Advice on Foot Care

Millions of runners, in the form of casual joggers, trail runners, sprinters, marathon runners and elite competitors, take to the streets, tracks and trails everyday. People run for health, for fitness, for stress relief and for fun. Despite these differences, all runners are susceptible to foot problems. Common foot and ankle conditions in runners include blisters, foot fungus, ankle sprains, stress fractures, tendonitis and plantar fasciitis. Fortunately, most of these conditions can be prevented and many are easily treated. When foot and ankle conditions are ignored they can become difficult to treat and in some cases resistant to therapy.

Heel pain
Over one million runners will develop heel pain each year. The most common cause of heel pain is plantar fasciitis, which is the result of excess stress through a long ligament type structure in the bottom of the foot. The excess stress causes tearing and results in inflammation and pain. Most people describe pain in the heel at the first step in the morning or upon rising after long periods of rest. Runners may only experience the pain while running, and many state that the pain develops at the beginning of the run and tends to work itself out after about 1 mile, but then returns by the end of the run or at the end of the day. The key to treating plantar fasciitis is rest, ice, stretching and supportive shoes. It’s important to cross train while healing plantar fasciitis or at the very least tone down the workouts, avoid hills and stairs, minimize the distance and intensity of the runs. Ice for 15-20 minutes twice a day at the heel and arch. Stretch multiple times a day, at least 10 times for 2-3 minutes, and consider a night splint. Make sure you have supportive shoes and not too flexible and consider a prefabricated orthotic or arch support. More information on heel pain.

Achilles Tendonitis
Achilles tendonitis and calf problems are the most common injuries in runners. The pain commonly develops at the back of the heel or in the calf. The pain is described as sharp with running and deep and dull with rest. Although many will describe it as a pulling pain, a stiff pain, soreness, a tearing feeling or bruising. Runners may experience sharp pain in the heel area at the beginning of a run, which then becomes a dull annoyance during the run. In some cases, the pain may be so intense that it will bring the run to a halt. Achilles tendonitis and calf injuries are both aggravated by hills and stairs. The treatment for Achilles tendonitis is almost the same as plantar fasciitis. The resting, icing and stretching are also very important. Sometimes night splints work for tendonitis as well. Ice at the back of the heel, 15-20 minutes twice a day and avoid all stairs and hills, even if you are not running. Try a heel lift in your shoe and also check your shoes to make sure they are supportive and not too flexible. More information on tendonitis.

Ankle Sprains
Ankle sprains are another common injury in runners, especially in trail runners. When the foot twists rolls in and the ankle rolls out, this is called an inversion ankle sprain. This is the most common type of ankle sprain and results in the ligaments on the outside of the ankle tearing. There are three main ligaments that hold the ankle joint in place on the outside of the ankle. When the ankle is twisted, one or more of these ligaments may be torn. Most ankle sprains involve partial tearing of the ligaments. Severe ankle sprains involve partial to complete tears of two or three ligaments. For mild ankle sprains the general treatment is ice, rest, compression and elevation. A return to running can happen within a week or two. For moderate ankle sprains, bracing is necessary and a return to running could be up to 6 weeks. For severe ankle sprains, a cast or cast boot may be necessary and recovery time may be 3-6 months. For moderate to severe ankle sprains it is recommended to seek medical treatment.

Stress fractures
Stress fractures typically occur in the metatarsal bones, the long bones in the middle of the foot. A stress fracture is an incomplete break of the bone. The pain is usually sharp and develops suddenly, but it is not the result of a specific injury or trauma. Stress fractures are generally the result of overuse. If you experience a sudden development of pain, swelling and bruising on the top of your foot, but can’t remember any specific injury, it is time to see your podiatrist. The typical treatment is a surgical shoe (fully rigid shoe) for 4-6 weeks.

Foot & Toenail Fungus
Peeling, scaling, redness and itching on the bottom of the foot are the classic signs of foot fungus. Toenail fungus is characterized by white or yellow, splotchy areas covering part of the nail or thickness and discoloration of part or the entire nail. Fungus grows in moist, warm environments, which puts all athletes at risk. Toenail fungus can cause ingrown nails and thickened nails, both of which can cause pain and even result in infection. Over the counter treatments will usually cure foot fungus and prevention is extremely important is avoiding re-infection. Treatment for fungal toenails is much more complicated and difficult. More information on treating Toenail Fungus.

Blisters
A blister is the result of friction, shearing forces on the skin. Blisters most commonly develop on the side of the big toe or in between the toes, but also can occur at the heel. The blister is actually a defense mechanism of the body, which occurs when the shearing forces separate the outer layer of skin from the deeper, dermal layer of the skin. Fluid collects between these layers, providing a cushion against the aggravating force while a new layer of skin re-grows underneath.

The best treatment is prevention. Blisters can be prevented with the appropriate socks and proper shoe fit. Sometimes, blisters are unavoidable. Small blisters that are not painful and not infected should be left alone. There is no need to pop and drain these blisters. Drain larger blisters with a sterilized needle (unless you are diabetic) by puncturing the side of the blister and placing gentle pressure with absorbent gauze to absorb the fluid. Don’t remove the top layer of skin. This layer is the body’s best protection. Dry the area, but don’t use antibiotic ointment over the area. Any blister that has redness, streaking or pus may be infected. You should see your doctor immediately.

Sock and Shoe Fit
Runners should avoid cotton socks and pure synthetic socks and choose synthetic blends, small fiber wool blends or acrylic socks. Cotton socks absorb moisture and don’t allow for evaporation of that moisture. Synthetic socks won’t absorb moisture, but also don’t allow for wicking. It is important for your sock and shoe combination to allow for wicking. The shoes should have some areas of breathable fabric, typically a mesh on the sides.

When choosing shoes, make sure to measure your feet with your socks on. Pick a shoe with a rigid midsole, but with some flexibility at the ball of the foot. Your toes should have some wiggle room. The back of the shoe (heel counter) should be supportive and not too rigid. It should have some flexibility, but should not collapse when pressed on. Most importantly, the shoe should feel comfortable. More on wicking socks, shoe fit for runners.

As in most cases, prevention is your best treatment. Proper shoe and sock fit, gentle stretching after warming up and recognizing a problem before it becomes serious are your keys to staying active and avoiding foot problems. More on Foot Problems in Runners.

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