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[EXERCISE ADVISER]

Pain-Free Feet

Lloyd Nesbitt, DPM

THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 12 - DECEMBER 98


Runners like to accumulate miles, accomplishments, health gains, and satisfaction. They don't have to pile up foot pain and injuries as well. In fact, marathoners often have fewer foot problems than 10-K runners. Some veteran runners could probably write the book on foot care since they are so well attuned to taking care of their feet with stretching exercises, training techniques, footwear, and other measures.

The following tips can be helpful whether you are a beginning runner or the most seasoned.

Choosing Shoes

If you're not wearing good-quality running shoes, you shouldn't be running. It's amazing how many people have run road races in flimsy sneakers or even tennis shoes! This seems to be changing now, but some people don't realize that tennis shoes or cross trainers don't cushion your heel well when it strikes the ground.

A good shoe is designed specifically for running and should fit your foot well (ask an experienced salesperson for help). It should provide sufficient cushioning and stability. Styles are available for runners whose shoes wear unevenly.

To determine if you need new shoes, check for excessive shoe wear. The back of the shoe should stand upright and not slant inward (figure 1). Badly slanted shoes may indicate a foot structure problem called overpronation, a condition in which your feet flatten and your ankles roll in. Worn spots on the shoes also provide clues about bone imbalances within the foot. (See "Foot Imbalance and Orthotic Inserts," below.)

[Figure 1]

After 300 to 400 miles, your shoes have lost about half their cushioning. You may want to get a new pair and use the old ones for muddy runs.

Before Running

If you're prone to blisters, replacing your shoe insoles with Spenco insoles (Spenco Medical Corporation, Waco, Texas) may reduce friction. They can be found in many drug stores or sporting goods shops. These insoles also provide more cushioning than the original insoles for runners who have rigid arches or "shin splint" problems.

In addition, you can eliminate points of friction or rubbing. For a toe, cut a hole in a small moleskin pad (available in most drug stores or department stores). Place the hole over the friction spot so the pressure is around the sore spot, not on it. Dabbing petroleum jelly on friction points before a run can also help.

If you are considering running with a sore toe, strained tendon, or dull foot ache, proceed with caution. If such minor pain worsens when you run, stop running and consult your podiatrist or doctor.

If you do run, you can add stability and comfort by wrapping a small compressive dressing around a toe or the foot. Try an elastic wrap like Coban (3M, St Paul), which is a thin, self-adherent wrap available in medical supply stores and some pharmacies. Take care, though, not to wrap it too tightly, and remove it if you notice numbness, tingling, or discoloration in your toes.

Finally, your body will feel better if you stretch before your run, and even after about 5 minutes into the run when you're warmed up. Ask a healthcare professional about good all-purpose stretches for runners, like calf and hamstring stretches.

After Running

In addition to stretching before you run, postworkout stretching will help keep muscles loose.

To treat blisters that develop despite precautions, use a sterile needle to gently puncture them to let out the fluid. (It doesn't hurt, and a needle and the blister can be cleaned by wiping them with rubbing alcohol.) Leave the skin on, because it is a blister's own best protection. The underlying skin will toughen up in a couple of days.

For blisters or calluses, you can cut a hole in moleskin as described earlier and place the moleskin patch around the blister or callus.

Minor injuries and soreness require RICE: rest, ice, compression, and elevation. Take time off, apply ice for 5 to 10 minutes at a time, wrap the injury with elastic wrap to prevent swelling when you're not icing it, and raise the injury above the level of your heart, if possible.

For road racers, ice and first aid will be available at the finish line. But any runner needs to seek medical attention after a serious injury for quick healing and a speedy return to pain-free running.


Foot Imbalance and Orthotic Inserts

Some people have feet that are structurally imbalanced, which can place added stress on the feet, legs, knees, or other areas of the body and lead to injury. A podiatrist or sports medicine doctor can evaluate foot function to determine the cause of such imbalances. Orthotic devices, if made correctly, will allow imbalanced feet to function more efficiently. Custom-fit devices are prescribed by a medical doctor or podiatrist. Prescription orthotic
devices typically work more effectively than off-the-shelf inserts found in stores, but they may be more expensive.

Distance runners have to adjust gradually to the mechanical correction of orthotic devices. If you have new orthotic inserts (less than a month old), don't run a marathon with them unless you have comfortably logged a 10- to 15-mile run with them. Otherwise, the inserts may become too uncomfortable by the end of the race.


Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Dr Nesbitt is a podiatrist in private practice in Toronto.


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