• Dr. Jennifer Nicole Falk

How To Treat Common Runners' Feet Problems

Updated: Aug 13, 2018



Each sports has its own potential for putting athletes at risk for sustaining certain sport-related injuries. For runners, it is their feet. With the thousands of steps taken, and up to 3 times ones body weight placed on the lower extremities during a run, the feet take a beating, so much that "Runner's feet" is a commonly used term amongst the running community.

As I sit writing this blog, I look at my own feet. A small toe on my left foot has a subungual hematoma (blood underneath the nail) from a long run months ago, while the big toe on my right foot has the remnants of a healed blister from the San Diego Rock n' Roll Half Marathon and the top of my second toe has a small abrasion from a recent run I did without socks (because I forgot them at home!). If you are a runner, you have probably dealt with at least one of these problems and maybe on more than one occasion. My goal with the below list is to help explain why these problems occur for runners, and then, not only provide ways in which they can be treated, but also detail some preventative measures that can be taken to help avoid them from occurring again.

1. TOENAIL PROBLEMS

Toenail problems are a very common issue for runners. Between nail fungus, subungual hematomas, and loss of toenails, most runners have likely dealt with one or more throughout their running career. Although there may be different causes for each, there is one thing that can be the main cause for all: shoe gear. If your shoes don’t fit properly and your toes repeatedly hit the end of the shoe, that trauma can cause any one of the above toenail problems.

Treatment Options:

Nail fungus

  • Over-the-counter antifungal nail lacquers + antifungal powder in shoes + antifungal cream (if athlete’s foot is present)

  • Oral anti-fungal medication (prescribed by a healthcare professional)

  • Home remedies (not anti-fungal medications): Vicks® VapoRub™, Tea tree oil - applied to the toenails daily

Subungual hematomas

  • Often resolve on their own after several months

  • If painful, the nail can be punctured to release the pressure underneath or it can be removed - both should be performed by a healthcare professional

  • If the discoloration is not due to running, it should be evaluated by a healthcare professional for further work-up

Loosening of toenails

  • It is OK to trim the nail back until you reach the part of the nail that is intact to the underneath skin; however, avoid pulling a partially loosened toenail off as you may tear your skin.

Prevention:

  • Properly fit shoes in both length and width

  • Cutting toenails straight across instead of with rounded edges

2. BLISTERS

Blisters occur where there is friction and this friction can be increased with added moisture to the feet. For runners, they often occur along the toes or the back of the heel. These are the areas where the shoe is rubbing abnormally against the skin. For the toes, it may be a result of the shoe not fitting properly. In addition to the shoe gear, when blisters occur at the heel, it may also be related to a runners’ biomechanics and the way their foot moves inside in the shoe.

Treatment:

I most often advise against popping or de-roofing blisters. It is better to keep the area protected and allow the outer blistered skin layer to dry up and fall off. My exceptions to this rule: #1) If the blister is very large and interferes with putting shoes on or participating in activities. In this case, I may puncture the blister to allow for the fluid to drain. It is then important to keep the punctured site covered until the blister fully heals. #2) If the blister is filled with blood or pus. If the fluid is not clear, it is important to evaluate the area further. The blister should be de-roofed and the area should be thoroughly cleaned. Both of these scenarios should be handled by a healthcare professional using clean instrumentation.

Prevention:

3. STRESS FRACTURES

Having had four metatarsal stress fractures myself, I know how these can affect training and set a runner back; however, it is more important to treat them properly than try to push through the injury and end up doing more damage or delaying your ability to get back to pre-injury level. Stress fractures occur one of two ways: #1) repetitive trauma (or over-use) on weakened bone, or #2) an acute traumatic incident on healthy bone. It is important to know which mechanism is the cause because preventative measures can be taken for certain cases.

Treatment:

Unfortunately, the main treatment for stress fractures comes down to resting the area. Depending on the location, you may need to be put a specialized stiff-soled shoe or a walking boot. Activities should be modified, as necessary. You may be able to swim or use a stationary bike until you are released to resume higher impact activities, but this should be left to the discretion of your physician. If you have access to an Alter-G treadmill, rehabilitation during the injury may be possible, but again, the decision to continue running should be determined by a healthcare professional and the rehabilitation program should be closely monitored by one, as well.

Prevention:

  • Avoid over-use by cross-training

  • Medical work-up for vitamin D level and bone density, especially with history of multiple stress fractures

4. PLANTAR FASCIITIS

The plantar fascia is the large ligament located along the bottom of the foot, extending from the heel bone to the forefoot. It functions to help support the arch of the foot. When added stress is placed on the ligament (i.e. excessive running, other high impact activities, change/absence of shoe gear), it can become inflamed, tear, and/or cause pain. The pain is typically felt along the bottom-inside part of the heel. This is where the plantar fascia inserts into the bone. Others may experience pain along the arch of the foot. The pain may be worse with activities and is usually improved with rest. One may also experience pain with first steps in the morning or after periods of rest. This is called post-static dyskinesia.

Treatment: (click here to see more details on each treatment option)

  • Rest, Modification of activities, & Immobilization

  • Icing & anti-inflammatory medications

  • Injections - e.g. steroid, prolotherapy, PRP

  • Shoe gear

  • Orthotics

  • Night splint

  • Rehabilitation exercises

Prevention:

5. ACHILLES TENDINITIS

The Achilles tendon is the soft tissue structure that connects your calf muscles (gastrocnemius and soleus) to the back of the heel bone and functions during the gait cycle to help you propel forward and lift your heel off the ground. In runners, the pain may be related to tight calf muscles, an acute injury, or over-use. It is important to distinguish tendinitis from bursitis, a “pump bump” (aka Haglund’s deformity), gastrocnemius muscle strain, and a tear/rupture of the Achilles tendon.

Like plantar fasciitis, pain associated with Achilles tendinitis can occur with first steps after periods of rest or with excessive running (or other activities). Walking up hill, or with an incline, can also aggravate the tendon as it is being stretched out.

Treatment: (click here to see more details on each treatment option)

  • Rest, Modification of activities, &/or immobilization in severe cases

  • Icing & anti-inflammatory medications

  • Shoe gear

  • Orthotics

  • Heel lifts

  • Stretching

Prevention:

  • Calf-stretching exercises

  • Avoidance of wearing higher heeled shoes for extended periods of time (which, over times, can shorten the tendon)

Disclaimer: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have questions or concerns related to your health.

References:

Alter-G website. Retrieved from http://www.alterg.com.

Richie, D. (2010, June). How To Manage Friction Blisters. Podiatry Today. Retrieved from http://www.podiatrytoday.com/how-to-manage-friction-blisters.

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