During the course of a marathon the average runner will take between 30,000-40,000 steps so it’s obvious we rely on our feet a lot!

I’ve read that the running motion causes impact forces on a runner’s feet 2-3 times his/her body weight.

This episode and blog post is all about taking care of your amazing feet that survive 26.2 miles of pavement pounding each marathon.

I will give you a little anatomy lesson about the foot, and information on how to deal with problems like blisters, arch pain, plantar fasciitis and more. Your feet will love it!

Anatomy of the Foot

The foot and ankle are quite complex in structure and mechanics. They serve as a foundation for your body, have shock absorbing properties, and help propel you forward. When you think about it, the foot sustains enormous pressure and is very flexible and resilient.

The foot and ankle contain a total of 26 bones (25% of the bones in your body are in the feet), 33 joints, more than 100 muscles, tendons (fibrous tissue connecting muscles to bones) and ligaments (fibrous tissues connecting bones to bones), and blood vessels, nerves, skin and soft tissue. There’s a ton going on in our feet and we often don’t think about them unless something is going wrong.

Anatomically the foot is divided into three main parts: the forefoot, midfoot and hindfoot.

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• The forefoot is made up of the five toes (phalanges) and their connecting bones (metatarsals). Each toe (known as a phalanx) is composed of several small bones. The toes are connected to the metatarsals by five joints at the ball of the foot. The forefoot balances pressure on the ball of the foot and bears approximately half of the body’s weight.
  
• The midfoot forms the foot’s arch, serving as a shock absorber. The bones in the midfoot connect to the forefoot and hindfoot by muscles and the plantar fascia (the arch ligament).
  
• The hindfoot consists of three joints which link the midfoot to the ankle (talus). The top of the ankle is connected to the two long bones in your calf—the tibia and fibula. The heel bone (calcaneus) is the largest bone in the foot. Underneath the heel bone there is a cushioning layer of fat.(2)
  

History (Feet Then and Now)

Our modern feet are very different from what the foot looked like thousands of years ago and among indigenous peoples around the world.

These images were taken from a study performed over 100 years ago, published 1905 in the American Journal of Orthopedic Surgery. The study examined the feet of native barefoot populations in the Philippines and Central Africa. If you try to visualize a natural bare foot, think of a line that runs through the heel, ball, and big toe of a habitually bare foot. The little toes spread naturally and fan out to provide a wide, stable base for walking, standing, and climbing (information and pictures are a reprint from Nature’s Magic Bullet).

We “Tender Foot” Moderns

Back in 1995 when I was a teenager I spent a summer in Papua New Guinea on a work project. We were a 2 hour airplane ride and 6 hour boat ride from the nearest big city—-way out in the jungle. The native New Guineans went barefoot and their feet were amazing—-more like hands. Their feet were wide, more dextarious, and very tough. They actually made fun of our feet which were white, narrow and tender. I guess that’s where the term “tender foot†comes from.

Don’t get me wrong, I’m very thankful for shoes. But I think we often bring many foot problems on ourselves by smashing our feet into narrow shoes, high heels, and sweaty socks.

Dealing with Foot Problems

(This is not my foot)

As I was thinking about this topic I saw a Runner’s World website story about ugly feet. Don’t look at these pictures if you’re eating.

As runners we probably spend a little more time thinking about our feet than the average person. You might have dealt with things like black toenails, blisters, foot fungus, plantar fasciitis, arch pain, and warts. I want to give you some suggestions about how to deal with these problems. Remember that none of this advice is a substitute for the advice of your healthcare provider.

Find Your Foot Problem

Below is a fun little game called Find Your Foot Problem. In order to make this page a little quicker to read I have conveniently hidden the solution to each foot problem under the boxes below. Find your pain and click on it.

Black Toenails
I look at black toenails as a marathon rite of passage. Some runners are more prone to bruising of the nail bed than others due to their nail shape, wearing shoes that are too small, and a primarily downhill course. I tend to get at least one black toenail per marathon. You usually don’t notice it during the race (other than generalized foot sensitivity) but then your toes become very sensitive by the end of the day. Rarely the pressure (fluid build-up) under the nail will be so extreme that even wearing socks and shoes can be excruciatingly painful.

What to do

If this happens you may need to drain the fluid under the nail. You can do this by sterilizing and heating a needle and pressing the sharp point through the top of the nail. This will burn a hole in the nail and allow some of the built up fluid to escape. Make sure you thoroughly clean and sterilize the area afterward and apply a light dressing to the toe. Warning–this procedure is not for the faint of heart. For a normal bruised toenail you shouldn’t have to go through those lengths. The affected nail first has a reddish cast, then turns blue and finally darkens over time (hence the name black toenail). Eventually the damaged nail will grow out and be replaced by a new nail. Other than being uncomfortable at first and then unsightly, after a while you won’t pay much attention to them. In fact, I probably have a couple toenails in various stages of blackness right now. In flip flop/sandal season I often keep my toenails painted a dark color like blue, purple or green to disguise the problem and not offend my non-running friends.

Blisters
Blisters are a common problem for many runners and are caused by heat, moisture, friction and pressure building up on the foot. When a blister is coming on it is called a “hot spot†and you can typically start to feel an uncomfortable pressure and pain in that area.

What to do

The best thing to do with blisters is prevent them. Make sure that you’re wearing properly fitting shoes (many times shoes are too small and will rub), invest in good technical socks (and test them first as each runner likes something a little different), and lubricate your feet before putting socks on if you’re prone to blisters in one area. Other tricks include wearing two thin pairs of socks, wearing socks with extra cushion in affected areas, applying tape to blister-prone areas, and carrying extra socks to change into if your feet get wet or are excessively sweaty. To treat blisters the best thing you can do is leave them alone and allow the fluid to gradually go down. However, if the area is so large that it prevents you from walking normally you may want to help speed the draining process. Sterilize the area and a needle and poke a hole along the edge of the blister, gently squeeze the fluid out, clean the area, apply antibiotic ointment and a light bandage. As new skin grows underneath the outer layer will harden and peel off.

Athlete's Foot
Athletes Foot is a foot fungus that is best prevented by wearing technical running socks, washing and drying the feet thoroughly after running, and not re-wearing wet shoes until they’re dry.

What to do

If you notice itching and scaling of the feet the best thing to try is an anti-fungal cream for 7-14 days. You can also try soaking your feet every day in 1 part white vinegar with 10 parts water for 5 minutes, then drying the feet thoroughly for a week. If these treatments aren’t effective make sure you see your doctor for a stronger treatment.

Plantar Warts
Plantar Warts are a skin growth caused by a viral infection on the top layer of the skin and they can be transmitted from person to person. They range from annoying to painful depending on the size and location. They can often grow in clusters called mosaic warts. You may notice little black dots in the wart which are not seeds (as commonly thought) but are blood vessels which grow up into the wart.

What to do

About 50% will go away on their own but some are stubborn and require treatment. There are over the counter wart kits that debride the outer skin layers, some people treat them by applying duct tape for several days, soaking, using a pumice stone and reapplying tape. Your doctor can also remove them with liquid nitrogen, lasers, surgery or medications to support the immune system.

Plantar Faciitis
Plantar Fasciitis- Fascia is a tough fibrous connective tissue located throughout the body. The plantar fascia connects the heel bone (calcaneus) to the base of the toes. Inflammation, irritation, and swelling of the tissue along the bottom of the foot is usually most painful in the morning. The pain is often located directly in front of the heel and can result in a hobbling walking motion when weight is placed on the heel. Extreme point tenderness at the origin of the plantar fascia from the heel may be noticed when you press on that area. Risk factors include men over the age of 40, a history of foot injury, wearing shoes without good arch support (like flip flops) frequently, pregnant women, high arched, rigid feet, and leg length inequality. This problem usually develops over time and recovery can be a slow process.

What to do

To treat plantar fasciitis be sure to stretch the calf muscles before getting out of bed in the morning (simply flex the toes toward your knees), strengthen the calves by doing toe raises, don’t do any uphill running or speed work, consider better arch support or orthotics for shoes, and ice and massage the bottom of the foot every day by rolling a golf or tennis ball or frozen water bottle under foot. If this is not helpful an appointment with a podiatrist would be helpful. They may recommend a foot splint which is worn at night for 14 weeks.

Arch Pain
Other types of arch pain can be related to the posterior tibialis tendon which attaches at the arch. Injury or inflammation of this tendon may cause the arch to drop causing discomfort. A stress fracture of the navicular, one of the main bones in the arch, will also cause arch pain. Be sure to have non-typical arch pain evaluated by a sports medicine specialist or podiatrist. You don’t want to run though pain that causes a change in your running form.

Bunions
A bunion is an unnatural, bony bump that forms at the base of the big toe where it attaches to the foot. Since it occurs at a joint, where the toe bends with walking or running, your entire body weight rests on the bunion at each step leading to pain. Excess pressure and friction from shoes and can lead to the development of calluses in the area exacerbating the problem. Some people are more prone to bunions and it can often be caused by weak or poor foot structure, arthritis, wearing high heeled and pointed shoes, and leg length discrepancies.

What to do

Diagnosis can be confirmed on x-ray. Some people find relief from hot or cold treatments, anti-inflammatory medications, orthopedic shoes, custom made inserts, or even surgery.

Gout
Another pain in the joint of the big toe can be from gout. Gout is a type of arthritis that can cause stiffness, swelling, redness and pain. When uric acid levels in your blood are too high, the uric acid may form hard crystals in the joints which cause the symptoms. This condition is more common in men, those who are overweight, certain medications, alcohol, and eating foods high in purine.

What to do

Taking an anti-inflammatory medication (not aspirin), drinking lots of water, reducing foods high in purine and treatment from a doctor can be beneficial. In an acute attack be sure to rest the area and apply ice to reduce the swelling. A corticosteroid shot into the joint can help reduce symptoms more quickly and prevent further damage.

Neuroma
Morton’s neuroma is a swollen or thickened nerve located within the ball of the foot. The swelling, burning or sharp pain can feel like a small lump inside the ball of your foot, usually between the third and fourth toes. It can be painful to walk and run.

What to do

You can often treat this problem at home by wearing comfortable shoes with a wide toe box (avoid tight, pointy, high-heeled shoes). It’s also helpful to apply ice for 10-15 min per time, use an anti-inflammatory medication, and rest from high impact activities during a flare-up. A foot massage may help relax the muscles around the nerve and provide some relief. In rare cases where this does not respond to home treatment your doctor can give you a steroid shot to reduce swelling and pain.

Foot Pain During a Marathon
Foot pain during a marathon. It is normal to have sore feet during the later miles of a marathon without it indicating an injury or long term problem. In fact, I remember during my first marathon that my feet were very sore. They were also more sore after coming back from pregnancy. However if you have a continual sharp pain in your foot or ankle that causes you to change your running form you should stop at a medical station and get it evaluated. In rare cases you could be dealing with a stress fracture.

Keeping your feet healthy

There are things that you can do to keep your feet healthy. Make sure that you invest in appropriate running shoes, break the shoes in carefully before a marathon, wear comfortable and well-fitting shoes in your daily life, and do stretches and strengthening exercises for your feet.

Yoga is excellent for strengthening the feet. When I do yoga I can feel the muscles in my feet working and stretching. After your marathon be sure to bring comfortable shoes to change into. No one wants to wear their sweaty shoes for a prolonged period. I like to wear either comfortable sandals or Uggs with my compression socks.

When choosing your running shoes don’t just go with the “in†brand, something your friend is wearing or a color scheme that you like. Make sure you understand what your foot type is like. Foot types can be divided into three general categories which measure the height of the arch: high, normal or flat arch.

Paper Bag Test

To do a very easy test to determine the general height of your arch you can do the paper bag test. Lay a flat piece of the bag on the floor, wet the bottom of your foot, and step on the bag. Look at the imprint to determine whether your foot has a high, normal or flatter arch. (6)

Visit a Specialty Running Store

It’s also helpful to know whether you have issues with over-pronation (or the way your foot rolls in the landing and pushing off stage of your stride). A specialty running store can be a great resource to get your running gait evaluated and try on multiple shoes to find a comfortable fit. You should make sure that there’s a thumb’s width of room between your toes and the end of the shoe and that you have plenty of room in the toe box.

Track Your Mileage

No matter how much you love your running shoes they won’t last forever. Be sure to track the amount of mileage you have on each shoe in your running log. The insoles of the shoe are often good for around 350-500 miles while the outsoles may still look good for around 800 miles. Don’t just go by appearances. I’ll often notice that my legs feel more tired and I’ll realize that the shoes are getting to retirement age. A heavier runner or someone who does mostly road running will wear their shoes out more quickly too.

In conclusion

Hopefully you’ve gained a new appreciation for your feet and the important job they play in running and life. Take good care of your feet because it’s easier to prevent problems rather than deal with them when they occur.

Sources:

1) http://www.runnersworld.com/photos/these-are-ugliest-runners-feet-youve-ever-seen?cm_mmc=Facebook-_-RunnersWorld-_-Content-RunnerStories-_-UglyFeet

2) http://www.healthcommunities.com/foot-anatomy/foot-anatomy-overview.shtml

3) http://www.fourhourworkweek.com/blog/2009/05/07/vibram-five-fingers-shoes/

4) http://www.webmd.com/

5) http://www.runnersworld.com/running-shoes/runners-world-shoe-donation

6) http://www.runnersworld.com/running-shoes/take-wet-test-learn-your-foot-type

7) http://www.runnersworld.com/shoe-finder/shoe-advisor

8) https://www.roadrunnersports.com/

Also Mentioned in This Episode

The Fat Adapted Eating Plan -learn how to burn your fat as fuel

Rock My Run a website that provides running mixes created by professional DJs.

Nike Reuse a Shoe -a place to donate your old running shoes