be the cause of the nocturnal cramps. Clearly, if the symptoms do not improve with simple home measures, a more detailed medical assessment is necessary to sort through these and other potential causes of the foot cramping.

Stuart Weinstein, MD.

Seattle, WA

REHAB AFTER PLANTAR FASCIA SURGERY

Three weeks ago I had an endoscopic plantar fasciotomy after over a year of stretching, icing, taping, ultrasound, night splints, and finally a month of immobilization in a cast. I would love to return to running. I had been doing about 25 miles a week for 15 years. I am 45 years old and want to do everything possible for my recovery to progress to running again. I haven't run for over three months. I have been cross training with a stair machine and kickboxing (in a Bledsoe boot).

Linda Wright

Savannah, GA

It is disappointing that your trouble with plantar fasciitis did not respond to conservative care; however, you have every reason to be optimistic about running again. Endoscopic plantar fasciotomy, when done appropriately, can produce a full return to running. Your rehab will be to avoid overuse as you return to normal activities including sports. Flexibility continues to be of extreme importance. I suggest that you sleep in the night splint for up to 12 weeks after your surgery. Continue stretching, and ice can be used as needed after activity, but avoid anything that involves enough activity to cause pain or swelling. You should continue to wear orthotics for all sports and use them throughout the day for at least six to eight weeks.

Gene S. Mirkin, D.P.M.

Silver Spring, MD

Rehabilitation from plantar fascia surgery should introduce impact very gradually. Start off with a comfortable walking pace for 15 minutes every other day. (On the off days, it is okay to try cycling or swimming for cross training.) Increase your walking pace until you are covering one mile in 15 minutes. Then begin to increase duration so that you are walking up to four miles in one hour. At that point in recovery you can reintroduce the impact of running, again very gradually.

The key to successful recovery is to avoid overuse. Begin with a 30-minute walk-run in which you walk four minutes and run one minute. Slowly decrease walking and increase running until you are running 30 minutes. From that point on in your full recovery, be careful not to make increases of more than 10% in speed or distance each week.

Mitch Goldflies, MD.

Chicago, IL

ARE YOU BOTHERED BY AN INJURY? DO YOU HAVE A TRAINING OR DIET QUESTION?

Ask The Clinic, in care of The American Running Association. 4405 East West Highway. Suite 405. Bethesda. MD 20814. FAX [phone], or e-mail at [e-mail]. Write a letter Including as much relevant information as possible about you (age. weight. etc.) and your Injury (type and location of pain), training schedule (typical weekly workouts, pace, surface), athletic and medical history, sole wear, recent changes in training. etc. Type or print your letters. Hand-written FAXed letters cannot be accepted. All letters, even e-mail, must include your name, address and phone number. Responses usually take three to four weeks, but can take as long as five.