Whether you’re training for your very first marathon or preparing for your 10th, it’s important to begin your training program on the right foot. A lack of experience coupled with the repetitive impact placed on the feet and ankles during a long run can produce enough stress to cause hairline fractures and other debilitating foot injuries.
Many foot problems seen in marathoners are caused by the repetitive pounding over the months of long-distance running. With some people, injury is triggered by the abnormal foot biomechanics, and in others it is because of poor training. During a 10-mile run, the feet make about 15,000 strikes, at a force of three to four times the body's weight. Even if you have perfect foot mechanics, injuries and pain are often unavoidable with this amount of stress.
To prevent injury during training, it’s important to pay close attention to your feet. When increasing mileage, avoid doing so too quickly. The increased forced can make your feet more susceptible to stress fractures.
Basic tips for training include:
- Follow a training schedule that is appropriate for your experience level
- Start easy and increase your mileage slowly
- Stretch and warm up properly to reduce strain on muscles, tendons and joints
- Choose appropriate footwear based on your foot structure, function, body type, running environment and training regimen
- Never ignore pain. If the pain gets worse with reduced exercise and rest, stop training and visit your podiatrist
Aside from stress fractures which often occur from overtraining, additional foot problems you may experience include:
- Toenail problems, including ingrown and fungus
- Heel pain, such as plantar fasciitis
- Achilles tendon and calf pain
- Toe pain, such as bunions
- Shin splints
Before you start training, our practice recommends visiting a podiatrist for a complete evaluation of your lower extremities. Our office will examine your feet and identify potential problems, discuss training tactics, prescribe an orthotic device that fits into a running shoe (if needed) and recommend the best style of footwear for your feet to allow for injury free training all the way up to your race day. It is especially important to come in for an exam if you have already started training and are experiencing foot or ankle pain.
Training for a marathon is hard work. It takes time and dedication. At our practice, we offer special interest and expertise working with marathoners to ensure good foot health throughout your entire training program to help you achieve your goals.
Regular foot evaluations are extremely important for diabetics. This is because prevention is the key to avoiding complications to the feet and ankles that can be caused by diabetes. Diabetes affects the nerves and the circulation to your feet. Because of this, it is very important to monitor your feet and ensure that there are now new issues arising. When you see us for diabetic foot checks there are three main categories that we are evaluating: circulation, sensation and skin problems. The pulses to the feet and the nerves are evaluated and documented in your chart. Each has their own grading system and this ensures that no changes are occuring between your visits. We also check and make sure there are no open lesions or prominent areas to the feet that could cause an open sore. Things like bunions, hammertoes, bone spurs, dry skin, cracked web spaces, blisters, corns and calluses can all lead to ulcers to the feet. If you have nerve and/or circulation problems because of your diabetes, this could lead to serious issues including infection and possible amputation. Your physical exam findings will determine your return visit increments. This also allows you to be established with our practice and same day appointments are available for any new or concerning problems. Again, prevention is the key. The Providers at Advanced Foot and Ankle Center all have extensive training related to diabetic issues with the foot and ankle. Please give us a call at 972-542-2155 for an appointment.
The Achilles tendon is the strong band of tissue that connects the calf muscle to the heel bone. This lower leg tendon enables you to walk, jump, stand on your toes and climb stairs. You rely on it virtually every time you move your foot.
When the tendon is stretched beyond its normal capacity, a complete or partial tear may occur. Most Achilles tendon ruptures occur as a result of sport-related injuries when forceful jumping or sudden accelerations of running overstretch the tendon and cause a tear. Individuals with Achilles tendinitis -- weak and inflamed tendons -- are also more susceptible to tendon tears.
Signs of a torn Achilles tendon include:
- Sudden, sharp pain in the back of the ankle and lower leg
- Snapping or popping sensation at the time of the injury
- Swelling down the back side of the leg or near the heel
- Difficulty walking or rising up on the toes
The best treatment for a torn Achilles tendon is prevention. Avoiding this injury could save yourself months of rehab and extended time away from your game. Help prevent injury to your Achilles tendon by:
- stretching your calf muscles regularly
- limiting hill running and jumping activities that place excess stress on the Achilles tendons
- resting during exercise when you experience pain
- maintaining a healthy weight
- alternating high impact sports, such as running with low-impact sports, such as walking or biking
- wearing appropriate, supportive shoes with proper heel cushioning
If you suspect a ruptured Achilles tendon, visit our practice as soon as possible. Until you can seek professional care, avoid walking on the injured tendon and keep it elevated. Ice the affected area to reduce pain and swelling and, if possible, wrap the injured foot and ankle. For partial tears, swelling and pain may be less severe, but prompt treatment should still be administered.
Treatment for an Achilles tendon rupture can be surgical or non-surgical. Surgery to reattach the tendon is generally recommended, followed by rehabilitation, especially for individuals who want to return to recreational sports. Our pracitce can evaluate the severity of your tear and suggest the best treatment plan. With proper care, most people return to their former level of performance within six months.
A subungual hematoma is a collection of blood beneath the nail and is usually from trauma to the nail unit. This can be from obvious injuries like dropping something on the toe or stubbing it or it can occur from repetitive microtrauma. This is usually the case with runners or athletics when the toe is constantly and repetitively hitting the shoe. A small sore develops beneath the nail plate and bleeds under the nail. This then forms a blood blister beneath the nail which can be very painful and feel like there is a lot of pressure beneath the nail.
Treatment options vary depending on the injury and the amount of nail involved that has the hematoma. If there is any known injury, an Xray may be obtained to rule out a fracture to the underlying bone. If the hematoma encompasses a small area and the nail is not painful, the area can typically be left alone and the bruising will slowly grow out of the nail. If there is pain to the area and the hematoma involves a large portion of the nail, the pressure can be relieved by puncturing a small hole in the nail plate and allowing the fluid to drain or the nail is removed in its entirety and allowed to grow back. This is done under local anesthesia in the office.
If you experience this or any other foot and/or ankle issue, please call us at 972-542-2155 for more information.
Are you starting to notice your second toe rising up and crossing over your big toe? If so, you may be suffering from a plantar plate injury or pre-dislocation syndrome. This usually occurs with a bunion deformity in which the big toe sways over and points torward the lesser toes. The second toe has no where to go so it begins to rise up and cross over the big toe. This can also occur without a bunion deformity if there is injury to the plantar plate.
The plantar plate is a thick ligament on the bottom of your foot that connects the toe to the ball of the foot. You can develop micro tears in the plantar plate from injury or abnormal foot biomechanics. If you develop a small tear on portion of the ligament that is closer to the 3rd toe, the opposite portion of the ligament is now tighter and pulls the toe toward the big toe.
If you have a plantar plate tear, it will most likely be painful at the ball of the foot beneath the 2nd toe and will probably be worse with increased activity or walking barefoot. After a thorough lower extremity physical exam, an X-ray will be taken to ensure there is no bony pathology to the area. Sometimes when the plantar plate tears, it takes a small portion of bone that it was attached to with it.
Treatment of plantar plate tears begins conservatively and varies with orthotics, Non-Steroidal Anti-Inflammatory Drugs (NSAIDS such as Advil, Aleve) , walking boots, Injections and a special device to wear that holds your toe pointed downward to help faster healing. If conservative treatment fails and the area is still painful, the plantar plate may need to be surgically repaired. This is performed outpatient at a surgery center.
At Advanced Foot & Ankle Center, all of our providers have extensive experience with this condition. If you are experiencing this issue or any other foot or ankle disorder, please call us at 972-542-2155.
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