Footcare for Runners. Ellen Wade.

Footcare for Runners

The foot absorbs more force during running than any other part of the body, they propel us forwards and have the absolute power to make running comfortable – or miserable. Our feet can ache, blister, sweat, crack, peel, itch and smell and are one of the runners most valuable tools.

Most runners give their feet little care until something goes wrong. Hamstrings are stretched, core stability worked upon and muscles carbo-loaded but the foot barely receives any attention.

After the knee, the foot is the most injured part of the body with one in five runners having had a foot injury within the last year.

For every mile you run, your feet hit the ground about 1,500 times and with each step, your foot will absorb a force several times your body weight. An 11 stone man of average size will process 112 tonnes of weight through each limb per mile!

Footwear

There are so many different brands of shoes available for different sporting needs and this applies equally to running shoes, as footwear brands invest huge sums in research and marketing, as it is a multi-billion pound industry. It can be very daunting when trying to find the best running shoe for you as there is so much information out there and advertising for the training brands such as Nike and Adidas is ubiquitous. Generally, go with what feels ‘right’ for you once you have got the correct fit for your size, width and foot-type – more of which later.

I recommend going to reputable running shop with trained staff to assist you in your footwear choice. Locally these include:

1. Intersport at Bakers and Larner in Holt.

2. Intersport at Pilch in Norwich (next to Jarrolds)

3. SportsLink at Taverham (www.sportslink)

These particular outlets all have video gait analysis so you can have your running style analysed whilst wearing particular brands.

It is also a good idea to have walking and running analysed whilst barefoot as you will be able to see exactly how your foot functions before you put footwear on. Even the most expensive running shoe is simply a ‘container’ for your feet and if for example you are overweight and/or have faulty foot mechanics the foot can move, even small amounts, which through repetitive action can be enough to contribute towards injury to the with the foot and lower limb.

Always have your shoes fitted at the end of the day when your foot is at its largest. Make sure there is enough room between the end of your longest toe and your shoe – generally a thumbs width or half a size larger than your regular fit. If you haven’t had your foot measured recently it is a good idea to do so as the foot increases in width and length as we age. Training shoes that are too small, narrow, not deep enough can all contribute to haematoma in the toenails or blackened toenails. These can be treated if it is done quickly by piercing the nail with a sterile needle to release the blood much like a blister. However if left it is common to lose the toenail – the nail can become painful as it lifts from the nail bed and is best cut back by a qualified professional to reduce any discomfort you may experience.

Always ensure your toenails are trimmed straight across to help stop them being ripped or pulled by your running socks.

Foot-types

Very basically* for the purpose of running shoe selection the foot can roughly be divided into 3 foot – types viz:

1) The everted foot (over pronators) including extremely everted or pes planus foot type.

2) The ‘normal’ foot

3) The inverted foot (supinator – highly arched foot)

All of these foot types are genetic i.e inherited from your parents or grandparents and are predetermined before birth.

The inverted, highly arched or cavus foot is rarer. Because of its rigid nature and retraction of the flexor tendons exposing the metatarsal heads to ground reaction forces it has a lack of shock absorption. Common mechanical problems in runners with this underlying foot type include inversion sprains; subluxation of the cuboid and chronic knee pain as well as painful corns and callus.

Somewhat confusingly for the non-trained eye, feet may look high arched due to a high instep but still pronate excessively at the midfoot and forefoot – this is not a true inverted foot type or cavus foot and should not be treated as such – more a mild overpronator.

The everted foot or over pronator is the commonest foot-type with 75% of the population inheriting this foot. An everted foot is well adapted for running over uneven terrain as our distant ancestors once did barefoot. However it is poorly adapted for walking and running on hard surfaces such as pavements. This foot type can be prone to a range of foot and lower limb associated with runners including:

Sesamoiditis, capsulitis, bursitis, neuroma, stress fractures, achilles tendonitis and eversion ankle sprains.

Although not strictly a foot injury I feel that shin splints warrant a mention here as they are commonly experienced by runners.

Anterior shin splints – these can also be caused directly by running downhill, running on hard surfaces or overstriding when the anterior muscles (extensor hallucis longus and tibialis anterior) work to decelerate pronatory forces and become overfatigued.

A runner can suffer from medial and posterior shin splints because running prolongs the amount of pronation in the gait cycle. More pronation requires more resupination by the posterior tibial muscle leading to this muscle so it becomes fatigued and pull where it attaches at the lower third of the tibia.

Pes Planus Foot-type – this extremely flatfoot is rarer in caucasians although it tends to be prevelant in afro-carribeans. It certainly doesn’t stop those that have this foot-type being excellent runners!

Within the lower limb there are also many other intrinsic and extrinsic factors which contribute towards injury in the runner. These include tight calf and hamstrings

As well as foot types there are other intrinsic and extrinsic features of the foot and lower limb which can give rise to injury within the foot and lower limb such as overshortened calf and hamstrings more especially those who sit, drive, stand, walk, run or exercise – or who may have genetically tight calf and hamstring muscles.

Generally, I recommend normal foot-type purchase a neutral running shoe.

The inverted foot-type will require a more cushioned style shoe such as anti-supination trainers.

The excessively pronated generally foot requires a stability shoe, although if the runner is overweight and a lot of force is going through the foot a motion control shoe may be beneficial.

If the over-pronated patient is wearing an orthotic I would recommend that if they are under 12 stone they can wear this in a neutral running shoe whilst if the patient weighs over 12 stone they wear a stability shoe.

The pes planus foot type can benefits from wearing motion control shoes although heavier to wear control the excessive forces going through this foot type.

Orthotic Therapy

This depends entirely on what your presenting condition is. An off the shelf orthotic can work as well as a custom made orthotic in some cases. A simple heel raise or metatarsal pad may suffice

With a high arched foot the forefoot hits the ground before the heel and this may require balancing with a simple heel raise, similarly if you have mild Achilles tendonitis all that may be required is a heel raise and stretches.

However if biomechanical examination revealed a functional hallux limitus with mild overpronation at the midfoot then an orthotic to control the midfoot, with first ray cut out to allow normal function at the first metatarsal phalangeal joint, may be indicated along with a programme of dynamic calf stretches.

Plantar fasciitis in a high arched foot would require a close fitting orthotic incorporating heel raises to compensate for the forefoot hitting the ground before the heel. A programme of calf and plantar fascia stretches alongside the wearing of a night splint may also be indicated depending on severity and duration.

Metatarsalgia may require an othoses incorporating a metatarsal pad to spread the metatarsal heads and this can work equally well for an interdigital neuroma; it depends entirely what a biomechanical evaluation reveals and your foot problem.

Running Socks

Just as with shoes there are a wide variety of running socks available nowadays; from double layered anti-blister socks; socks to help with sweaty feet by ‘wicking’ moisture away from the foot; ergonomic running socks to help cushion ‘vulnerable’ parts of your foot such as your heel and your forefoot; socks made from newer materials such as acrylic and bamboo and so on. As with running shoes ensure that the fit is correct.

You can experiment more with socks as they are less of a financial outlay than running shoes. Once you have found the brand and style that suits you best buy several pairs to allow for washing. Bear in mind what works well for a 5k summer run may not provide the same comfort during a marathon or keep your feet warm in winter.

General Footcare

Prevent cracked skin by using an ‘emery board’ style foot file on dry areas before bathing or showering.

Apply moisterizer immediately after your bath or shower if the skin is dry – it doesn’t matter what type you use providing you use it regularly. A tub of aqueous cream can be bought cheaply from the chemist and costs a fraction of the cost of branded names such as E45.

However, if you are diabetic; have excessively dry (anhidrotic) skin; or are overweight and prone to cracked skin then I would recommend using a cream with high urea content (10-25%) such as the Swedish CCS cream (boots/major pharmacies). The urea helps ‘knit’ the cracks and fissures back together allowing them to heal more quickly than normal – cracked and fissured skin anywhere upon the foot can be very painful to walk on let alone to run upon.

If the skin is excessively sweaty (hyperhidrotic) an old fashioned cost effective remedy that works is surgical spirit. Don’t be tempted to drink it even if you have not hit your PB….!! apply daily on a cotton wool pad all over the soles of the feet and especially between the toes as this will help dry and slightly toughen up the skin.

Surgical spirit is also excellent if you are training for distances – it helps dry and harden the skin enough to prevent blisters from forming and works far better than Vaseline at doing this, contrary to what you may have read! I recommend you apply surgical spirit to the skin three times a week for two months before race day – or just do it as part of your footcare routine.

Blisters

If you do get a blister anywhere upon the foot the advice is to use a sterile pin or needle (sterilize in boiling water or alcohol) and gently pierce the roof and allow the fluid to drain out onto cotton wool. Do not remove the roof of the blister as this helps to prevent infection occurring and making the area sore – simply cover with a sterile dressing and tape into place. Leave the dressing in place for 24-48 hours, remove and place the foot in a bowl of tepid salt water. Soak for 15-20 minutes before drying the area gently and applying another dressing. Continue with this regime until the area has fully healed which may take up to 10 days. You can also use Compeed blister plasters once the area has fully healed although it is best to determine why you are developing blisters and this can range from poorly fitting footwear, damp socks, or feet excessively pronating within the running shoe allowing the posterior heel area to move medially and laterally against the heel counter.

Fungal Feet

Tinea pedis (or atheletes foot) is a fungal (less commonly yeast) infection of the feet most often picked up from damp communal areas such as changing rooms and showers much like verrucae. The best way to avoid both this fungal infection and virus is to wear flip flops or verrucae socks whilst walking anywhere others have previously walked to prevent cross contamination. If you do contract atheletes foot – this most commonly presents between the toes and is usually itchy; in the instep – mostly as tiny red blisters and as ‘peeling skin’ over the entire soles of the feet. Use an antifungal cream daily for 4-6 weeks (I recommend Daktarin Gold as it is a broad spectrum antifungal cream) and it is important to continue for 2 weeks after symptoms have cleared as the fungal infection will still be in the skin but invisible to the naked eye. Lamisil Once is an antifungal treatment, which as the name suggests is applied once to the skin. However this does not seem to be such a broad spectrum antifungal so is generally not so effective.

If the fungal infection has spread to the nails and both the skin and the nails are chronically infected it may be expedient to get an oral medication. This is generally only available through your G.P – although some podiatrists do now hold prescribing rights.