RUNNERS AND FOOT PROBLEMS


 

With each of your feet pounding the ground some 800 times per mile, it's no wonder serious runners who rack up the miles often have some very specific foot problems. We created this section to help guide runners on possible foot problems, how to understand symptoms and when to seek treatment. There are also some great tips and tricks for runners looking to prevent foot injuries from happening.

COMMON FOOT PROBLEMS FOR RUNNERS

Blisters

Blisters are caused by friction, most commonly when your shoes and socks rub against your skin. This usually occurs due to poor fitting shoes, foot deformities (such as bunions, hammertoes, and heel spurs), or high-intensity training. Moisture and heat can make the friction more intense as your feet can swell.

The blister starts when the body reacts to the friction by producing fluid. This fluid builds up in the skin under the area of friction. This causes pressure and pain. Blood blisters form when that friction also ruptures tiny blood vessels. Blisters can be extremely disabling due to the pain, but are rarely a serious health issue. The blister can get infected, but that is usually due to people popping the blister with an unsterilized needle.

HOW DO YOU PREVENT BLISTERS?

  • Wear proper fitting shoes and socks. There should be a thumbs width of space between the toes and end on the toe box. Your socks should fit smoothly with no bunching.
  • Purchase blister-free socks. Synthetic socks keep the skin moisture-free. Socks with reinforced heels and toes also help. Cotton actually retains fluid and can contribute to blistering.
  • Moisten your feet. Dry skin is equally prone to friction as wet skin. Keep your skin moisturized.
  • Apply friction reducing products such as Vaseline and BodyGlide. Second Skin can also reduce friction.

HOW DO YOU TREAT BLISTERS?

If the blister is large, Gotham Footcare recommends draining it. We recommend only popping blisters with a sterile needle. After the blister is popped, the liquid is slowly drained by applying pressure to the blister area around the hole. We do not remove the loosened skin, but we wait until it dries and falls off on its own. Skin under the blister tends to be very sensitive. The blister is then covered with a bandage.

If the blister is small, Gotham Footcare recommends leaving them alone. Popping smaller blisters often produces more pain and problems that it solves.

Blackened Toenails

Also, know as subungual hematoma, blackened toenails occur when blood collects underneath a toenail or fingernail. This typically occurs when the toe and nail are exposed to either direct trauma (an object falling on the nail) or repetitive trauma (such as running in tight shoes). Subungual hematoma is often called “runner’s toe” or “jogger’s toe” as it occurs quite often in long distance runners.

HOW DOES A SUBUNGUAL HEMATOMA PRESENT?

The nail will appear reddish-black. Patients will typically note moderate to severe pain, especially if the nail is touched.

HOW IS A SUBUNGUAL HEMATOMA TREATED?

When the injury is acute and painful, the pressure is released by drilling holes through the nail into the hematoma or by removing the entire nail. Gotham Footcare only removes the nail when: 1. The entire nail is dislodged, 2. A large laceration of the nail bed is found, and 3. A distal toe fracture is found. This would be done in the office under local anesthesia to the toe.

WHEN WILL MY NAIL BE NORMAL AGAIN?

It can take about 6-9 months for the nail to grow back. The nail can return to its normal state, but if the nail root is damaged it can grow back abnormally.

Shin Splints

WHAT ARE SHIN SPLINTS?

Shin splints (also known as medial tibial stresss syndrome) are characterized by lower leg pain occurring below the knee on either the inside of the leg (medial shin splints) or outside part of the leg (anterior shin splints). Medial shin splints are more common. Shin splints are typically caused by repetitive trauma. Shin splints usually occur in people who do not gradually increase their mileage or markedly shifted their training regimen.
There is no consensus as to what exactly happens in shin splints. Ideas include inflammation of the periosteum (this tissue wrapping around the bone), small tears in the muscle that has pulled off the shin bone, inflammation of the muscle, inflammation of the tendon, or a combination of these.

WHAT ARE SOME CAUSES OF SHIN SPLINTS?

  • Overpronation
  • Inadequate stretching
  • Worn Shoes
  • Excess stress on the leg (from improper shoes and hard surfaces)

WHAT ARE OTHER CAUSES OF SHIN PAIN?

If your shin pain is not alleviated by conservative treatment or becomes so severe that you have difficulty walking, Gotham Footcare recommend that you be seen by a doctor immediately. Two other causes of shin pain:

  • Stress fracture: an incomplete fracture in the shin bone (tibia) which can be caused by repetitive trauma.
  • Compartment syndrome: Typical in anterior shin pain, a swelling pressure builds in the anterior muscle compartment of the lower leg which can cause severe pain, numbness, or muscle weakness.

WHAT ARE THE TREATMENTS FOR SHIN SPLINTS?

  • Stop running completely or significantly decrease your mileage.
  • Ice the shin.
  • Stretch the Achilles tendon (medial shin splints) OR sit on your feet with your leg and feet together and your feet pointing backwards and sit back slowly onto your calves and heels until you feel tension in the shins for 15 seconds (anterior shin splints). Repeat twice.
  • Trace the alphabet on the floor with your toes while in the sitting position.
  • Wrap your affected leg before running. Tape and Ace bandage can work, but the new compressive running stockings work well. Continue usage until pain is relieved.
  • If the pain is severe, stop running and start swimming, run in the pool, or ride a bike.
  • After the pain starts to resolve, SLOWLY return to running. Start with lower mileage recommended by your coach or doctor. Increase mileage by no more than 10 percent weekly.
  • Make sure that you have proper shoe gear for your foot type. Gotham Footcare can match your feet to the proper running shoes. If orthotic are required, Gotham Footcare can design them for you.
  • Avoid hills and hard surfaces until you are pain-free while running, and start SLOWLY when you do.

Stress Fracture

A stress fracture is a small crack in the surface of the bone. The most common area in the foot and ankle for a stress fracture is the lower leg and metatarsals in the foot. Stress fractures are due to repetitive trauma, such as running, that places too much pressure on the bone which begins to fail. This often happens when runner increase their mileage or intensity too quickly.

WHEN SHOULD I SUSPECT THAT I HAVE A STRESS FRACTURE?

Stress fractures can begin as soreness or stiffness in the area of concern. This can develop into an area of pinpoint tenderness. This pain tends to be moderate to severe.

WHAT SHOULD I DO IF I SUSPECT A STRESS FRACTURE?

You should immediately see a doctor. Further weight bearing can worsen the fracture making treatment even more difficult. At Gotham Footcare we will perform an X-ray, but often times stress fractures don’t show up immediately on Xray. In those instances, an MRI can be performed when necessary.

HOW ARE STRESS FRACTURES TREATED?

The main objective of stress fracture treatment is to offload the fracture. This can be accomplished through the use of a hard-soled surgical shoe or fracture boot.

Ankle Sprain

Ankle sprain is a stretch injury of the ankle ligaments. It is one of the most common injuries of the lower extremity. Most ankle sprains are on the outside of the ankle when the foot is turned inward (inversion injury). A fully torn ankle ligament can lead to ankle instability which requires more aggressive treatment.

WHAT ARE THE SYMPTOMS OF AN ANKLE SPRAIN?

An ankle sprain presents with swelling and pain on the outside of the ankle just in front of the ankle bone. In more severe sprain there can be bruising. The pain can range from a mild ache to severe pain that inhibits weight bearing.

WHAT CAN I DO FOR MY ANKLE SPRAIN?

The initial care for ankle sprains is the commonly used RICE (Rest, Ice, Compression, and Elevation). The initial goal of ankle sprain treatment is to control pain and swelling during the immediate/acute phase. Initially, icing should be at least 15 to 20 minutes per hour. We recommend placing a paper towel or cloth between the ice and the skin to prevent frostbite. NSAIDs (such as ibuprofen or Aleve) can alleviate the pain and swelling as well, but take care to take them with food.

Studies have shown that early rehab is important for returning the ankle to regular usage. If fact, prolonged immobilization of the ankle can result in joint stiffness, muscle atrophy, and loss of proprioception.
Gotham Footcare will only recommend casting or non-weightbearing when the ankle joint is completely unstable.

HOW CAN I REHAB MY ANKLE?

After the first week of acute phase treatment, the second phase of rehab is aimed at restoring normal ROM of the ankle without loss of proprioception. This phase usually lasts from 2-4 weeks. This accomplished with range of motion exercises, calf stretching exercises to increase ankle dorsiflexion, and progressive use of balance training. Balance training should start with balance on both ankles then progress to injured ankle by itself.

At Gotham Footcare, we provide in-office physical therapy during this second phase. Icing and NSAIDs are continued during this phase.
The third phase of rehab is aimed at training of muscular strength, endurance, and neuromuscular function. This is achieved with increased weight bearing exercises. This phase usually lasts from weeks 4-8.

WHAT ARE THE SPECIFIC ANKLE STRENGTHENING EXERCISES?

The initial exercise performed is to gently move the ankle up (dorsiflexion) and down (plantarflexion). You can start to perform this exercises during the first week. Gotham Footcare recommends 3 sets of 20 dorsiflexion/plantarflexion.
After the first 5-7 days, we recommend slowly beginning “alphabet” exercises. In this exercise you elevate your foot off of the ground while sitting and draw out the letters of the alphabet by using your big toe like a pen. Perform one round of the alphabet.

After 2-4 weeks we recommend performing heel raises by standing while facing a wall. You raise onto the balls of the feet while using the wall for support. Perform this exercises 3 sets of 20.

Finally, after 2-4 weeks we recommend performing balance exercises. You will stand on the injured leg with the other foot in the air and your hands out to the side. Hold this position for 30 seconds. If this seems too easy then perform the movement with your eyes closed.

Gotham Footcare recommends that you warm your ankle prior to performing these exercises. After you are finished we recommend that you ice your ankle to limit the inflammation that can be produced by the exercises.

WHEN SHOULD I SEE A DOCTOR?

You should see a doctor if you cannot put weight on your ankle or if your ankle does not feel better within the first few days.

HOW IS THE TREATMENT I GET FROM A DOCTOR DIFFERENT FROM ME REHABBING MY ANKLE AT HOME?

Gotham Footcare can provide you with a more accurate diagnosis of your ankle. We can do this through our physical exam, in-office digital X-ray, and in-office diagnostic ultrasound machine. Better diagnosis will allow a more specific treatment regimen for your particular type and level of injury.

Gotham Footcare provides in-office physical therapy, including therapeutic ultrasound, Hot and Cold therapy, range of motion exercises, electrical stimulation, and therapeutic whirlpool. We also can provide ankle braces and teach injury-specific strappings to our patients.

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