Recently, my blistered and bloodied toes from marathon training led me to Dr. Bryon G. P. Butts, DPM, of Performance Footcare of New York, just a short limp away from the Flatiron at 36 West 44th Street (between 5th and 6th Avenues), Suite 1216 (212-768-0012). Not only did Dr. B hook me up with some gel toe sleeves and other advice, he was happy to answer a few questions and introduce himself to my running friends and colleagues.
What makes your practice unique? Performance Footcare prides itself on providing the most up to date treatment methods for your sports medicine ailments. We have in-office digital X-ray, diagnostic ultrasound, physical therapy modalities, and shockwave therapy. We provide treatments ranging from physical therapy to surgical management. Plantar fasciitis treatment has advanced as well. The basics are the same: proper stretching, strengthening, icing, NSAIDs (both oral and topical), orthotics/insoles, proper shoe gear, night splint, and occasionally steroid injections. Advanced treatments Performance provides include shockwave, Topaz, Tenex, and PRP.
What percentage of your patients are runners? About 40%. I’m busier before the major marathons and halfs.
Why this specialization? Are you a runner yourself? I grew up participating in many sports, track being one of them. I have always been passionate about athletics. I grew up idolizing track athletes like most people do football, basketball, and baseball stars (Carl Lewis, Evelyn Ashford, and Edwin Moses were favorites). Swimming was my first passion. I competed through my four years at Harvard where I ended up spending a good amount of time in the training room. I saw firsthand how rewarding it is to keep athletes on the track, field, court, or pool. I always knew I wanted to be a doctor, and sports medicine allows me to aid in the treatment of athletes. My college girlfriend actually broke her foot while competing in track. After casting failed to heal her fracture she ended up having foot surgery with a podiatrist. That was my first link to the profession.
In a survey this month thirty percent of our club members said they suffered from plantar fascitis. Is this an equally common ailment among your patients? What are your other most popular injuries? Plantar fasciitis is both the most common problem I treat and my favorite pathology to treat. It is very difficult to improve a foot problem when runners take over 10,000 steps a day on their heels. Other common injuries among my athletes: Achilles tendinitis, stress fractures, ankle sprains, painful flatfeet, Morton’s neuroma, blackened toenails, ingrown toenails, athlete’s foot/smelly feet.
Do you have any good tips for helping us find the right size and style of running shoe? First thing that most runners know: there is no perfect shoe for everyone. Runners must start by shopping at a reputable running shoe store. Running specialty stores can guide you through general ideas of which shoes will work for you. They can look at your foot type and gait to see which types will work best. I recommend shopping for shoes in the afternoon or evening. Your feet swell during the day, so it is not a good idea to try to fit yourself for shoes in the morning. You should try multiple pairs during the visit. I also recommend trying two different shoe on at a time if you cannot decide between two pairs. You should wear running clothes and try the shoes on the treadmill. People don’t buy cars without a test drive. I believe that same thing goes for you shoes.
Do you recommend having more than one pair in use at a time? I do recommend having more than one pair of shoes. Many runners have their distance work running shoes and lighter, speed work running shoes. Recent studies show that even having two pairs of shoes of the same type of running shoe can lessen the chance of injury due to small variations in the way the shoes support and protect your feet. I have a list of shoes that I provide my runners at the end of their initial visit with recommendations of shoes to try on their next visit to the shoe store.
In general do you think your patients wait too long before consulting you about a foot issue? My experienced runners do a pretty good job of keeping themselves healthy through their routine: stretching, icing, NSAIDs, proper shoes, compression, taping/strappings, and supplements. Many of my runners come to their first appointment already knowing their diagnosis. I think my biggest difficulty is trying to SLOW THEM DOWN. I can manage some patients with treatment while they are training, but some require either a reduction of their mileage or a complete shut down for weeks or even months. This all depends on the diagnosis. My rule of thumb for my possible patients: if your home treatment doesn’t help a nagging mild/moderate pain OR if your pain continues to worsen or becomes severe, it is time for a visit to your sports doctor.