THE BLOG

Are Your Feet Marathon Ready?

08/10/2011 08:11 am ET | Updated Oct 10, 2011

Your feet need to be in tip-top shape if you expect to run 138,336 feet to actually finish a marathon.

Being that your feet are the connection to the ground, they have to primed and steps should be taken to avoid injury that can slow you down or knock you out of the race. So whether you are training to win or simply running to run, it is important to know what foot problems can occur, and hopefully treat them before they become a marathon-breaker.

Specific Marathon Foot Issues: No matter how experienced a runner, the foot is always susceptible to running injuries, and this risk amplified during marathon training. On marathon day, however, there is specific injury risk because runners tend to me more committed to "running though" a problem (new or old).

A method to remember marathon-related foot problems is the mnemonic "ABCD":

Abrasions & Blisters
Bone Breaks
Cramping & Tendon Problems
Disorders of the Toenail

Provided below are explanations of marathon-related foot injuries as well as preventative measures. Should you, the reader (or runner), have any additional preventive solutions or tips for any of the running ABCD's, please share them.

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Abrasions & Blisters: Pressure points and repetitive irritation set the stage for abrasions and blisters. Common runner pressure spots are on the top of the toes, big toe joint area and the back part of the heel. Runners with bunions and hammer toes are more likely to have skin irritation. An abrasion is a simple break in the skin, whereas a blister is lifting of the skin with a fluid collection beneath it.

  • Preventive Solutions: Prevention is best form of treatment. Keep skin thoroughly moisturized, as dry skin is more prone to tearing. Callused areas should be targeted, and urea creams are specifically useful in breaking down excessive skin build-up. Callus/corn removers should be used cautiously as they contain salicylic acid and can excessively deteriorate tissue, leading to open sores.
  • Socks are important in the battle against skin irritation when running long distances. Specialty socks have specific protective cushioned areas dedicated to pressure spots.
  • Ill-fitting footwear is one of the main reason for friction, so it's important to have sneakers that best fit your foot type. Also, carefully inspect the stitching at the front of the sneaker where the toes bend to be sure that it does not rub when fully extended. Newer sneakers are more likely to be problematic.
  • Bone Breaks: Fractures (aka bone breaks) are the most serious problem that a runner could develop. They typically start as a microscopic fracture (stress fracture) and can progress onto a through and through break. Most common are metatarsal stress fractures involving the second toe region. Heel strike runners may be more susceptible to stress fractures of the heel bone.

    An acute stress fracture is often present with varying degrees of pain, swelling, and sometimes redness, though stress fractures may occur without you even knowing it. Running with a stress fracture is not medically advised, and most health care professionals would recommend calling off the race. Runners who don't heed such advice may fully fracture through the bone which could lead to bone displacement (malalignment) -- a potentially serious problem. Some people may have brittle bones making them more likely to develop a bone injury. Certain foot types seem to be more prone to stress fractures -- very flat feet or very high arched feet.

  • Preventive Solutions: Over stressing the foot is what often leads to fractures. Pain may also be an indicator that you are training beyond the current capability of your foot, so it may be necessary to scale back. Pain should not be ignored, and any could be a sign of a fracture, so seeking professional medical care is recommended.
  • More cushioned sneakers do not necessarily offer more protection from developing an injury, and running form may be more important. Nonetheless, properly fitting running sneakers are important to help you become more in tune with your running technique. Depending of foot structure, orthotics may help balance the foot and take pressure off those spots prone to stress fractures.
  • Proper nutrition is important in maintaining strong bones. Vitamin C is necessary for collagen formation, a precursor to bone. Calcium is needed for proper bone health and Vitamin D helps promote Calcium absorption. Eating a balanced meal should be a part of your overall health plan.
  • Cramping & Tendonitis: Biomechanical and structural problems within the foot tend to manifest as shin splints, arch cramping, plantar fasciitis and/or tendinitis. Less experienced runners tend to develop these problems and is commonly the result of training past the capabilities of your foot. Tight musculature may also be at the root of cramping and shin splints. These problems tend to be self-limited and resolve with targeted treatment programs, but can set you back in terms of being marathon ready.

  • Preventive Solutions: Building strength and stamina slowly is the best method to avoid injury. Be sure to incorporate a thorough stretching program to keep muscles and tendons stretched and warmed up. Weak muscles within the foot can be strengthened with specific foot training programs. Ease cramping in the foot with post-run Epsom salt baths. Deep tissue massage is also a helpful measure.
  • Arch supports (orthotics) can help manage arch pain by providing support and perhaps better alignment of the foot in certain people. Of course, foot type plays a big role in selecting the proper amount of support. Running in the wrong-type of sneaker for your foot may be responsible for discomfort, so changing sneakers may be beneficial. A break from running may be necessary to resolve the problem. Runners with persistent problems should seek the advice of a health care professional.
  • Disorders of the Toenail: A black toenail is a problem that every marathon runner has experienced, and is the result of bleeding beneath the nail plate. Pressure and friction from repetitive running seem to be the culprit. The damaged nail can be painful and often results in the toenail falling off. Fortunately, a black toenail doesn't typically interfere with training and common is self-limiting.

  • Preventive Solutions: Prevention is difficult, as the black toenail is often the result of prolonged toenail irritation from the intense mileage of training. Again, properly fitting shoes with enough room for the toenails are helpful. Keep toenails well trimmed to not create a fulcrum for the nail to become lifted. It is unclear if moisturizing the toenails offers any protective benefit but a soft nail may, theoretically, be less prone to damage. Should you develop an acute painful black toenail, then medical attention may be needed to alleviate the active collection of blood. An irritated loose nail may become infected and this can be serious.
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    By the time marathon day rolls around, and if you have avoided or overcome injury during your training and your feet are pain free, then you likely have feet that are ready to start a marathon.

    ~ Dr. Neal M. Blitz

    To learn more about Dr. Blitz, please visit www.nealblitz.com

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