Coping quarantine for runners

Which foot issues often plague runners and how these can be exacerbated during quarantine?

Plantar fasciitis is the most common cause of heel pain. The plantar fascia is a shock-absorbing bowstring like thick ligament that connects your heel to toes. When you stand your arch collapses causing this bowstring to stretch out leading to the formation of micro tears in the ligament that can result in weakness, swelling, and irritation of the plantar fascia.

The most common sign of plantar fasciitis is stabbing pain in the bottom of your foot when you get out of bed in the morning, after standing for prolonged periods of time, or when you stand up after sitting for a while. It's also common to experience pain after you exercise, not during your workout.

Metatarsalgia is another common injury. It's a general term used to describe pain and inflammation in the metatarsal region of the foot, more commonly referred to as the ball-of-the-foot. This is a common foot disorder that can affect the bones and joints at the ball-of-the-foot. Metatarsalgia is often located under the 2nd, 3rd, and 4th metatarsal heads-the rounded ends of the bones that connect to your toe bones, or more isolated at the first metatarsal head near the great toe joint.

Sometimes a single factor can lead to metatarsalgia. More often, several factors are involved, including: Intense training or activity. Runners are at risk of metatarsalgia, primarily because the front of your foot absorbs significant force when you run. During the push-off phase when one jumps or runs, one's body weight is transferred to one's toes and metatarsals. The first and second metatarsal bones take the brunt of this force. This condition commonly occurs when performing high impact activities especially if one's shoes are ill fitting or are worn out.

There are two reasons people will start to experience this now:

1) Because they are walking barefoot at home. Walking barefoot on hard surfaces allows our foot to collapse which can lead to a tremendous amount of stress not only to the foot but to the rest of the body. Our feet naturally pronate during the gait cycle, however when we walk barefoot we pronate for a longer period of time which then alters the biomechanics and distribution of pressure and weight across the foot.

2) Because they are doing at-home workouts in inappropriate footwear. Whether they are creating their at-home workout, doing barefoot exercises while working out to their gym's Instagram videos or going just a little too hard on the weekends, it's important to mimic the routine you normally had pre-quarantine AND wear the appropriate foot gear. Barefoot exercises are almost worse than walking barefoot as you're putting more strain on your plantar fascia.

Which injuries require immediate attention from your podiatrist and simple tricks for treating

foot pain at home?

It's important to pay close attention to your feet as they are the most neglected part of your body. It's important to pay attention not only to how your feet feel, but also how they look. If you're questioning the color of your toenails or the scaliness of your feet, you should contact your podiatrist for a telehealth appointment as they could indicate underlying health issues.

· Check your feet daily for any signs of pain, swelling, or changes in the color texture, and hydration of your skin and nails.

· Wash your feet daily and dry them thoroughly, especially between the toes.

· Trim your toenails regularly if you can reach them or have them trimmed by a professional. Trim your toenails straight across without cutting them too short and file the edges with an emery board or nail file.

· Apply a thin coat of cream such as Eucerin Advanced Repair Foot Cream to your feet daily while avoiding the areas between your toes. If you have athlete's foot and notice scaliness on the bottom of your feet or fissures in between your toes you may want to consider using Lamisil twice a day (morning and night) for 1-week or as directed by your foot doctor.

· If you suffer from thick pain and painful calluses, I recommend applying urea cream to your feet at night by wrapping your feet with saran wrap, and then placing socks onto your feet before going to sleep. In the morning use a pumice stone to remove your corns and calluses as they will be easier to remove.

· Schedule a Telemedicine conference with your podiatrist to discuss any concerns especially if you are diabetic or develop corns, calluses, ingrown nails or other worrisome foot care related issues.

· Make sure to inspect your shoes especially if you are diabetic. Look for objects in the shoe and for wear and tear to determine whether it's time to get rid of an old pair of shoes and get a new pair. Spray Lysol into your shoes at the end of the day to kill any organisms such as fungi or bacteria that can lead to odor, athlete's foot, or fungal nails.

· You should also pamper those feet and give them a little TLC – after all, they do take a lot of abuse even from home! I often suggest combining four parts water, one part apple cider vinegar with three tablespoons of Epsom salt for 20 minutes. This often does the trick to solve issues with calluses, blisters and foot pain. Afterwards, follow the exfoliating and hydrating recommendations noted above.

How to care for your feet as you plan for virtual marathons?

One of the biggest mistakes my patients make prior to any marathon is to not trim their toenails as short as possible. By not doing so, they can experience black toenails that will eventually fall off, cause blistering and bruising. Black toenails are caused by repetitive microtrauma to the nail plate subsequently resulting in small blood vessels bleeding underneath the nail plate forming a bruise known as a subungual hematoma.

Another mistake my patients make is to not wear shoes that support your foot type even while running or working out at home. Barefoot running puts a lot of stress on your arch. The extra weight increases the likelihood of injury to your plantar fascia as our feet pronate we may subsequently lead to plantar fasciitis, achilles tendinitis, and shin splints.

How often should you be running outside?

Running outside is beneficial as it can help improve your physical and mental well being. Beginner runner's should start gradually with 3 days a week and progress from there on as tolerated and pain free. Pain can be minimized if you wear proper shoe gear for the terrain you will be running, use of custom orthotics as well as stretching. For regular runners that prefer to run I suggest at least one day minimum of rest if they are not experiencing any pain.