Runners Foot

    Dr. Jason Denton, Deaconess Clinic Podiatry

    Welcome runners!  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
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