With each of your feet pounding the ground some 800 times per mile, it's no wonder that they feel the occasional pang. Come here to diagnose and treat foot injury, including plantar fasciitis, heel spurs, flat feet and stress fractures.
Posted Saturday, 27 December, 1997
It goes without saying that your feet take the brunt of the punishment on your run. Each one pounds the ground some 800 times per mile. Any structural flaws in your feet or slight imbalances in your stride will eventually result in an ache here or there. Shoes that fit properly and are well matched to your foot structure are crucial, and many of the injuries described below are the result of simply wearing the wrong shoe. Click here for tips for finding the right shoe.
- > Blisters
- > Corns
- Toes and the front of the foot
- > Black toenail
- > Thick toenail
- > Soreness under the ball of the big toe
- > Bunions
- > Hammer Toes
- > Pain under your three smallest toes
- > Neuromas (burning between the toes)
- Body of the foot
- > Metatarsal stress fracture
- > Pain on top of the foot
- Arch and heel
- > Plantar fasciitis
- > Heel spurs
- > Flat feet
- > Pain in the bottom and back of heel
Blisters are caused by rubbing and irritation of the skin. Your shoes are almost certainly the culprit -- they either don't fit properly, or you have run too far in them without breaking them in adequately.
If the blister isn't causing any pain, leave it alone. But if it's interfering with your running, you should feel free to "operate" as long as you're careful to avoid infection. Sterilize a razor blade (boil it for 10 minutes), wash the area of the blister (preferably using an antiseptic like alcohol or Betadine), and make a small slit in the blister. Don't be squeamish -- because the skin of the blister "bubble" is dead, you won't feel any pain. Press the fluid out. Carefully clean the area, again using an antiseptic. Let the blister dry, without putting on any ointment, and cover the blister with gauze or a Band-Aid. Problem solved.
To avoid blisters in the future, there are four things you might do. First, make sure that your shoes fit. They should be snug so that your foot does not rattle around inside, rubbing against the shoe and causing blisters. Make sure that you have laced your shoes tightly enough that they form to your foot. They should not, however, be too tight -- particularly not too narrow or too short.
Second, some manufacturers, such as Thorlo, sell "blister-proof" socks. Give these socks a try, and in general keep in mind that nylon socks tend to be more abrasive than cotton.
Third, feel free to lubricate your feet to cut down on the friction that causes blisters. Rubbing some vaseline on your feet before runs can do the trick, but if you find that too goopy, talcum powder is a good substitute.
Fourth, if you are aware of specific blister problem areas, try protecting those ahead of time. Moleskin may work, but it often doesn't stick very well to sweaty feet. Duct tape, believe it or not, is often more reliable. Put it on before your foot becomes moist, and it won't come off until you want it to.
Hard, painful lumps on the skin.
Constant rubbing and pressure from shoes that are too tight.
First off, get shoes that fit better. Very likely, the shoes you have are either too short, too narrow or both. Take some of the pressure off the corn by putting a doughnut pad on it. You can find doughnut pads at most drugstores; they're small pads with a hole in them that eases friction when fitted over the corn. With the right shoes and the pressure relieved, the corn will disappear in a few weeks. You can speed this process by giving the corn a few strokes with an emery board a couple times a week.
Your toenail is, well, black. It may be painful.
Repeated pressure and impact on your toenail. It could be from running downhill, when your shoe stops short and your toe keeps slamming into the end of the shoe. Or the toebox of your shoe could be too large, and your toe keeps banging against the top (over long distances the cumulative effect of this can be miserable on the nail). Whatever the specific cause, the result is bleeding under the nail, thus the blackness.
The blood must be released to relieve the pressure. Some people will tell you that you can do this yourself with a razor blade or a hot needle, which you poke through the skin. That takes guts; you're probably better off seeing a doctor to take care of it. If you don't take care of it in the first couple of weeks, the nail will probably start to come off, and several weeks later it will ultimately drop off. Not to worry, while this is not a particularly attractive process, it's not painful or unhealthy either.
The nail is noticeably thicker than normal -- perhaps up to 1/2-inch or 3/4-inch thick. The pressure of the shoe probably makes the nail quite painful.
A thick toenail is often the result of repeated trauma to the nail -- injury after injury. Maybe it's from constant pressure and impact within your running shoes, or maybe you've just dropped stuff on your toe a few times too many.
File the top of the nail, using an emery board to smooth it down. You'll likely find that the nail will grow back and thicken again, and you may have to file it again. NOTE: If your nail is also discolored and mottled with yellow and white, this may be fungus nail instead of a mere thick toenail. See a podiatrist about applying a fungicide.
Soreness Under the Ball of the Big Toe
(Bruised or broken sesamoids)
Tiny bones called sesamoids are located under the ball of your big toe (where the toe connects to your foot). These bones sometimes bruise -- it's a hassle, but it's also a warning system; they start aching before you damage the bones of your big toe. To see if you've bruised these little guys, press hard on the head of your big toe with your thumb. If you're howling in pain, that pretty much confirms that you've bruised, maybe even broken, your sesamoids.
Increased mileage, maybe new hillwork or speedwork. Whatever the cause, you are running too much on the balls of your feet. Also, it is possible that your running surface is responsible -- too much hard pavement. A final possibility is that you are doing nothing wrong at all, but you may have been betrayed by your own bone structure (i.e. you have bony feet without much fat padding).
Ice your foot, putting it on ice for ten minutes, off for ten minutes, and repeat. Do this often, maybe four times per day. This, of course, only treats the symptoms. You also have to treat the root cause and stop pounding the balls of your feet into pulp. Reduce hillwork and speedwork, and also take a look at your stride. Your heel should hit the ground first, rolling through the middle of your foot and then springing off from your toes. You should not be landing on the balls of your feet.
The problem can further be avoided in the future by padding around the ball of your foot to take pressure off of it. Get a piece of felt or foam rubber (try using a Dr. Scholl's heel pad, for example). It should be 1/4" thick and about 2" square. Cut a shallow "U" out of the pad so that it fits snugly behind (not over) the ball of your foot. Behind, incidentally, means on the heel side, not the toe side. The pad should fit right behind the painful area. You'll know you've got it right when you try it out and walk around -- the pressure will be off the bone, and the pain will be far reduced. Tape the padding to your foot and wear it in your daytime shoes as well as your running shoes.
You should be able to hit the road immediately, and the pain will likely disappear in about two weeks. If it does not, you may need custom orthotics. See a podiatrist, preferably one who is also a runner.
A bunion is a swelling near the bone connecting to the big toe that sticks out at the side. Having a bunion is not necessarily a problem unless it begins to be tender and painful.
Bunions may become enlarged if too much weight or shoe pressure is applied to them. If this has happened to you, your big toe is probably angled in and overlaps your second toe, causing a problem of weight distribution. As a result, extra weight is getting put on the ball of your big toe, possibly aggravated by the pounding of running. The ball has responded by growing larger in an attempt to handle the weight better.
Unfortunately, you can't undo this, with the exception of going under the knife to trim it down. You can, however, ease the discomfort. First, be sure that you are not wearing shoes that are too tight. Second, try to take pressure off the bunion. Your local drugstore probably sells bunion pads which will cover the bunion and pad the area around it to help take the pressure off the bunion itself. (You can also make your own out of foam rubber. Try a 1/4"-thick piece, and cut a hole to match the size and shape of the bunion). Finally, an arch support (available at most drug stores and running stores) may help to take some of the pressure off of the bunion. If you still have trouble, visit a podiatrist.
Your toes, or maybe just one of them, will not stay straight. With effort you might be able to get your toes to straighten, but they won't stay that way. The tops of the toes hurt when you run, probably from corns that have formed there (you may have also formed corns on the tips of the hammer toes). Any toe except the big toe can be a hammer toe.
Your hammer toes are almost certainly caused by shoes that are too short. After extended use of ill-fitting shoes, the tendons on the bottom of your toes have actually shortened and now they won't stretch out again.
Wear shoes that are looser in the toes. If you do have corns on the tops of your toes, wrap lamb's wool around them; you can find lamb's wool in the footcare section of your local drugstore. It lasts for three or four days of straight use. If you have a corn on the tips of your toes, try putting some padding in the arch beneath the toes to lift them up. This should stop the tips of your toes from pounding into the sole of your shoe.
Pain Under Your Three Smallest Toes
Pain under your three small toes. If you press with your fingers between the toes and balls of your feet, you feel pain.
Too much pounding. You're probably coming down too hard on this area of your foot when you run. As a result bursitis may have developed, with your foot building a cushion called a bursa to protect the area. The pain you feel is the bursa getting irritated.
Take the pressure off of this area with some foot pads. You can probably find some metatarsal pads in the footcare section of your drug store, but a piece of felt or foam rubber will do the trick, too -- about 1/4" thick, two or three inches long. The idea is to put padding behind the balls of your feet so that you won't pound them so hard. Bend your toes back and press until you find the spots that hurt; tape the padding to the area just behind (that's on the heel side of the pain, not the toe side). This should take care of the symptoms, but the cause itself is probably due to an imbalance in your foot. Visit a podiatrist, preferably a runner, to see if orthotics may help.
Neuromas (burning between the toes)
A neuroma is a bundle of nerve endings whose covering has become inflamed. Probably between the third and fourth toes, you feel a burning sensation, maybe more like an electric tingling or a shooting pain, possibly with some numbness. Whatever the exact sensation, it is no doubt excruciating. There is no swelling, no bumps. The pain may come on at odd times, even when you are not being particularly active.
This problem is apparently fairly common for people with a "loose foot," where there is too much movement between the metatarsals, the bones that connect to the toes.
Ice the foot for ten minutes, then ten minutes off, and repeat five times to bring down the inflammation. Take pressure off of the neuroma by putting some padding right behind where the toes meet your foot. Bend your toes back and press on the bottom of your foot to find the most painful spot. Put the padding right behind that (that's on the heel side of the pain, not the toe side). Use some foam rubber or felt, about 1/4" thick. Tape the padding to your foot, or glue them into your shoes.
You will probably always have to use this padding to run since the source of the problem is in your foot structure. Rest assured, though, that even though the nerve bundles will always be there, they won't hurt so long as you're wearing the padding. If, however, you continue to have pain, it's time to see a podiatrist. Hopefully, she can fit you with appropriate padding, but surgery may be a necessity in the long run to remove the neuroma. (As surgery goes, this is said to be not terribly disabling; most can start running again two or three weeks afterward).
Metatarsal Stress Fracture
Pain in one of the long thin bones that run along the top of your foot and attach to your toes (the metatarsals). There may be a little redness or swelling, and if you touch this area the pain will practically knock you over. Press along the shaft of the bone toward the outside and then toward the inside, and you feel a stabbing pain.
The metatarsals can be broken or bruised under the stress of running, particularly for long distances. You're running harder and longer than your feet are able to take.
This is not a do-it-yourselfer. Stop running and see a podiatrist or an orthopedist immediately. Under a doctor's care, you should be back to running in about six weeks.
Pain on Top of Foot
If your symptoms do not match those listed above for a metatarsal stress fracture, the pain is probably caused by either a bone spur or simply shoes that are too tight. A bone spur is an enlarged bone; you'll see it as a bump on top of the foot. The bone has probably grown as a result of pressure being applied to it.
Try wearing larger shoes and don't tie your shoe laces quite so tight. (Remember when buying shoes that your feet swell when you run, especially over long distances). In the case of a bone spur, try taking some of the pressure off of the bone. Cut a piece of foam rubber (about 1/4" thick) to make a doughnut-shaped pad that fits over the bone spur. Either put it on before running or glue it to the tongue of your running shoe.
This is among the most common of foot injuries and is signaled by pain on the front of the heel or all along the arch. You probably have a lot of pain when you first get out of bed -- it's probably murder just to walk out of your bedroom. Ditto on standing up after a long time of being seated. The pain may range anywhere from a vague pull along the arch to the impression that your arch is ripping in half (don't worry, it's not actually doing that). To make sure it's plantar fasciitis, as opposed to a heel spur (see below), press your thumb up hard on the middle of your heel. If you feel pain, it's plantar fasciitis.
Fascia is the stuff your body uses either to separate muscle groups or to connect separate parts. In your foot, fascia form the arch, connecting your heel bone to the balls of your feet. In the ideal foot with the ideal stride, your weight during your stride rolls efficiently from your heel, through your arch, and off of the ball of your foot. The arch flattens a little bit to absorb your weight and then springs back. Of course for most of us, it's a bit much to ask for both an ideal foot AND an ideal stride. Plantar fasciitis is the all too common result of your weight moving improperly through your arch so that it is overstretched. In more extreme cases, the arch loses its flexibility altogether so that it no longer springs back (in which case you have a fallen arch, see flat feet below). The injury is aggravated, like most injuries, by running too much. It also doesn't help much to run on hard surfaces or run on the balls of your feet (for example, when running hills or doing trackwork).
First, ease off on the miles and cut out the hills and speedwork. When you do run, make sure your calves and hamstrings are well stretched.
Plantar fasciitis is essentially an inflammation of the fascia. Give it ice immediately after running -- ten minutes on ice, ten minutes off, and repeat. Take anti-inflammatories to reduce the swelling. For that early-morning pain, avoid getting out of bed barefot. Put on some thick socks or slippers first.
To get at the source of the problem, you have to give your arch some help and support. Try wearing an arch strapping. This will add support to your arch. If the strapping does not provide enough relief, pick up some arch supports. You should be able to find them (probably by Dr. Scholls) at a drug store. They raise the arch and shift burden off the heel. By wearing these you also give the fascia a little slack -- the arch doesn't have to stretch as far. If the strapping and the arch supports together are not enough, try adding heel pads. You can buy these, or just use make-up sponges (you're looking for 1/2-inch sponge rubber).
Also, tight calves can add strain to the fascia. Spend some extra time stretching your calves with wall pushups.
This kind of home treatment is usually fairly successful for plantar fasciitis. Give it a try, it's a lot cheaper than orthotics. But if after two weeks you still have pain, see a podiatrist who treats athletes (and who is preferably a runner herself). Orthotics may be necessary. If so, they should solve the problem for good.
The symptoms of heel spurs are nearly identical to those for plantar fasciitis (above). There is pain in the front of the heel and possibly in the arch. The pain probably seems particularly acute when taking your first steps of the day or walking after a long period of sitting down. When you have a heel spur, unlike with plantar fasciitis, you will feel pain when you press the front of the heel, at the intersection of the heel and the arch, pressing up and backward toward the heel. This is where the heel spur has formed -- it's a pointy extension of the heel bone.
As with plantar fasciitis, you may have strained the fascia that form the arch of your foot. In doing so, some of the fascia may have actually been yanked off of the heel bone, leaving some blood behind. Over time these little droplets, sitting on your heel bone, calcified and actually formed an extra little piece of bone, the heel spur. The pain you feel is not the spur itself (that's bone), but the flesh and fascia around it which are now taking an extra pounding from the new arrival in your skeletal neighborhood.
There are some things you can do to ease the discomfort and possibly even cure the problem. Keep in mind, though, that home treatment very rarely does much for these little guys but that your friendly neighborhood podiatrist can fix you up with very little fuss.
First the home treatment. Ice your heels (cool your jets, etc) right after running. Apply ice for ten minutes, take it off for ten, then repeat. This will help take down some of the swelling and ease the pain.
Try wearing heel pads when you run, too. You can buy commercial heel pads at the drugstore, or simply use makeup sponges or any piece of sponge rubber, about 1/2-inch thick. These will absorb shock and shift your weight somewhat away from the front of the heel where your heel spurs are. Arch supports (also found in many drugstores) may help, too. Try wearing an arch strapping to give your arch further support.
While there is a chance that doing these things will make your problem go away, don't count on it, it hardly ever happens. If your pain continues, and certainly if it increases, go to see an orthopedist or a podiatrist. She will likely fit you with orthotics which should take care of the problem, which is essentially a problem of weight distribution. She may, however, recommend surgery to remove the spur, though you will probably still have to wear orthotics anyway.
(a.k.a. fallen arches, or weak foot syndrome)
There are a variety of symptoms for flat feet, and not everyone will experience all of them. Symptoms might include tired, sore feet (particularly on the bottom); lower back pain; pain in the arch; or tired legs. Your feet probably feel better when you roll your feet toward the outside. To confirm whether you have flat feet, press on the arch at the highest point. If you have weak foot, you will find this fairly painful. Another test is simply to look at your feet. When standing, you pronate; your weight falls toward the inside of your foot, and your arch almost disappears entirely.
You may have simply been born with a very low arch (just because you are born with low arches, by the way, does not necessarily mean that you will ever have the symptoms of "flat feet"). On the other hand, your arches may have fallen. This happens when the flexible bands (the fascia) that form your arch become overstretched. This is usually the result of an imbalance in your foot. Your arch loses its flexibility and no longer springs back.
You need to give your arch some extra support. Wear an arch strapping until the pain is gone, probably about two weeks. You should also wear an arch support, both in your running shoes and your regular shoes. You can probably buy these supports in your local drugstore, and you should continue to wear them even after the pain goes away. If you do not, you run a serious risk of inviting back the pain. If these steps do not solve the problem, see a podiatrist to find out if orthotics might be necessary.
Pain in the back and bottom of the heel
(Apophycitis of the heel)
This injury happens to runners under twenty, most commonly to children around eleven. The pain dances up the back of your heel, and if you grab the heel and squeeze, you'll be howling in pain.
Right through the teens, the heel bone is in two pieces which eventually fuse after adolescence. If you are under twenty and you have been running very long distances, you may have jarred and separated these bones.
Try a heel strapping, using 1-1/2 inch adhesive tape. It's easy to do: Put one piece around the bottom of the heel toward the front, then another around the back of the heel toward the top -- from the inner ankle bone to the outer ankle bone. Then put another piece at the bottom, just behind the first piece of tape and overlapping by 1/2 inch. Do the same with another piece of tape at the back of the heel. Continue to add pieces of tape alternating between the bottom and the back of the heel until the last tape around the back of the heel borders the sole of your foot.
Also be sure to wear heel pads -- try inserting makeup sponges in your running shoes. Be patient: the injury will probably take about six months to heel, and during this period you should avoid all running and jumping. It's tough medicine, but to do otherwise will risk making the injury worse.