6 Things Which Can Ruin a Run: A Short List From A Never Ending Story  

  1. Not Warming Up…Properly
    “Warming up” is about more than just increasing blood and oxygen supply to the muscles before higher intensity training, although this is an important principle. Something that is more commonly over looked by runners is the priming and activation of muscles which are going to be utilized in the upcoming training session. Priming the muscles is important as it prepares them for activity after a time of rest, whether that’s sitting at a desk all day or rolling out of bed to start the day.
    Using dynamic movements which utilize the muscles that are intended to be used, provides the best outcome for running.
    Below are a number of exercises which may help you prepare for your next run:


  1. Starting Out Too Fast
    Starting out faster or harder than required can very quickly have you working in an anaerobic state and as such beginning to build the hydrogen ion levels within the muscles which can lead to a feeling of heaviness and reduced efficiency. In addition to the physiological impacts that exerting yourself prematurely may have there are also functional contributions which may lead increase your possibility of injury – namely – over-striding and increase ground contact time.

The most efficient way to combat this from happening is to have a goal for every training session you are completing including your Primary Goal of your session, the estimated duration, Intensity, frequency and intervals.
More information about the effect of these functional issues can be found on previous contributions:



  1. Poor Fueling
    How you choose to fuel for your individual session or in the lead up to a competition is just as important as your recovery and your training. Before a run, it is important to stay away from food which are high in fibre. These foods are fantastic for your overall health, however, in the hours before a run this can lead to gastronomical distress (more about that in our next section). junk food.jpg
    Refined sugars and foods which are high in simple sugar can cause a spike in glucose level, which then ends in a significant drop and a potential decrease in performance. This can be just as true for sports drinks, which may be better saved for after competition or training instead of beforehand.
    High Fat Foods can lead to indigestion and heart burn, but most of all can feel as though it takes a considerable time to digest, making you feel heavy.
    The best options when fuelling for a training session or competition is to stick to water and Low-GI foods and at the very least foods you have trialled previously on shorter runs.
  2. Getting The Runs On The Run
    As mentioned earlier high fibre foods are great for an individual’s health but for someone who is about to head out on a run it can quickly lead to looking for the nearest public bathroom.
    Caffeine is a runners best friend especially in the early morning or after work. It is also a diuretic which means that buzz can quickly become an uncomfortable shuffle as you try to decide whether to stop and walk the way home or run faster to make sure you make it in time.
    The usual suspects of poor fuelling are also the classic foods which can lead to these circumstances so play it safe.


  1. Equipment Choices
    It’s always exciting to try new technology or clothing when running, it always seems to give you a little boost! But when deciding to use these exciting newtrail run equipment.JPG products you should probably do so on a shorter course than what you may normally run.
    Why is that you ask? Let’s have a quick look at the commonly used products which tend to cause problems:
    * Over-Dressing – dehydration, carrying uncomfortable objects, over-heating
    * Under-Dressing – chaffing, running nose, sun burn
    * Energy Gels – make you thirsty, can make you feel sick
    * Runners – blistering, tissue loading, small changes in an updated shoe
    * Sunnies – fog up, fall off, give headaches
    * Orthotics and Braces – Blistering, tissue loading, changes in function
    * Drink Bottles – add weight, slip from belts, are awkward to carry
  2. Chaffing
    Coming back to equipment choices, sometimes there are positives…. like Vaseline. Chaffing is caused by repetitive friction between two body parts or the material that cover them. Chaffing may be caused by poor equipment choices like ill-fitting shorts and tops or even running technique – if your legs are passing too close together.
    However, sometimes it’s as simple as weight gain just expanding those body parts more than you were once used and that gap which was once there – now isn’t.


Until Next Time

Jackson McCosker
Director/ Chief Editor

The VISA – A: Indexing the Severity of Achilles Tendinopathy

shutterstock_243796033Given that over the last 4 years I have published at least 3 article based on achilles tendinopathy I am surprized I haven’t discussed this topic earlier. The VISA-A questionnaire was developed by some of the greatest names in tendon research. It aims to provide a measurable outcome to determine the severity of achilles tendinopathy within an individual and can be revisited post intervention to monitor the success of that which has been put in place.

The VISA-A was established using a previously developed patella tendinopathy severity index as a template, with questions and scaling adapted specifically to achilles tendinopathy based on focus group analysis and input. The focus group consisted of; two physiotherapists and a primary care sports physician.

The questionnaire consists of eight questions across three categories; pain, function and activity. The first seven questions are given a score out of 10, while the eighth question is given a score out of 30. The final result is x/100, with an asymptomatic individual receiving top marks.

A free copy of the questionnaire is available from BJSM here: http://bjsm.bmj.com/content/suppl/2001/11/09/35.5.335.DC1/01055_Fig_1_data_supplement.pdf

In the assessment of reliability and validity the following was found:

  • Reliability was found to have a p-value 0.58; no difference of score was found during the initial test or re-test.
  • It is believed the excellent reliability is due to the uncomplicated nature of the questionnaire.
  • Validity assessment showed that achilles tendinopathy patients had significantly lower scores (p<0.001) than those within the control group.
  • Continuous numerical results are ideal for comparing patient’s progress in a clinical setting.

Additionally, the VISA-A Index has transcended cultural and linguistic barriers that sometimes inhibit the reliability and comparability of research of this nature. In 2009 an advisory committee determined an English to German translation of the VISA-A questionnaire to be Acceptable. Similar to the original study, the German base reproduction showed moderate to excellent test and re-test reliability.

A quick one for this week and more for the practitioners than the public.

Until Next Time

Jackson McCosker
Director/ Chief Editor


Lohrer, H., & Nauck, T. (2009). Cross- Cultural Adaption and Validation of the VISA-A Questionaire for German-Speaking Achilles Tendinopathy Patients. BMC Musculoskeletal Disorders, 1 – 9.

Robinson, J., Cook, J., Purdam, C., Visentini, P., Ross, J., Maffulli, . . . Khan, K. (2001). The VISA-A Questionaire: A Valid and Reliable Index of the Clinical Severity of Achilles Tendinopathy. British Journal of Sports Medicine, 335 – 341.


Decrypting the Language of Insoles

Medial_OTxFor most people when asked what an “in-sole” is, they would reply “something that you put inside a shoe”. To a degree this is true, although overly generalised. The word insole is an umbrella term for exactly that described above, however, there are a multitude of variations to insoles and their purpose for both footwear and individuals. The use of an insole may be necessary to improve foot function, facilitate healing, reduce friction, decrease shoe odour and improve comfort. The following article gives an overview of the different types of footwear inserts that can be obtained in a commercial or healthcare setting.

Medical Grade Inserts
In the medical/ allied health setting there are a number of ways that an insert can be used to benefit a patient.

Orthopaedic Additions may be used for a short period of time in the case of an acute or low risk injury. These additions include; heel lifts, wedging, metatarsal domes, arch fillers and cushioning just to name a few.

Semi-Custom Prefabricated Devices can be easily adjusted by a podiatrist, through heat moulding, subtraction of bulk from the device and the addition of support in appropriate areas.

Custom Fabricated Devices are footwear inserts that have been designed and prescribed specifically for an individual’s foot and their presenting complaint. A cast is taken of the foot with plaster or a 3D scan. From the mould and an accompanying prescription a device is constructed to suit the requirements of the patient.

How the podiatrist develops a patient’s prescription can be based on a number of biomechanical theories associated with observations made during clinical assessment. I have talked about those previous theories here: https://footnotesblogging.com/2016/12/15/biomechanical-theories-and-foot-orthotics-1000-recipes-for-the-same-dish/

Commercially Available Inserts
Commercially available inserts are generic devices; they are made for the “average foot type”. However, feet are like snow flakes – not as pretty by any means, but no one foot is the same.

Cushion and Comfort Insoles are commonly made from a gel like substance similar to silicon. Structurally the insoles offer little in regards to support, however for shoes that provide more of a fashion statement than something of comfort these low bulk easily malleable insoles can be perfect for softening the ground under foot.

Anti-Odour Insoles use substances such as charcoal to reduce the smell from inside the shoes. For mild cases this may prove successful, however, in many cases further investigation is required to assess the cause of the odour.

Diabetic Insoles aim to reduce pressures in common known areas of friction. It is recommended that patients with diabetes take serious consideration when purchasing over the counter devices as they are at an increased risk of developing complications. The most appropriate device for a diabetic patient is a custom designed device made specifically for their individual feet.

Until Next Time

Jackson McCosker
Chief Editor/ Director

What I Didn’t Learn At Uni and What I Struggled To Apply As A New Grad: Jessie Duff

It’s hard to believe that it is nearing 6 months since starting work as a new graduate podiatrist. This time last year I would have been in the midst of studying for mid-year exams and working two jobs on the side to get me through. Full-time work seemed a lifetime away, and the idea of myself as a graduate podiatrist was very idealistic.

As a 13-year-old I imagined my twenty-something-year-old self as being mature, organised, wealthy and settled. In a similar way, as a podiatry student I imagined myself as a new graduate as being confident, independent and knowing absolutely everything there is to know about the podiatry profession.

Little did I know just how much there is to learn outside of finishing university. University teaches so many important things; the in’s and out’s of diagnosis and treatment, anatomy and physiology, practical skills, patient centred care, the high-risk-foot, biomechanics, pharmacology, surgery, paediatrics, I could honestly go on and on. But there are some things, which I will explain throughout this article, that are not learnt in the classroom, rather when you begin working as a podiatrist.

I was lucky to find myself in full-time employment within about a month of finishing exams. Better still, I was lucky enough to land myself in a workplace that was supportive, encouraging and on hand when I needed help. I was eased into a full patient load and still to this day do I wonder how I got so lucky. It made facing these challenges simple and so much less stressful.

Developing patient/practitioner relationships

This is not something I ‘struggled’ with as much, more something that I found myself learning along the way in my first months as a new graduate. At the La Trobe University Podiatry Clinic, the most times you would be able to review someone is once per week. Even still, there is the risk of changing semester timetables or the ‘first in, first served’ allocation system that meant that even if your name was signed and dated in grey lead on the front of the patient’s file, you may not necessarily get to review that same patient twice in a row.

Fast track to the real world, you may see the same patient every 8-12 weeks, every month, fortnight, or sometimes once or twice a week for an extended period of time. This is something I really enjoyed and continue to enjoy, as you can develop a strong bond with patients. At the La Trobe University Podiatry Clinic, conversations often began with “How has your day been?” “Do you have any grandkids?” “Do you live close by?” or “It’s cold/hot out isn’t it”. Obviously from there conversation would be tailored to the individual, but by the time the half-hour was over you would be back to square one with a new patient.

Since leaving University, I have valued more and more the interpersonal skills required to be great in this position. I have learned that patients’ value you remembering and asking about how their football team is going, how their work conference that they had previously been planning for went or how their bathroom renovations turned out. As well as being polite and personable, this increases patient rapport, meaning that patients will return for their follow up appointments once pain is resolved, return to see you for any secondary complaints, and comply with your treatment recommendations.

The in’s and out’s of private health insurance:

Which private health company does and doesn’t cover podiatry, what codes to use for what service, the effect private health insurance could potentially have choosing treatment, that people not covered by private health insurance may not wish to return for a review, and that they may not be able to receive the same gold-standard treatment as someone who is covered. Okay, that was a mouthful! Basically, I knew nothing about private health insurance and I had never considered how it could affect my treatment. I had never considered the affect private health insurance could affect whether or not someone is happy returning weekly for dry needling, shockwave therapy or review of a return-to-sport rehabilitation program. The affect of this only occurred to me during treatment of a painful wart for a child who wasn’t covered by private health insurance. The patient was eligible for ongoing treatment of a painful wart; in fact this would have been considered the gold standard in treatment. But just like financial status, the private health status of this patient meant that treatment had to be tailored to what was affordable for the family.

My only advice on this note for a new graduate would be to of course take into consideration the patients financial status. But always educate the patient on all of their options, offer the benefits and risks to each treatment, and allow them to decide on which treatment plan is affordable for them based on your recommendations. Most importantly, do not assume which treatment someone can and cannot afford.

How to self-marketing and develop a client list

This is something else that dawned upon me when I was a couple of weeks into starting work at a new clinic. It made me realise: a) that I had no idea how to self-market myself, and b) how lucky I was to be in a position where I did not have to worry financially about how many patients I was seeing in a given week.

Nonetheless, starting work in a brand new clinic drove me to self-market myself out of my wish to gain more experience faster, and be a valuable asset to my workplace. Starting work in a brand new clinic was frustrating in the beginning. All I wanted to do was see patients. I wanted to get out of the awkward nervous new graduate stage and be comfortable seeing patients with confidence, and the only way for that to happen was to see as many patients as possible. This taught be to be creative with marketing ideas. I set up a business’ instagram account, met with local personal trainers, assisted in giving injury prevention talks to junior sporting clubs and assisted in the treatment and management of players in NPL team Oakleigh Cannons.

My advice to new graduates that may find themselves in a similar situation would be first and fore mostly to find a workplace that is supportive. It helped tremendously that I have always been given the opportunity to see new patients, as complex as they may have been, when they walked in the door. Secondly, 90% of marketing can be done in your treatment room. Every patient you see will have a family, friends, neighbours, kids, and friends that may need treatment. All it may take is one junior footballer to walk in the door and if you leave a lasting impression, you have the potential to see 17 more little footballers and their families.

I hope that this can help any future new graduate with the transition between University and the workplace. At the end of the day, these are things that will come naturally to most people. ‘Not learning’ something at university does not necessarily mean that the course has a loophole in the curriculum. Rather there are certain things that can only be learned through personal experience.