The Clinic.

Q. Light On Your Feet

I recently got a new pair of sport orthotics. They replaced my original pair that dated back to 1987. Since that time my foot structure has become flatter, so the new orthotics offer more support but are much heavier. They feel great to run in but I wonder if they will slow my race times. I am considering using the old orthotics for races, but if I run more efficiently in the new ones maybe this compensates for the additional weight. I am 59 years old and need all the help I can get when I race. Any suggestions?

Arnold van der Schalie

Hazel Green, AL

A. The difference in weight from one orthotic to another really should be negligible, not more than a few ounces. Also, since 1987 shoes have become lighter as new materials have been developed. If your mechanics are noticeably improved with your new orthotics, I strongly suggest that you stay with them. You should be fine with a newer, more comfortable (if slightly heavier pair), which will also help protect you from injury If you have the perception that you are slowed down by the extra weight, ask your doctor about using a carbon-reinforced fiberglass material (which is extremely lightweight) to make your orthotics.

Gene & Mirkin, D.P.M.

Kensington, MD

Q. Fluttering Racing Heart

I am a 51-year-old male, 6'2", 170 pounds. I've been an avid runner for 22 years, usually covering about 30 miles a week. For the past 15 years I've known that I have a mild mitral valve prolapse (MVP), with premature ventricular contractions (PVCs) that I can feel. These come and go.

Sometimes I have several days with none; at other times I have PVCs on and off all day. This year for the first time I've been having short (15 seconds to a minute) episodes of supraventricular tachycardia (SVT) when running, confirmed by a stress treadmill test. They follow the same random pattern as the PVCs, but only occur when running.

I know that I'm having an SVT when my legs suddenly become very tired, although I haven't changed my pace. I can feel my heart thumping harder and faster than usual. If the SVT is more than just fleeting, I stop and walk for a minute or two and it goes away and I can resume my run.

I'm not taking any medication for this problem. I don't smoke or drink alcohol or caffeine. I know that stress and psychological factors can have an affect so I try to maintain an even keel and keep the challenge to my running in perspective. If I have to walk during a run, it's okay

Can you give me any better understanding and possible treatments or behavioral changes that can help?

Joel Schartzer

Goshen, IN

A. First of all, it is not entirely clear whether mitral valve prolapse is associated with PVCs and SVT. In the past, it was thought that MVP caused arrhythmias, but more recent studies have cast doubt on the association. At any rate your MVP is mild and therefore does not impair your heart's function.

There is tremendous variability in the symptoms people experience with cardiac arrhythmias. Some people are nearly incapacitated with what appears to be a fairly minor disturbance whereas other people can be completely asymptomatic despite the presence of a rather severe arrhythmia. Your feelings of weakness are clearly related to your SVT episodes. It is not understood why one person would have that experience and the same arrhythmia in another would not produce any symptoms. The natural history of these conditions is widely variable as well. Arrhythmias can lie dormant with occasional flare-ups, or produce regular occurrences. They can be mild early in life worsening with age, or have the opposite progression. It is not known why arrhythmias behave this way.

You have eliminated many things known to aggravate the condition including alcohol, caffeine, and certain over-the-counter cold and sinus medications. Medications can be highly effective, including beta blockers, digoxin, and calcium channel blockers. All medications have side effects but often one medication will be well-tolerated. You can't know how you will respond without a trial.

A certain kind of SVT (known as dual AV nodal re-entrant tachycardia) responds well to a procedure that places a catheter into the heart from one of the blood vessels in the leg or arm and delivers electrical current to the irritable focus to cure the arrhythmia. This procedure is highly effective for treating SVT although there is a small risk of complication with the procedure. You should discuss the possibility of this treatment with your cardiologist.

Todd D. Miller, MD.

Rochester, MN

In general, the importance of seriousness of arrhythmias depends on whether they occur in a person with a normal heart or one with heart disease (like a heart attack, a scarred heart, or heart failure). Mild mitral valve prolapse would not place you in die second category. Although your symptoms may be a nuisance, they are unlikely to have serious consequences.

Charles Schulman, MD.

Brookline, MA

Q. Protein Diets for Weight Loss

I run about five miles a day, eat a high fiber, low fat diet, and drink about three quarts of water daily. My wife would like to lose weight and has been convinced to try one of these high protein diets: no carbohydrates, fruit or vegetables, just basically meat and dairy. This sounds very unhealthy to me, but those who push the diet always have an answer and my wife is ready to sign on. Do you have any advice?

Joseph Morgan

Minneapolis, MN

A. The high protein diets, so popular today, do not provide the protective nutrients available from plant-based foods--phytochemicals, antioxidants, and dietary fiber. The reason you lose weight on high protein diets is that often these diets are lower in calories than what the person is currently eating. Some of these diets are around 1,400 to 1,600 calories. Another reason you may lose weight on high protein diets is that you lose water initially. Carbohydrates tend to store water in our body. When weight plateaus and you do not continue to lose weight (as is often the case) many try to find another way to continue to lose weight. If you return to your old diet, you'll put lost weight back on.

Controlling or losing weight is complex but for most people the key is to have a greater energy output than calorie intake. You mention that you run, but didn't mention your wife's activity level, nor her current eating pattern. If she does not exercise regularly she might consider increasing her activity. She might walk for the same amount of time as you run, working up to that amount gradually.

Without increasing activity, food intake must be adjusted. A nutritious, well-balanced diet according to the Food Guide Pyramid is about 1,600 calories a day to maintain weight for a sedentary woman. If your wife has a higher calorie intake, changing to the recommendations of the Food Guide Pyramid may result in pounds lost, safely and with adequate nutrition for good health. A healthy diet includes six, half-cup servings of bread, cereal, rice, or pasta; two servings of fruit; three servings of vegetables; two servings of low fat or non fat dairy; and five ounces total of lean meat, fish or poultry.

The bottom line is that it is often easy to lose weight. The challenge is to keep it off. Help your wife find a way that works for her, not just now, but for the long run. She may only need to adjust portion size, learn lower calorie choices within each food group, and get more active to lose the weight she wishes to lose. A trendy high-protein weight-loss diet, which excludes nutritious fruits, vegetables, and grains is not a healthy diet. A healthy diet that includes a wide range of foods will also provide the benefits of reduced risk of coronary artery disease, reduced cancer risk, healthy blood pressure, more vitality and adequate calcium intake to help prevent osteoporosis.

Your wife may benefit from a consultation with a Registered Dietitian in your area. You can check with your doctor for a referral or call a local medical center, medical university or AR&FA at 1-800-776-ARFA.

Mary Jo Feeney M.S., R.D., F.A.D.A.

Los Altos, CA

Q. "Slap Foot" Can Be Serious

I am 69 years old and an avid runner. I recently completed the Pike's Peak Marathon and six triathlons. Two months ago, while participating in a Senior Olympics Race Walk event, I developed pain in my right ankle. I had to hobble off the course as the pain became excruciating. X-rays taken at the time of injury and again a few weeks later showed no stress fractures.

Since the injury, I have been walking and riding the road bike. About a week ago, I attempted to run a 5K after adequate stretching and warm up. As I neared the end of the race my ankle started to hurt. I stopped in time to prevent further injury. Now my right foot has a "slap" to it when I try to run, as if I were running flat-footed. I can't seem to correct it by landing on my heel first.

I have been cross training with swimming and bike riding but I really hope to get back to running. What can I do to heal from this injury?

Oakland A. DeMoss

Fort Smith, AR

A. You may be suffering from chronic tendonitis of the posterior tibialis tendon. The tendon extends deep behind the arch of the foot. Its function is to stabilize the foot and hold up the arch as you run and pound the foot at two to three times your body weight. The tendon can give out with a complete rupture, and when it does the foot goes flat as the arch drops. Then you notice your "slap foot" problem.

I have to say that this is potentially a very serious problem and can develop into adult acquired flat foot syndrome. Other possibilities include nerve damage that can result in the same foot slapping that you've noticed. I recommend that you stop all activity and see a sports medicine orthopedist or podiatrist right away. Even your cross training activities can aggravate this problem.

An MRI can confirm this diagnosis, provide information about the extent of the injury, and distinguish between inflammation or rupture. Treatment can include ankle/foot orthotics, night splints, physical therapy, and a removable cast. Hopefully you have not done permanent damage. Please see a professional right away. Your level of activity has been tremendous and I hope that with treatment you can return to your inspiring schedule of competition.

Joanne Davis, D.P.M.

Chicago, IL

A. You have developed a foot drop, which can arise from inflammation or rupture of the anterior tibialis tendon or the extensors of the toes. Another possibility is exertional compartment syndrome associated with a tear in the compartment fascia and muscle herniation. An L4-5 disc herniation or spinal stenosis could also cause your problem. In any event, you have a serious problem that demands a thorough evaluation by a sports medicine professional, either an orthopedist or a neurologist. Please get the help you need as soon as possible.

Mitch Goldflies, M.D.

Chicago, IL

Ask the Clinic!

Are you bothered by an injury? Do you have a training or diet question? If so, ask The Clinic, in care of AR&FA, 4405 East West Highway, Suite 405, Bethesda, MD 20814, FAX [phone], e-mail [e-mail]. Free personalized sports medicine, training, and diet advice is an exclusive benefit for AR&FA and AMAA Members only. AR&FA has more than 255 Clinic Advisors representing more than 27 specialities. Include 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. Handwritten FAXed letters will not be accepted. Include your address and phone number in case the Advisor has additional questions or would like to discuss your case with you. Responses usually take three to four weeks, but can take as long as five.