Millions of runners take to the streets, tracks and trails everyday. People run for health, for fitness, for stress relief and for fun. There are casual joggers, the trail runners, sprinters, marathon runners and elite competitors. 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.
Heel pain
One million runners will develop heel pain every year. The most typical cause of heel pain is plantar fasciitis, which is the results of excess stress through a long ligament type structure (the plantar fascia) in the bottom of the foot. The excess stress causes tearing and results in inflammation and pain. The classic symptoms are pain in the heel at step one in the morning, or upon rising after long periods of rest.
Achilles Tendonitis
Achilles tendonitis and related calf problems are the most common injuries in runners. Pain develops in the back of the heel or in the calf and can be sharp with activity and feel deep and dull with rest. The pain may be apparent at the first step in the morning or rising after long periods of rest. Runners may experience sharp pain in the heel area in the beginning of a run, which then becomes a dull annoyance during the run.
Runners develop plantar fasciitis and tendonitis for a wide range of reasons. Some of the common reasons for the development of plantar fasciitis is wearing poor quality or worn out shoes. It is common to grab old "mud" shoes to run in bad weather, or to start Spring training in shoes that were used the entire previous season. The older shoes may have a worn out midsole and may have lost all aspects of support and stability.
The keys to treating plantar fasciitis and tendonitis are rest, ice, stretching and support. Give your foot a break! Cross train with swimming or biking and avoid impact activity on your foot. If you must run, cut back on mileage, avoid hills and speed work and gently stretch before your run, but after a 10 minute warm-up. Ice the area for 20 minutes, after the run. Try to ice for 20 minutes, twice a day. Stretch the calf and/or the arch multiple times throughout the day. Don't forget to start with gentle stretching, and avoid overstretching. For plantar fasciitis, night splints are very helpful. Buy supportive shoes and use an over-the-counter orthotic for support. When you have flatfeet you may need custom made orthotics. If this is a chronic problem, see your podiatrist.
Stress fractures
Stress fractures most commonly occur in the metatarsal bones. The metatarsal bones are 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 isn't the result of a specific injury or trauma. Stress fractures are more commonly the result of overuse. If you develop a sudden 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.
Ankle Sprains
Ankle sprains are another common injury in runners, especially in trail runners. The most common ankle sprain is called an inversion ankle sprain. The ligaments on the outside of the ankle tear when the foot turns in and the ankle turns out. There are three 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 one or more ligaments. Severe ankle sprains involve partial to complete tears of two or three ligaments.
Very mild ankle sprains may only need an ace bandage and high top shoes for support for a week or two. For more moderate sprains, a lace-up ankle brace and sometimes an aircast are necessary. If there's a considerable amount of swelling, bruising and pain, a visit to the doctor is recommended. An evaluation will be done to assess the stability of the joint and X-rays will be taken to rule out a broken bone. Mild ankle sprains may only take a week or two for full recovery, but most ankle sprains will take about 6 weeks. More severe ankle sprains typically take 3 months and may not feel 90-100% for almost a year. If you experience a severe ankle sprain, consider a visit to a podiatrist. When you've got not healed from an ankle sprain after 6 weeks, see a podiatrist.
Blisters
Friction blisters are one of several more common foot injuries in runners. Blisters most commonly develop on the back of the heel, the side of the big toe or in between the toes. A blister is a result of friction, of shearing forces on the skin. The blister is actually a defense mechanism of the body, which occurs when the shearing forces separate the outer layer of skin, the epidermis, 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 aren't painful and not infected should be left alone. There isn't a need to pop and drain these blisters. Crucial treatment is to reduce friction and look for the cause. Was the sock folded or crumpled at the toes or heelall Is there stitching in the shoe that is prominent or defective? Is the shoe not fitting properly? You can place moleskin directly on top of small blisters to help reduce friction. Drain larger blisters with a sterilized needle (unless you are diabetic) by punctured the side of the blister and placing gentle pressure with 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. If you plan to continue running, place moleskin directly over the blister. Pat dry with a towel after each shower and the moleskin should stay on for quite a few days. Cut the edges of the moleskin if the corners peel up, but don't pull off for at least 3 days. This will tear the top layer of skin off and create an open wound. Any blister that has redness, streaking or pus may be infected. You should see your doctor immediately.
Foot & Toenail Fungus
Foot fungus is characterized by peeling, redness and itching on the bottom of the foot and in between the toes. Toenail fungus is characterized by white, splotchy areas on the nail or thickness and yellow discoloration of part of the entire nail. Fungus grows in moist, warm environments, which places runners, in particular, at risk. Foot fungus rarely causes any pain or considerable problems, but is mostly an annoyance. Toenail fungus can cause ingrown nails and thickened nails, both of which can cause pain.
Foot fungus can be treated with over the counter anti-fungal medications in combination with anti-fungal powder and spray in the shoes and eliminating the moist, warm environment. Toenail fungus is much more difficult to treat. The treatments range from simple home remedies to expensive oral medications. Prevention is the best treatment. Decrease the amount of moisture by using wicking socks and ensure to have proper sock and shoe fit.
Sock and Shoe Fit
Avoid cotton socks and use socks with synthetic blends, small fiber wool blends or acrylic. Cotton socks absorb moisture and don't allow for evaporation. It is necessary for your sock and shoe combination to allow for wicking. The shoes should have some areas of breathable fabric, like nylon mesh. When picking out shoes, make sure to measure your feet with your socks on. Pick a shoe with a rigid midsole, but has flexibility at the toes. Your toes should have some wiggle room. The general rule is one finger's width between the longest toe and the tip of the shoe. The heel counter (back of the shoe) should be supportive and not too rigid. It should have some flexibility, but should not collapse when pressed towards the front of the shoe. Above all, the shoe should feel comfortable.
As in many cases, prevention is your best treatment. Proper shoe and sock fit, gentle stretching after warming up and recognizing a problem before it become serious are your keys to staying active and avoiding foot problems.
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