Caring for Active Feet

    Dr. Jason Denton, Deaconess Clinic Podiatry

    Welcome runners and walkers!  This article is all about keeping YOUR feet healthy and feeling good.

    Not only am I a podiatrist, but I’m also an avid runner. I’ve been a runner for about 6-7 years, since I started in podiatry school.  I lost about 100 pounds before I started running, and so I took up running to keep it off. The first timed race I ever did was the Des Moines (Iowa) Half Marathon, which I ran with my twin brother.  My time was about 1:37.  I’ve ran numerous races since then—4 full marathons, 3 ultra marathons (50k, 50 mile), and numerous half marathons. I’m excited about getting involved with the local running community. I’m also excited about sharing some helpful tips—both personal and professional--about keeping your feet healthy.

    Protecting Your Feet as a Runner: Choose the Right Shoe

    • Make sure that you get properly sized. Most shoe stores will have a sizing device. And keep in mind that over time, the foot can change. Be aware that with running, the foot tends to spread over time, sometimes adding as much as a half-inch in length.
    • If you’re a runner, buy a running shoe. If you’re a walker, buy walking shoes.  The cushioning is designed to be different.
    • If you have orthotics, be SURE to have them along and try out your shoes with them in. Also try on your shoes with the type of sock that you’ll be wearing with the shoe.
    • Different brands, different styles within the same brand, etc. can all fit slightly different. And try on both shoes, not just one.
    • Try shoes on later in the day, as feet can swell a bit over the course of your day.
    • Make sure you have enough room in the ‘toe box’ (front of shoe) for your toes to splay out.
    • Don’t lace the shoe too tightly, as it will prevent the natural splaying of the foot. 

    Addressing Common Running Injuries
    • Blisters.  Friction blisters are very common, and are caused by rubbing from the shoe/sock.  I strongly recommend socks designed for running, which have no cotton in them (cotton absorbs moisture differently and can increase friction).  Seamless socks are an excellent idea.  These special socks are a little pricier than a 6-pack from a department store, but well worth the price in comfort and pain avoidance.
    • Bleeding under the nail. The medical term for this is subungal hematoma.  This will form from the toe hitting the front of the shoe (shoe too big or too small), or laced improperly allowing the foot to slide in the shoe too much.  The remedy is obviously getting a pair of shoes that fit better and lacing them correctly. 

      Sometimes, the hematoma needs to be drained to relieve the pressure behind the nail, and sometimes, the nail may even need to be removed.  This should be done by your primary care doctor or a podiatrist.  If it’s not significantly painful, let the body reabsorb the blood.  There will just be a discoloration on the nail until it grows out.
    • Ingrown Toenails. Ingrown toenails can result from a shoe that isn’t wide enough.  Ingrown toenails usually need to be professionally treated, as they only get worse and can cause significant pain and infection.  A small hangnail you can probably address on your own with clippers and antibiotic ointment (but monitor it, and if the pain increases, be treated).
    • Athlete’s Foot. If your feet are damp a lot, athlete’s foot can set in.  It’s a fungal skin infection, and can be treated with breathable socks (non-cotton), topical OTC antifungal cream,  antifungal spray in the shoe—and setting your shoes in the sun to fully dry, alternating running shoes from one day to the next so shoes can dry fully between runs.  In a serious case, be evaluated by your PCP or podiatrist. Prevention is important, so wear good socks, alternate shoes, consider waterproof shoes for trail/rainy-day runs, etc.  Also, wear shower shoes in locker rooms.
    • Shin Splints. Shin splints are common ailment of runners. Prevention starts at the foot.  These are caused by abnormal stress/strain on the muscles of the lower leg.  The pain is up the front of the calf (the shin) and feels like a sore/pulling/tearing/stretching sensation.  This pain can really limit your ability to increase your mileage or finish a run.  Prevention starts with stretching, correcting any abnormal foot function, gradual increases in length and intensity of running, and proper shoe selection.  Treatment can include icing for 20 minutes on/off, deep tissue massage/manipulation, and gentle stretching.  And if shin splints are an ongoing issue for you, consider orthotics (which are discussed in full detail later in this article).
    • Achilles Tendonitis. Finally, Achilles tendonitis is a big problem among runners. Increased activity/stress can irritate the firm tendon that runs from your calf to the back of your heel.  Usually it’s found in sudden overuse or in someone who has increased their activity suddenly beyond what the body is conditioned to do.  Running on a lot of inclines (up hills) creates more stress on that tendon as well. Stretching the calf muscle is good for the feet of a runner and it’s related to preventing Achilles tendonitis.
    Remember that stretching pre and post run, fixing any foot abnormalities and gradually increasing your activity will lead to the best outcome for not only your feet, but for your future as a runner.

    Stress fractures
    Stress fractures are typically from overuse, commonly related to high-impact activities (such as running), which increase stress and force to bones that can lead to cracks in the bone.

    Stress fractures commonly seen in the foot involve the mid-foot (arch) area.  Swelling is noted on the top of the foot, as well as a small localized area of pain (small pressure point).  Stress fractures are typically more painful the longer you’re on your feet or involved in activity. Because of this, a stress fracture often hurts less in the morning and gets more painful as the day goes on.

    An important thing to understand about stress fractures is that as they heal, they change the stress points in the foot.  As a fracture heals, the bone growth is increased at that point—a “bone callous”- meaning increased bone in that area.  When you’re doing an activity, it can shift the normal pressure to a different area of the foot, or back to the same spot that is still healing.

    This is where orthotics come in, as they’re custom designed to support the foot in a corrected way that can help minimize abnormal pressure.

    Plantar fasciitis
    Plantar fasciitis (aka ‘heel spurs’) results from structural abnormalities in the foot. The foot type tends to be inherited.  Certain changes in the foot alignment, as well as lifestyle changes, can cause the problem to be noticed and become painful.

    If the rear portion of the foot rolls in to the center, this can over stretch the plantar fascia, which is a tense band of tissue on the bottom of the foot which supports the arch. It spans the difference between the base of the toes and the heel bone.

    If this band gets overstretched, it may sustain small tears along its length, resulting in plantar fasciitis. If the band pulls excessively on the heel bone, it will form a heel spur.

    This problem is usually noticed because of the following symptoms:

    • Plantar fasciitis produces pain in the arch, and heel spurs produce pain in the bottom of the heel.
    • Both of these issues hurt more when the patient stands, either first thing in the morning, or after standing after a long rest.
    • This is not a result of “pounding,” meaning that if you put something “cushy” in your shoe, it won’t help. This is a structural issue, and can best be addressed by controlling the structural problem by way of orthotics. Also, medications can be used to reduce the inflammation associated with these problems.

    The Benefits of Orthotic Devices
    A true orthotic is a device constructed to a corrected model of an individual person’s foot. Most orthotics are rigid in nature, to be able to control the abnormal function of the foot. However, when working properly, the orthotic will not feel hard—it will feel supportive. Orthotics are designed to be worn daily, for long periods of time. They don’t “fix” your foot —they correct the structure. Eyeglasses are a similar example: they don’t fix what’s wrong with your vision, they simply correct it.

    At Deaconess Clinic, we have advanced orthotic-development technology. A laser scanner is used initially to capture a model of each foot. We then use a computerized digital system to make corrections to the structure to develop an orthotic that will help bring the foot into the closest-to-normal alignment and positioning possible. The closer to normal the foot performs, the less structural pain that results.

    Various foot structural issues, such as flat feet, plantar fasciitis, high arches, etc. are best addressed via custom orthotics. This, again, controls the function of the foot. The better the foot works, the less it hurts. Orthotics also help prevent knee, hip and back issues as well, since they're helping with alignment.

    Deaconess is also one of only 35 labs world-wide certified by the Prescription Foot Orthotic Laboratories Association.  The way we make our orthotics is really, really innovative, and I’m excited to be able to use the technology in place here. 

    Posted: April 10, 2014 by Pam Hight

    Tags: Dr Denton, feet, foot, foot pain, podiatrist, runner

angie wampler
I went to a podiatrist because of heal pain, it was very difficult to walk without having sever pain. He x rayed my heals and said that I have bone spurs on both heals, he gave me shots in both heals. I received relief for a short time. Done therapy, didn't help. Went back to dr and he examed and took another x ray and said that a piece of bone on bone spur had broken off and surgery was needed. Went thru that, unable to walk on it for 6 wks, received relief for short time, Pain is returning hard to walk after sitting and when I get up in morning.
4/19/2017 7:00:09 PM
Bill Donnelly
James Bergman
The shoe should feel comfortable after wearing them at this point. Shoes are sometimes made for supinator’s (high arches) or pronators (low arches). It might be a matter of findings the right shoe for your arch. If you have not been to some of the local running shoe stores, they usually can help to fit you into a shoe that would be good for your feet and then it’s a matter of making sure the shoe feels comfortable when you wear it. Sometimes the shoes feel comfortable when you initially buy it, but then later becomes painful. Some shoe stores will allow you to try the shoe for a short period of time and if it is uncomfortable will allow you to trade-out the shoe.
3/21/2016 4:50:05 PM
James Bergman
One of my least favorite things to do is to shop for shoes. I recently got new running shoes, but after two months they still hurt my feet. I think the arches in the shoe are too high. I imagine this is not normal and I should get new shoes. How will I know if the shoe fits correctly when trying them on? I thought my current shoes felt fine when I bought them.
3/21/2016 9:14:44 AM
Dr. Jason Denton
Hi, Deanna,

Bunions are a progressive form of arthritis. Walking is a great form of exercise. I would encourage you to continue with exercise activities as best you can, but with that having been said, the more you are on your feet the faster bunions can progress. The best way to decrease progression of bunions with exercise would be with wearing a good supportive shoe with an orthotic.
8/1/2014 1:43:57 PM
Deanna Spells
I have a bunion starting on my foot well it has a good start. Will walking long distance make it worse and does it matter if I am on concrete, asphalt or ground?
7/31/2014 6:25:06 PM
Dr. Jason Denton
Hi, Dianna,

I also follow the same cortisone injection delivery technique. The medial approach will help reduce the injection pain associated with the shot.
7/28/2014 2:57:05 PM
Dr. Jason Denton
Hi, Jennifer,

The pain you are experiencing could be related to an area of the foot that the bone is becoming overstressed and developing a stress fracture You could also be having a soft tissue issue.

Depending on if the pain is coming from the bone vs soft tissue, the treatment might be different. If you continue to have the pain after trying appropriate shoe-gear and stretching, this is something that should be evaluated.
7/28/2014 2:56:31 PM
Dr. Kaylor used to be my podiatrist, but he has retired. He took excellent care of my feet. When he gave me cortisone injections in my heels, he always went through the medial side of my foot rather than the bottom, which made the pain from the injection considerably more tolerable. My question is, do you follow this same procedure when giving steroid injections into the heel? I am in need of a new podiatrist, but I would like to find one who uses this same method.
7/27/2014 11:16:00 PM
I have had off and on pain across the top of my foot and on the lateral aspect of my right foot. I have been fitted for shoes and have tried stretching my feet more. Is this something to be seen about?
7/25/2014 3:17:23 PM
Susan Gerth - Deaconess Clinic orthotics technician
Hi, Tammy,
Yes, if you are not having any problems with your present orthotics. I would need the molds and the orthotics, briefly, to trace on the mold. The cost would be $275, which is half the price. If you are asking for a second pair because your orthotics are worn out, I can usually repair orthotics for minimal cost. if you would like to call me to discuss more details, please do at 812-four-two-six-6639.
7/23/2014 3:33:13 PM
Tammy Hayes
I have a mold of my feet that was done about 5 years ago. My question is can I have a spare pair of orthotics made from this?


Tammy Hayes
7/23/2014 2:39:58 PM
Dr. Jason Denton
Hi, Susanna. Thanks for your question.

Custom orthotics are designed to fit the particular individual and their arch as opposed to an over-the-counter (OTC) arch support such as Birkenstock. OTC arch supports are designed to provide some support and control but can have their limitations. Some individuals will do fine with the OTC arch support, but for others, they require more specialized control and this is where a custom orthotic comes into play. See how the pain is doing while wearing the current arch support, and if you continue to have pain, I would recommend you consider other options.
7/23/2014 1:32:38 PM
Susanna Wallace
I have plantar fasciitis and use Birkenstock inserts in my shoes for work. I wear Birkenstocks any other time I wear shoes. Are these as good as custom orthotics? Or should I consider a visit to a podiatrist?
7/22/2014 5:33:24 PM
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