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Meet Dr. Feet

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Meet Dr. Feet
Published June 27, 2007

The pain in Mike Levad’s heel first pricked up after the Twin Cities Marathon last fall. “It felt like someone had whacked my heel with a hammer,” he said, describing a pain that shot through his foot and up the leg when he got out of bed in the morning.

In April, Levad ran the Boston Marathon.

“I finished in 3 hours, 5 minutes and 46 seconds,” said Levad, a 38-year-old museum-exhibit developer from Minneapolis. “But then the pain in my heel got worse.”

Levad is victim of an injury caused not by a one-time traumatic incident, but by the repetitive strain of feet pounding pavement. Indeed, during peak training times, runners such as Levad tick off 30, 40 or more miles in running shoes each week, striking foot to road tens of thousands of times. The abuse can affect the physiology of the foot, creating conditions unique to the running world that—as in Levad’s case—are difficult for some doctors to diagnose or treat.

That’s where Dr. Paul Langer comes in.

As an avid runner as well as a podiatrist, Langer combines medical knowledge with a personal athletic expertise. He practices with Minnesota Orthopaedic Specialists in Minneapolis and also serves as a clinical faculty member at the University of Minnesota Medical School. As a runner, Langer has been at it for more than 20 years, with two dozen marathons, several triathlons and the Ironman under his belt.

“Running is a passion,” said Langer, a 40-year-old who lives in Minneapolis with his wife, Michelle, and his training buddy, Ripley, a lab mix.

Patients such as Levad, who started seeing Langer last month, are sometimes dissatisfied with the diagnosis or treatment of non-running doctors.

“My first doctor prescribed something that didn’t end up helping very much,” Levad said. “I needed someone with a more precise knowledge of the stresses that running puts on the feet.”

For Langer, the journey from a non-runner to a local expert on the foot in motion began as a sophomore in college when he noticed his pants getting tight.

“I was putting on a couple pounds, and I decided to start running,” he said.

A job at a running store during medical school further piqued Langer’s interest toward the foot. He was fascinated by running and the human gait.

Since graduating from Des Moines University as a Doctor of Podiatric Medicine in 1999, Langer has cultivated a niche as a local expert on running, the foot, athletics shoes, and all things medical in that orbit.

He has presented at symposiums for organizations such as the American Medical Athletic Association. His seminars have titles such as “Understanding The Biomechanical Effects of Running Shoes” and “Running Biomechanics and Running Shoes.”

Last year, traveling to the Gobi Desert of China, Langer was part of the medical staff for the Gobi March 250K race, a multiday ultra-running event. He was the podiatry consultant for “Running The Sahara,” a documentary about trying to cross the Sahara on foot.

But for runners such as Levad, the credentials are secondary to Langer’s main purpose: getting injured runners back on the go.

To Levad’s surprise, after an initial appointment about his heel pain, Langer recommended Levad to keep running, albeit cautiously.

“The heel didn’t hurt actually when I ran, so Paul said to keep training,” Levad said.

The diagnosed condition—a common heel malady called plantar fasciitis—meant Levad had inflamed the fascia tissue on the bottom of his foot.

Instead of recommending more padding in his shoe, which is what Levad’s first doctor suggested, Langer prescribed a specific running shoe type with less padding but more support. In addition, special insoles were employed to keep the foot aligned.

“Running in shoes that are too cushioned causes more injuries than running in shoes that are more stable,” Langer said. While a large cushion feels good, it’s often unstable, causing the runner to land on a surface that collapses and bends. This scenario is less efficient at absorbing impact, potentially leading to injury.

During Levad’s follow-up appointment earlier this week, Langer inspected the injured heel by poking and squeezing his patient’s foot. “Is this where it hurts now,” he said, a finger pressed firm on pink flesh.

Langer asked the patient about recent runs and the effect of the custom footbed. He tweaked a foam shim for Levad’s arch area.

Thinking out loud, Langer mentioned something called a night split, which demobilizes the foot during sleep, but then he took it back.

“Let’s try some pain management first,” he said.

Langer, who is conservative with treatments such as cortisone injections, advises patients to give injuries an opportunity to heal with methods such as better shoes or supportive insoles. But it was Levad’s third appointment, and he had been in pain for several months.

A needle was produced for medicating the heel. Before administering a shot of cortisone, the doctor joked with Levad that a 3:05 marathon runner should be able to handle the pain of a needle.

“I’m poking now on the calcaneus,” Langer said, a needle prodding under skin. “Hopefully, this will get you back running this week, feeling better on your feet again.”

SIDEBAR: Notable New Products
Dr. Paul Langer of Minnesota Orthopaedic Specialists is an avid runner and self-professed shoe geek. Plus, twice a month he works a shift as in-store physician at Marathon Sports in south Minneapolis, where he stays current on new products and running trends. Here are four footwear items that have caught his attention as of late. . .

Newton Running shoes—Lugs that extend from the base of the forefoot region on the sole of these shoes cause athletes to mimic a barefoot-running style.

Swiss Masai Inc.—These strange rocker-bottom shoes keep your gait smooth but somewhat unstable, working more muscles in the legs and reducing joint stress.

Adidas_1 shoe—This shoe, introduced in 2005, uses a tiny internal computer to adjust compression characteristics of the heel pad during each stride.

SOLE Custom Footbeds—These anatomically-unique insoles are molded at home with the aid of a conventional gas or electric oven.

SIDEBAR: Top Running-Related Injuries

1. Shin splints (overused muscle or inflammation of connective tissue on shins)

2. Plantar fasciitis (inflamed tissue at point where fascia connects to the heel bone)

3. Knee injuries (multiple scenarios; often stressed ligaments or cartilage)

4. Stress fractures (small breakage/cracking of bones most common in metatarsals or tibia)

5. Achilles tendonitis (inflammation of the tendon or tiny microscopic tears in the tissue)

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