Running And Your Feet

Based on a document produced in cooperation with the: American Podiatric Medical Association.

Nowhere is the miracle of the foot more clear than watching the human body in motion. The combination of 26 bones, 33 joints, 112 ligaments, and a network of tendons, nerves, and blood vessels all work together to establish the graceful synergy involved in running. The balance, support, and propulsion of a jogger's body all depend on the foot. But before entering a fitness regimen that includes jogging, don't forget to make certain your body's connection with the ground is in proper working order.

It is a good idea for a beginning jogger to visit a podiatric physician before starting an exercise program. Your podiatrist will examine your feet and identify potential problems, discuss conditioning, prescribe an orthotic device that fits into a running shoe (if needed), and recommend the best style of footwear for your feet.

Frequent joggers ought to see a podiatrist regularly to check for any potential stress on the lower extremities. During a 10-mile run, the feet make 15,000 strikes, at a force of three to four times the body's weight.

If you are more than 40 years old, see a family doctor before starting any exercise regimen. The doctor will perform an electrocardiogram, check for any breathing problems, high cholesterol levels, and high blood pressure before giving the go-ahead for a vigorous exercise program.

Anyone, regardless of age, should check with a doctor if a cardiac condition, diabetes, weight problem, or other serious medical condition exists.

The Importance of Stretching

Before beginning an exercise regimen, proper stretching is essential. If muscles are properly warmed up, the strain on muscles, tendons, and joints is reduced.

Before stretching warm up with a 10 minute walk or slow jog. You may then stop and gently stretch. Stretching exercises should take 5-10 minutes, and ought to be conducted in a stretch/hold/relax pattern without any bouncing or pulling. It is important to stretch the propulsion muscles in the back of the leg and thigh (posterior), and not forget the anterior muscles.

Wall Push-Up: This stretches the achilles and calf muscles one leg at a time. Stand with the rear foot approximately two to three feet from the wall. The rear leg should be straight, the front leg is bent and your hands touch the wall. Feet point straight ahead, heels are on the ground. Hold for 10 seconds, switch legs, repeat 10 times.

Knee Clasp: Lie on a firm surface. A carpeted floor or grass is best. Bring both knees to your chest. Hold for 10 seconds. Repeat 5 times. This stretches the hamstrings and lower back.

Hamstring Stretch: Straighten one leg, place it, with the knee locked, on a foot stool. Bend your body and bring your head towards the leg. Hold this position for 10 seconds. Switch sides, repeat 10 times.

More information on stretching is available at Dr. Pribut's Running Injury Site.

Proper Footwear

Shoe choice should be determined by foot structure (morphology), foot function (over or under pronated or neutral foot), body type (weight), running envirnonment and running regimen. Keep in mind that all shoes have a different shape, and sizes and widths are not uniform from shoe to shoe.

Consider whether an orthotic device will be placed in your shoe, and whether your running style is flat-footed or on the balls of the feet. Shoes should provide cushioning for shock absorption, and ought to be able to fully bend at the ball of the foot area and remain stable in the midfoot. Visit the shoe store in the afternoon and wear the type of sock you plan to use while training.

The best socks are those made of moisture wicking material such as Coolmax ®, rather than being made of cotton.

Training Tips

Systematic exercises must progress slowly from easy to rigorous to prevent debilitating muscle strain or more serious injury. The best and safest way to start a running program is with a four-day-per-week conditioning program for 12-16 weeks.

Begin with two sets of two-minute jogs interspersed with five minutes of fast walking. If muscles are stiff, walk only; have an "easy day" if you're in pain. As the weeks progress, gradually increase the number of minutes jogged per set to 20 minutes. Spend at least five workouts at each new level attained.

By the 16th week, you should be able to run two sets of 20 minutes each, with a five-minute walk before, between, and after. Make adjustments for heat and altitude, and don't be frustrated if you think your pace is too slow. The best way to avoid injury is to avoid what AAPSM Board Member Stephen Pribut, D.P.M. has called the "terrible twos": too much, too soon, too fast, too often.

Proper foot hygiene can also prevent injuries. Keeping feet powdered and dry is important, especially to the jogger suffering from blisters. Blisters can be limited by moisture control. Make sure to wear socks that wick moisture. This strategy can also help prevent athlete's foot.

Aches and Pains of Running

Even with the best preparation, aches and pains are an inevitable result of a new jogging regimen. If the pain subsides with slow easy exercise, you may continue, but if it gets worse, stop the activity and rest. If it persists, see your podiatrist.

The most common pain associated with jogging is known as runner's knee, a catch-all for jogging-related knee pain. One of the most common causes of runner's knee is excessive pronation, or rolling in and down, of the foot. This syndrome is now often called the patello-femoral pain syndrome.

Orthoses (arch supports -- shoe inserts) prescribed by your podiatrist are the best way to alleviate the problem. Occasionally, rubber pads in the arch of the shoe will help.

Shin splints, which painfully appear at the front and inside of the leg, are caused by running on hard surfaces, overstriding, muscle imbalance, or overuse. Treatment includes changing running technique or insertion of an orthotic device in the shoe.

Common Running Injuries

Plantar fasciitis (arch pain) -- Arch pain is often caused by frequent stress on the plantar aspect, or bottom of the foot. When the plantar fascia, a supportive, fibrous band of tissue running from the heel to the ball of the foot, becomes injured, pain on the bottom of the foot results. Forefoot and rearfoot instability, with excessive pronation, may result in plantar fasciitis. Overtraining may contribute. Shoes with good midfoot stability may help prevent plantar fasciitis. If pain persists visit your sports podiatrist.

Heel spurs -- Heel spur syndrome, related to plantar fasciitis, occurs after calcium deposits build up on the underside of the heel bone. Heel spurs form gradually over many months. Both plantar fasciitis and heel spurs can be avoided by a proper warm-up that includes stretching the band of tissue on the bottom of the foot. The soft tissue injury is usually the cause of the pain and not the spur itself.

Sesamoiditis -- Sometimes referred to as the ball bearings of the foot, the sesamoids are a set of accessory bones found beneath the large first metatarsal bone. Incredible forces are exerted on the sesamoid bones during aerobics, and inflammation and fractures can occur. Proper shoe selection and custom orthotic devices can be useful in treating sesamoiditis.

Shin splints -- Aside from ankle sprains, shin splints are perhaps the most common injury to the lower body, as the muscles attached to the shin bone bring the foot up and down. The pain is usually an inflammation of the shin muscle and tendon due to stress factors. Treat shin pain with cold compresses immediately after the workout to reduce inflammation. Proper stretching before the workout should prevent the onset of shin splints. Strengthening of muscles also helps reduce shin splints.

Achilles tendon and calf pain -- The frequent rising on the toes of an aerobics routine often creates pain and tightness in the large muscles in the back of the legs, which can create pain and tightness in the calf and inflammation of the achilles tendon. Again, stretching the calf muscles gently and gradually before and after the workout will ordinarily help alleviate the pain and stiffness.

Stress fractures -- Stress fractures often occur from overtraining. Make sure you gradually increase your running distance and intensity and have an adequate dietary intake of calcium.

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