Now that we’ve entered the season of no snow on the trails (called summer in some parts of the country), runners, hikers and power walkers can get lots of outdoor time.
Dr. Conway McLean, who practices foot and ankle medicine in Marquette and Munising, Michigan, expects his usual stepping up of traffic from marathon runners, regular joggers and distance hikers, all who face potential foot injuries with increased time on tracks and trails.
In entering the season, Conway outlines three of the most common foot problems and how to treat them.
1. Plantar fasciitis. This is the most common cause of pain in the heel and involves irritation of the plantar fascia, a thick ligament that runs across the bottom of your foot’s arch and does not stretch as the foot flexes.
Anyone who runs often or long distances puts tremendous stress on this ligament at the heel. It can become inflamed and cause sharp, stabbing pain.
Resting the foot’s arch can be difficult because serious runners don’t like being told they can’t run, Conway says. Before you stop running, though, less drastic measures can be tried.
A physical therapist can give instruction on exercises to stretch and strengthen the Achilles tendon, calf and arches. Physical therapy may also involve use of devices or methods to treat the inflammation and to help the body heal. Therapeutic ultrasound, the use of ultrasonic waves through a wand or probe, and hydrotherapy in a therapy whirlpool are two examples.
“I would guess that the most important measure, when it’s not something to resolve easily, is to get into a prescription, customized support. Those are called foot orthotics,” Conway says. “They can be tremendously beneficial when correctly prescribed.”
A prescription requires an impression of your foot (options include a fiberglass sock, plaster or 3D computer scan) and an examination to determine what will help your foot work better. Your physician will look at foot mechanics, how back, legs and feet line up and how you stand and walk.
To prevent plantar fasciitis, most serious runners know to change shoes regularly so that they maintain proper support. Yet many do run with old shoes or the wrong shoes for the activity (like choosing tennis shoes for cross-country running). “Shoes have a very limited lifespan when you’re placing those kinds of stresses on them,” Conway says. “The impact with each step running will wear out a shoe, and it will lose stability and shock absorption.”
2. Achilles tendinitis. This injury of the Achilles tendon, which attaches the calf muscles to the heel bone, produces pain in the back of the heel and back of the ankle.
It afflicts runners, as well as amateur athletes, who overdo it on weekend workouts or races. Because the problem can develop for many reasons, it’s best to see a professional to find the cause. One possibility may be how the arch in your foot does its work. “If your arch moves down too much, it causes excessive movement of the heel bone and that can irritate the Achilles. Or perhaps your arch is up too high, which causes the back of the heel to push against the back of the shoe and causes more pressure to the area.”
You also might be prone to calcium deposits (like bone spurs). Or the cause of the problem could be the shape of your heel bone.
There are many methods to treat the inflamed tendon, from immobilizing the foot with a wrap, cast or special boot to use of electrical stimulation of the tendon or injection of an anti-inflammatory medication.
3. Nail fungus. A common health problem for runners and regular folk, fungal toenail infections can grow slowly and may cause no pain.
They can start if your shoes are too short or you have a toenail injury.
“I see people who stub their toe or drop something on their toe,” Conway says. “Over time, that nail turns yellow and thick and (the infection) spreads to other toenails.”
Over-the-counter topical medications have only limited success, he says. Other treatments include nail lasers or surgical methods. Conway prefers a new option called photo-dynamic therapy: a topical antibacterial medicine activated by a special light source. It’s safer than medications that have side effects and is “incredibly effective,” he adds.
Fungal nails can be prevented by using an antifungal spray in your shoes (ask your pharmacist for suggestions among the many options), maintaining good foot hygiene with washing and nail clipping, and wearing shoes with sufficient space for toes, so they’re not banging against the shoe, as the doctor says.
So the best way to maintain good foot health and stay in the running is to treat your feet with the respect they deserve. Buy them quality shoes, keep them clean and when they’re injured, take them to a podiatrist or sports medicine physician.