Monday, April 16, 2018

The most common foot injuries after a marathon! Congrats to the Boston Marathon Runners now your feet need some TLC:)

To the brave people who have fun pushing themselves to the physical limits in a race such as The Boston Marathon we salute you!  Here at the Center for Ankle and Foot Care in sunny Florida we see our fair share of marathon runners, as Clermont is home to many professional runners and tri-athletes.  Once the race is over and the rush, thrills and endorphins wear off you may be stuck with a couple of little foot problems, if you're unlucky maybe some big foot problems.  Even with the best training and prevention efforts, sometimes stuff happens.  We are going to go over the most common foot problems we see in the runners after putting on so many miles in just one day, and of course all the training that leads up to that day, that can play a true toll on the feet!

Nail Problems
I started here because honestly this is one of the most common complaints we get from patients after they have trained for and ran a marathon.  All those repetitive miles in the shoes over the last several months training for the Boston Marathon has left you in great shape with a jacked up toenail!  The question I get all the time is "will my toenail ever look normal again?" I tell people "Maybe" , this is not a very popular answer I have discovered over the last 17 years in practice. The truth is runners usually have ugly toenails, that repetitive micro trauma plays a toll on these tiny fragile structures.  I have seen patients who have run multiple marathons over the years and during or after training for a marathon their toenails fall off.  Sometimes these nails grow back flat and smooth, but sometimes they grow back thick and lifted and much like this picture above the lifted part of the nail sets them up for a little fungus under the nail.  That is a treatable problem sometimes with a topical medicine or oral medication.

 The other type of toenail that comes into the office after a marathon is a blue toenail with blood under the nail.  I describe it to patient as a blood filled blister under the nail.  If it doesn't hurt and there are no no signs of infection we can do what I refer to as "skillful neglect", which means we just keep an eye on it.  If it continues to not hurt we just wait and watch it over the next several months until the nail is completely grown out.  You basically have to be patient and slowly see the little dry blood spot continue to advance to the end of your toe.  It is not pretty but this is usually self resolving in most people, but again the important caveat here is that there should be no pain and no signs of infection.

But when the toenail itself is actually painful after a marathon, which happens quite a lot, we sometimes have to remove part of or the whole nail. This is sometimes a very necessary evil.  The nail can be ingrown secondary to the repetitive micro trauma in combination with how your foot strikes the ground in time and space.  Like the picture to the left here, this needs medical attention, so if you just finished the Boston marathon and have a toe that looks like this, do not let it stay like this and get in to see your podiatrist! This link here to our website goes into more detail of the importance of treating an ingrown toenail and what the procedure entails.  .

Heel Pain (Plantar fasciitis or Achilles' Tendonitis)
Even in the best conditioned, rolled out, stretched out runner these injuries can happen.  The degree of pain after the marathon and time of how long it hurts usually dictates when we see these athletes.  The reality is after a marathon, these runners expect everything to hurt.  After a week if you are limping still due to a painful heel, either on the bottom like plantar fasciitis or in the back of the heel like Achilles' tendonitis you should get it checked out. These two structures are super work horses during a marathon and play a huge roll in propulsing your every step in forward progression. 

If you want to learn more about plantar fasciitis follow this ling to our website here

If your pain is more in the back of the heel/ankle then click on this link to learn the difference between instertional and non-insertional Achilles' Tendonitis.

Stress Fracture of a metatarsal bone
 The best example of a stress fracture is to grab a branch from a  LIVE shrub or tree and bend it.  You will hear a snap, but the branch will stay together.  This is what happens to bones in the foot.  If too much stress is placed on the bone it will snap, but not fall apart.  That is why stress fractures are often not seen on X-rays.  The foot will start to hurt all the same.  If you keep bending the branch back and forth, eventually it will snap in two.  Likewise, if you keep "stressing" the foot (running, jumping, walking) the foot bone may also snap in two. 

Marathons are the ultimate stress fracture maker. 26.2 miles of stressing these tiny little bones in the feet! 

We see stress fractures in the office almost weekly. They are very common and more importantly easy to treat!  The difficulty is in getting better.  Healing is 90% up to what the patient does and 10% what the patient is.  What the patient does (taking it easy) after the injury is often more important than who the patient is (healthy).  Our runners are usually very healthy but they are crazy and sometimes our most difficult patient to treat because they want to keep running, even with the broken bone in their foot.  That's right I called you crazy if you are a marathon runner but you already know you're crazy so calm down!

Marathon runners do not want to hear the treatment. The treatment is SIMPLE.  Stop stressing your foot!  I typically give the patient a fracture boot and say, "If you wear this all the time, except for sleeping and bathing, you should be healed in 1-2 months.  BUT YOU HAVE TO TAKE IT EASY!  If you get the boot and pretend your foot is not broken and run around all day long it may take 2-6 months.  If you only wear the boot "sometimes" it may never heal or get worse. Like anything when you are a  runner, if you do not convalesce an injury correctly you will suffer forever! 

Congratulations to all the men and women who participated in the Boston Marathon, it is an incredible feat but if you are having feet pain get into see your podiatrist!

Special congratulations to Desiree Linden took the women's race Monday with a time of  2 hours, 39 minutes and 53 seconds. She is the first American to win the Boston Marathon in 33 years!!!!!

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