Advice on Foot Care

China’s Olympic hopeful, Liu Xiang, walked off the track before making it over a single hurdle. Liu said “I knew my foot would fail me. I felt painful when I was just jogging.” Xiang was referring to the back of his heel, where the Achilles tendon attaches to the heel bone. He had thought the injury had healed, only to have it recur a week prior to the event. His coach said that he has been dealing with the injury for six or seven years and described the condition as an inflamed bone spur. Continue Reading »

The APMA (American Podiatric Medical Association) and Prevention magazine teamed up to determine the best and worst walking cities in the U.S. Over 500 cities were evaluated by using fourteen walking criteria, which included the number of parks per square mile, the use of mass transit and the percentage of adults who walk for fitness reasons. The winner was Cambridge, MA - Best Walking City in America for 2008. Continue Reading »

There are many foot problems which can plague tele skiers and like alpine skiers, most are from improper boot fit. Boots which are too tight can constrict circulation causing cold and numb feet and boots which are too short will cause jamming at the toes, black toenails and ingrown toenails. Boot liners which don’t fit appropriately can rub and irritate all areas of the foot, most commonly the inside of the ankle. But, one of the more common foot problems experienced by telemark skiers is pain in the ball of the foot. This is generally due to a neuroma.

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A Lisfranc’s injury is becoming a common term among football fans with Indianapolis Colts defensive end, Dwight Freeney, sidelined by this injury.

The Lisfranc joint is actually a group of joints where the long bones in the foot (metatarsals) meet the midfoot (tarsal bones). These joints are held together by a series of ligaments on the top and bottom of the foot. The lisfranc’s ligament connects the base of the 2nd metatarsal to the 1st cuneiform and is the strongest ligament of the group.

A Lisfranc’s injury is the rupture of the lisfranc’s ligament and the associated dislocation of the lisfranc’s joint. The rupture of the ligament may be accompanied by metatarsal base fractures (breaks in the long bones in the foot). This injury is called a Lisfancs fracture-dislocation. The injury is often misdiagnosed as a simple foot sprain because the changes on X-ray can be very subtle. Continue Reading »

About 10-15% of all football injuries occur in the foot, ankle and lower extremity. Common injuries include ankle sprains, shin splints, dislocated and broken toes, stress fractures and blisters. It doesn’t matter is you are playing college football, full contact flag football or touch football, you are at risk of foot and ankle injuries.

Ankle Sprains: An ankle sprain is the tearing or stretching of the ligaments on the outside of the ankle. Generally occurring when the player “rolls” their ankle running or landing from a jump. Some may hear an audible popping sound, which may indicate a rupture of the ligaments, while most may experience only a sharp pain. If the player can walk on the ankle, it is most likely a mild sprain.

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It is easy to mourn the loss of those long, warm summer days as we move into the Fall season. Cold, crisp mornings make winter seem just around the corner and many will put away their hiking boots until next Spring. But, Fall is one of the best times for hiking. The colors are vibrant and the summer haze is gone - along with the crowds. Although the mornings will be cool, most days bring perfect hiking weather.

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There are almost 7 million trail runners in the United States and they enjoy fantastic views, clean air and the peace and quiet of the outdoors. Trail running does have it’s own set of risks and injuries. Although many of the same foot and ankle problems a road runner might encounter, a trail runner may be more at risk.

An ankle sprain is the number one foot and ankle problem associated with trail running. Running on uneven surfaces, over roots and rocks, up and down steep terrain greatly increases the risk of an ankle sprain. To help prevent ankle sprains, the first step is buying a trail specific running shoe. Not a road running shoe and not a hiking boot. A trail running shoe will be lower to the ground, should have a wider base, more tread on the sole. Avoid shoes designed to control pronation. Continue Reading »

Mountain biking has inherent risks which are dependent on the type of trail and skill level of the rider. Many riders think of broken collarbones and separated shoulders as the main risk of mountain biking, but don’t realize the impact on the foot and ankle during cycling. Blunt trauma from rocks, roots and trees is certainly a risk, and only trail choice matching the rider’s skill level can minimize or prevent these injuries. Lesser known and more chronic lower extremity problems associated with cycling include Achilles tendonitis, ball of foot pain, numbness in the toes, knee and ankle pain. Continue Reading »

The piriformis muscle is a small muscle which sits deep in the buttocks over the sciatic nerve. It’s action is to rotate the hip out (external rotation) and extend the thigh back. When the piriformis is tight, is in spasm or on stretch, it irritates the sciatic nerve, which send pain down the back of the thigh or into the back. Continue Reading »

I worked at the Western States 100 finish line in Auburn this past weekend, giving the finishing runners needed foot care. The run is conducted along the Western States Trail starting at Squaw Valley, California, and ending in Auburn, California, a total of 100 miles. The trail ascends from the Squaw Valley floor to Emigrant Pass and then follows the original trail used by the gold miners. The runners head south and west and climbs over 18,000 feet during the run and descends almost 23,000 feet before reaching Auburn.

The most common foot problem is blisters. Blisters on the toes are common, especially the 5th toe and under the great toenail. Other common places for blisters are the heel and under the ball of the foot. Black toenails are standard for many ultra runners, and losing a toenail during training or after the race is not uncommon. The Western States run is unique in that there is a lot of descending and climbing in and out of the canyons. The decents are steep and the trail is rocky and loose. This causes more jamming of the toes against the front of the shoes and this friction causes blisters and excess pressure on the toenails.

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Freel Peak is the highest peak in the Lake Tahoe Region at 10,881 feet. The two most popular routes to the top are through Armstrong Pass. The shorter of the two routes involves driving on USFS road 051 off of Highway 89 to the base of Armstrong Pass. It is only 1 mile to Armstrong Pass and the junction of the TRT - Tahoe Rim Trail.

We decided to head up Fountain Place Road and take Armstrong Pass Trail, a 3 mile hike to the TRT. Armstrong Pass Trail is an enjoyable, mostly shaded trail following a creek at a reasonable grade. Continue Reading »

Cool New Gear For Runners & Walkers

The Nike+ iPod Sports Kit allows you to listen to your favorite tunes while you run or walk AND track your speed and distance. A sensor placed on the Nike shoes tracks time, distance and speed and transmits this information to the iPod receiver. The iPod can give audible feedback and let you know your pace or how many calories you have burned. The sensor and receiver come with the kit and Nike sells shoes with a compartment specifically made for the sensor, although other companies do sell sensor pouches which can attach to your current pair of running or walking shoes.

Hiking can be one of the most enjoyable and affordable ways to exercise. It is not necessary to buy lots of fancy gear to hike (although it may seem otherwise if you browse any of the retail outdoor catalogs). It is also not necessary to be at a top fitness level. You simply need a good pair of hiking boots, a water bottle and a trail.

Although hiking can be a sport for anyone, it is important to hike on a trail that fits your ability. Steep, rocky and lengthy trails with little shade should be left to experienced hikers. But, there are many shorter trails with beautiful views for beginner hikers. Carrying water is a must, but a hydration pack is not necessary unless large quantities of water are needed for longer hikers. A hat and glasses are a plus to keep sun off your face and out of your eyes. Sunscreen is important for most hikes and for longer hikes, reapplication is usually necessary. For medium length hikes or short hikes in moderate temperatures cotton shirts and shorts are fine. Shirts and shorts made with wicking fabrics are an advantage for longer hikes, hikes in warmer weather or when weather shifts more than 20 degrees during the hike. The wicking fabric allows the Continue Reading »

A recent article in Sports Medicine cited a significant increase in the number of people who are running marathons. The yearly incidence of injuries in marathon runners is reported as high as 90%, but it appears that less experienced runners are the ones who are more prone to injury. More experienced runners are less likely to experience injuries. The risk of injury decreases as the years of experience increase. But, the risk of injury increases once the once a threshold of 40 miles/week is crossed. The most common is injury was to the knee, citing patellofemoral syndrome as the most common. Other common running injuries included plantar fasciitis, meniscal injuries of the knee, achilles tendonitis, iliotibial band syndrome and tibial stress syndrome.

 

Fredericson M, Misra AK. Epidemiology and aetiology of marathon running injuries. Sports Med. 2007; 37 (4-5):437-9.

1. Consider buying your shoes at a specialty running store. The shoes may be a little more expensive, but you should be able to talk with a trained professional who knows about shoes, socks and foot types.

2. Have your feet measured while standing with your socks on. Socks can change the size of your feet enough to make a difference in fit. The measurement should include the heel to toe measurement, the heel to the ball of the foot measurement and the width taken while standing.

3. Make sure the shoe bends at the toes, and only at the toes.

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Callused feet and toes are common in runners and many times go unnoticed. But, a callus on the heel or the big toe can cause a lot of pain for a runner. The callus can develop an even more painful blister underneath and can limit performance or simply decrease the enjoyment of run. Some rub the area with a pumice stone, some apply cremes and others take a razor blade to the offending callus. Unfortunately, the callus always returns.

Callus tissue is a build of dead skin in response to pressure or friction. The medical term for callus is hyperkeratosis (hi – per – care – uh – toe – sis). A callus is actually a bone problem and a foot mechanics problem, not a skin problem. A foot deformity will cause excess pressure to that area from the shoe or the ground. The body’s natural defense mechanism will kick in and start building up the top layer of skin in response to the excess pressure. This is a protective response from the body in an attempt to prevent the pressure from wearing down the skin layers and resulting in an open sore. The problem is that as long as there is pressure, the body will continue to build up the skin. The continual build up of dead skin can become excessive and painful.

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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. Continue Reading »