Tarsal Coalition

The Atypical Flat Foot

Sometimes, a patient can present with a “sudden flatfoot”.  They relate functioning normally, then suddenly, typically after a trauma (large or small), their foot flattens and heel rolls with associated pain in the rear-foot and ankle.  This rarer type of flatfoot is typically caused by a spasm of the peroneal tendons on the outside of the ankle/rear-foot, and is referred to as peroneal spastic flatfoot.  Many times, this condition is a symptom of something called a tarsal coalition. A tarsal coalition is an irregular union of two bones of the rear-foot which should not be present. The coalition could be made of fibrous tissue, cartilage or bone.  Many people who have tarsal coalitions don’t know about it until they somehow injure the coalition.  This typically occurred in teenage years, as patients become more active in athletic activity. However, it can also present earlier or in adulthood.  As the coalition is damaged, the peroneal tendons go into spasm as a splinting mechanism. Essentially, as the tendons pull tighter, they restrict the range of motion of the painful joint. This pulling motion causes the foot to flatten as it pulls the heel outward and the arch downward. Sometimes the foot goes through period of spasm and relaxation, while other times the foot stays in a flattened position.

Conservative measures aim to reduce pain and attempt to release the spasm. These measures usually include rest, ice, anti-inflammatories, a period of casting, and injection of nerves to help release the spasm.  However, once symptoms start, many patients end up requiring surgical intervention. Depending on the severity of the coalition and the joints involved, some patients will have the coalition removed (many times placing a spacer between the joints). Other times, after resecting the coalition, the joints involved may need to be fused together to diminish pain and prevent re-occurrence.  If you develop he sudden flatfoot, seek medical attention ASAP.


7 Smart Strategies for Stress Management

What is stress?

Stress is a feeling that we all experience on a regular basis. Whether we are athletes, coaches, or administrators, it feels as if it invades us no matter what we do. If I said that stress is good, some of us may be skeptical given that we associate stress with feeling uncomfortable. However, our bodies secrete stress hormone, called cortisol, so we can get our muscles moving. Any activity that we perform requires an automatic physiological mechanism to allow us to react. Being alert to the referee’s whistle, running back to play defense, and sprinting the last 50 meters would be impossible to execute unless our bodies provided us with the energy to do so. However, it is a completely different experience when we perceive any one of those tasks as excessively negative or potentially threatening.

Unreasonably worrying about facing an opponent, paying excessive attention to an error, or being overly concerned about losing the lead increases our cortisol levels. The more we ruminate on the negative consequences, the higher our cortisol. Our heart begins to race, hands feel sweaty, thoughts are racing, memory recalling becomes more difficult, and our mood is increasingly irritable. Inside our bodies, our overall health equally suffers: excessive sugar is produced by the liver increasing risk for type 2 diabetes; the heart needs to work harder elevating the risk for hypertension and blood vessel problems; headaches become recurrent; our immune system becomes compromised; and, we become prone to getting physically injured.

Stress is not a sign of personal weakness. It is a physiological response connected to how we perceive the environment around us. Rather than hoping not to get stressed out, we would be better off recognizing our bodies’ stress signals in order to take pro-active approaches to deal with stress. These changes start by becoming more self-aware of situations where we tend to become stressed. Then, we must disengage from our typical thinking or emotional responses. Lastly, practice at least one of the seven stress management strategies mentioned below.

1. Breathe

If we find ourselves being frustrated and pessimistic, take a pause and re-evaluate what is triggering such a stress response. Going with the emotions of the moment and being carried away into a negative spiral will only increase our stress levels. Hence, take a brief pause and breathe by taking simple, but conscientious breaths. My favorite trick is to start counting backwards starting from 100 by skipping in 7s. Example: 100-93-86-79-72, etc. I don’t have to reach to zero, but I stop when I get to a number where I’ve regained a sense of calm.

2. Use positive reframing

Reframing negative thoughts into positive ones is a very powerful tool. We often find ourselves being immersed in negativity as we picture a pessimistic outlook. Sometimes, we become so ingrained in our negative spiral that it consumes our energy and we find ourselves spreading it out to people around us. The final outcome is definitely not productive. Hence, if we find ourselves heading into a place of negativity, we can put a strong stop to it and reframe it. Most of the time, what we have negatively envisioned may not even happen. Taking a pro-active action NOW can surely alleviate potential future negative scenarios. On the other hand, if there is nothing that can be done now, then worrying will only increase our stress levels. Remember, use positive re-framing when faced with a stressful situation or a negative mindset.

3. Find time to turn electronics off

Our pace of life is often quite busy. In a society where we have become so electronically dependent, we are increasingly using our computers, tablets or phones to such an extent that is rapidly becoming an addiction. We seem to have difficulty putting the electronics away. We tend to believe that unless we respond to every text or email right away, we may be socially cut-off. As tempting as it is to remain on top of every text and email, it is surely stressful attempting to do so. We must learn the difference between urgency and importance when faced with an overwhelming amount of electronic communication. Many of our messages or emails are important, but maybe just a few of them are so urgent that require our immediate attention. The important ones can wait. If reducing stress is our goal, then differentiating between important and urgent texts or emails will certainly alleviate some of our stress.

4. Visualize a positive outcome

There is a direct relationship between how we visualize a future outcome and its eventual result. The more negativity we project, the more likely such a scenario will occur. Hence, there is no point in projecting defeat before competition started. Even if the odds are against you, give yourself the best you’ve got. You never know! There have been many films produced and books written depicting successful stories of athletes who beat the odds and came out winning. The silver lining of trying your best is to feel empowered by your own efforts and go home feeling proud about yourself.

5. Get a good night’s sleep

Along the lines of our “electronic” life, it’d certainly help if we could turn our computer or TV off at least half an hour before going to bed. The blue light from either object triggers the brain into thinking that it is still daylight. As a consequence, the melatonin hormones, which helps us to rest, drop and our sleeping difficulties increase. At the same time, stress hormones remain elevated throughout the night. This combination of elevated cortisol and drop in melatonin makes our bodies feel tired. To compensate for this tired feeling, we tend to jump start our day by drinking coffee, which increases our stress hormones even more. Therefore, remain disciplined to shut down electronics half an hour before bedtime. Our bodies and minds will be very grateful in the morning.

6. Meditate for 10 minutes a day

Research shows that meditation has multiple benefits. It allows our bodies to disengage from our stress, produces calmness, builds our immune system, and promotes healthy hormonal balance. We would all be better off if we took 10 minutes before going to sleep, close our eyes and pay attention to our breath. Bring awareness to the inhale and exhale of each of our breaths. As we pay attention to them, we will likely notice thoughts coming up. Rather than following these thoughts, just notice them and bring the attention BACK to the breath.

7. Make time to socialize

Last, but not least, do maintain an active social life. Engage in face-to-face interactions with friends. Go out or invite them over for a pizza, or walk instead of drive. Any activity that promotes eye-to-eye interaction directly engages the right side of our brain, which leads to emotion regulation. The more we interact with others, the better our ability to manage our stress.

The Takeaway: Stress is unavoidable, but there are actions we can take that can certainly help us to mitigate its uncomfortable effects. The mentioned strategies can help us manage stress triggers in order to have better control over our emotions. As we begin to manage our stress, the people around us will less likely react in stress. As a result, there will be less stress to manage overall. Like any new habit, it takes commitment, but once we get used to following a stress reducing routine, we will feel more energized and ready to tackle any of life’s challenges.


Alex Diaz, PhD
Dr. Alex Diaz Consulting

Step-Up Exercise

How To Do Step Up


The concentric action is hip and knee extension. The primary muscles used during hip extension are the gluteus maximus  and hamstrings (semimembranosus, semitendinosus, and biceps femoris). During knee extension is quadriceps (vastus lateralis, vastus intermedius, vastus medialis and rectus femoris).

Starting Position

Begin the upward movement by stepping up with one leg. Keep trailing foot at start position and shift weight to the leg on the box. As the hip and knee extend on the box stand tall while simultaneously bring the opposite foot next to the starting foot.  The downward movement starts with shifting the body weight to the same start leg and stepping off the box with the opposite leg. Shift the body to the the opposite leg and the start leg will follow to starting position.


Training Tips

  • Keep torso erect and parallel to the tibia
  • Initial contact of lead foot with top of the box must be made by the entire foot
  • During upward extension push through the heels and squeeze the glutes
  • Maintain hip flexion, knee flexion, and dorsiflexion of ankle at top of movement

Warning Tips

  • Do not allow the heel to hang off the edge of the box

Charles DeFrancesco, NFPT, USAW, NASM
President & CEO of Pure Fitness Club, Owner of Fit and Functional

What do you expect

What Do You Expect?

Do you want to enjoy good health? It seems safe to say that the answer is most likely, “Yes”. Now, do you expect to enjoy good health? This answer may be quite different.

I recently heard an audio clip of a speech by a motivational speaker named Les Brown. He told a story about a conversation he had with his son in which Les asked if he wanted to be successful. Of course the answer was yes. He then asked if he expected to be successful based on his current behavior. His son fell silent and couldn’t answer. I found this simple conversation to be incredibly powerful and it really made me think.

The definition of “expect” according to Merriam-Webster’s Dictionary is, “to think or believe that something will probably or certainly happen.” If we want something that we don’t have, we must change our behavior in order to get it. When our behavior is in line with the results we want, we can then expect to have those results. When we have an expectation, our behavior should meet or even exceed the expectation. It is a very simple formula.

So I will ask again, do you expect to enjoy good health?

What are you feeding your body? How are you moving? How are you sleeping? How are you thinking? How are you feeling? How do you manage stress? What are you feeding your brain? What are you learning? Who and what are your influences? What are you reading? What are you watching? What are you listening to? What are you focused on? Are you focused on problems or solutions? Are you focused on what you want or what you don’t want? What are your dreams? What are you working towards? How are you spending money? How are you earning money? How are your relationships? What are you doing? What are you contributing? The list goes on, but I think you get the point. All of the above significantly affect our health. Taking a closer look at ourselves, it becomes evident that we have more control over our lives than we typically think we have.

I challenge you to take a look within and ask yourself some of these questions. Write them down. Write the answers. Then ask yourself what do you expect? This is a great step. If you don’t like the answer, then make a change. Take another step, then another, then another…

I’ll conclude with a great quote from one of my favorite Dr. Seuss books, “Oh, The Places You’ll Go”:

You have brains in your head.
You have feet in your shoes.
You can steer yourself any direction you choose.

Robert Inesta, DC, L.Ac, CCSP
Westchester Sports & Wellness


Help Your Heart

It is summer and the weather outside is beautiful! To stay in shape, many people opt to forgo the gym and exercise outdoors. There are so many options to choose from: walking, hiking, biking, running, tennis, and basketball, to name a few. But how do you know if you are getting the most from your workout?

Many people use heart rate monitors, which are effective for both beginners and seasoned athletes to see how hard they are working. For beginners, a heart rate monitor can help make sure they work out at the right intensity to burn enough calories without going overboard or risking injury. For athletes, monitoring their heart rate helps them reach specific goals, whether it be for aerobic training or for fat burning.

Your heart rate is determined by how many times your heart beats per minute. Like any muscle, the heart becomes stronger as you exercise it. As exercise intensity increases, your body requires more oxygen, and your heart has to pump faster to supply the muscles with this needed oxygen. Resting heart rate is determined when your body is at rest and not moving. The lower your resting heart rate, the more conditioned you are since a stronger heart is able to pump more blood per beat and thus requires less beats per minute. Maximum heart rate is the highest number of beats the heart has the potential to reach. It is generally determined by 220-your age, since it is difficult to measure accurately unless in a laboratory. The training heart rate (target heart rate) is the rate you strive to maintain during exercise to improve your fitness. It is usually determined by the Karvonen formula, which uses maximum and resting heart rate with the desired training intensity to get a target heart rate. Heart rate monitors determine your target heart rate, which is usually 50-85% of your maximum heart rate, depending on your goals and fitness level. After exercising, you need proper time to recover and rest. Your recovery heart rate should be about 20 beats within your heart rate before beginning your exercise regimen.

There are a variety of heart rate monitors on the market. Some track calories burned, speed, and distance. Heart rate monitors are generally easy to use, convenient, and not that expensive. If used properly, a heart rate monitor can provide some of the benefits of having a personal trainer or coach with you during your workouts. (I wouldn’t say this, you still want people to use a personal trainer.

At THE ARENA, we recommend the Nuvita Pro heart rate monitor, since it appears to be more accurate than many of its competitors. It also directly links with your phone and gives you the ability to have a personal trainer monitor your progress and give feedback and suggestions. Please see our website at https://thearenafitness.com/nuvita-pro/ for more information.

No matter which heart monitor you choose, remember that nothing can substitute for your own rate of perceived exertion. If you are tired or breathless or don’t feel well, stop immediately, no matter what the heart rate monitor says!!!

Summer Weight Loss

Getting in Shape for the Summer

By: Rick Weinstein, M.D., MBA

As the weather gets warmer, it is apparent who has been hibernating and not kept in shape in the colder months. This is the time of year where most people want to get into better shape. This should be a year-round activity, but the warmer days definitely afford you more opportunities to work out.
The journey to getting in shape always starts with the first step. This may mean starting with walking. It is best to have a good pair of sneakers or running shoes and a softer surface, such as grass or a track, which is better than the streets. You should be able to get a sweat going and get your heart rate up to get a real work out. Many phones can measure your heart rate using one of the work-out apps that are readily available. Try and get your heart rate up to 60% of your maximum heart rate. Maximum heart rate is approximated as 220-age.

It is important to do the work-out that you enjoy doing. If you like running or biking, then do that. If you prefer tennis or soccer, go out and play. You should be working out 6 days a week. If you do only 1-2 days a week, you will not get much benefit at all.

Before you get involved in working out and playing sports, warm up and stretch out. Do not push yourself too hard initially, but as you get into better shape, you do need to continue to push yourself. Give yourself short challenges and try to meet goals. Studies have shown that tracking your workouts on a calendar is more likely to keep you on the track to getting into better shape.

If you want to lose weight, working out can help, but the only way to lose weight is to burn more calories than you take in. Pick a reasonable diet that you can handle and stick to it. Don’t switch diets every few weeks or you will not lose any weight.

The goal of getting shape is to be healthier and feel better. Working out will give you a psychological boost and it is a cure for sadness and depression. The weather is warmer and the days are more pleasant, so get yourself outside and do something good for you.