HEALTH MATTERS

ATHLETES & FOOT PAIN

By: Linda Hepler, BSN, RN

If you’ve been experiencing foot pain and don’t know why, here are some common problems, what to do about them and how to prevent them from happening again.
Photo by Tony Di Zinno

IT’S SUMMER AGAIN, and you’ve taken your workout outdoors. And whether you’re gearing up for a triathlon or simply playing a weekend game of pickup basketball, your feet – 26 rather small bones held together by ligaments, muscles and skin – bear the brunt of your activities. In fact, each foot pounds the earth about 160-180 times per minute during an average run. It’s no wonder that foot pain is one of the most frequent of all athletic health complaints.

Here are some of the most common foot ailments and what to do about them:

Black Toenail: “Black Toenail is an accumulation of fluid and blood under the toenail caused by repeated trauma against the nail plate,” says Bryan Markinson, DPM, Chief of Podiatric Medicine and Surgery, Department of Orthopedic Surgery at Mt. Sinai School of Medicine in New York.

This can happen during any activity that causes your toe to slam into the top of your shoe, such as running downhill, especially if your feet are slipping around in an overly large toe box. The toenail can also be damaged when your feet swell during the warm summer months and rub against the top of the shoe.

What to Do: If the pain of a black toenail is manageable, no treatment is needed, says Markinson. But if it hurts too much, the pressure can be released by drilling a hole in the top of the nail to release the fluid. While some athletes do this themselves using a sterile or hot needle, it’s best to see a doctor for this procedure in order to avoid infection.

How to Prevent: Prevention of a black toenail, says Markinson, consists of choosing an appropriately sized toebox, deep and wide enough to keep your toenails from being jammed but not so large that your feet
slip around. “And for best results, go shopping for shoes at the end of the day, when your feet are slightly swollen; you’ll be able to notice if the top part of the shoe is rubbing against your toenails.”

Turf Toe: This is a painful condition that often is caused by a stubbing or jamming injury to the big toe. It can also occur with repeated pushing off while running or jumping. The name “turf toe” is because this condition, which is actually a tear of the joint capsule surrounding the base of the toe, is especially common among athletes who play on artificial turf.

What to Do: If you’re experiencing pain in your big toe, the most important thing to do is to rest the foot for a few days. You can also elevate your foot and apply ice to the toe every few hours. “If pain and redness continue after several days,” says Michael Levi, DPM of Santa Monica, Calif., “see a doctor.”

While turf toe is not difficult to diagnose, x-rays may be necessary to make sure that there’s no fracture.

How to Prevent: Prevention is difficult, says Levi. But it’s important to know that once you’ve had a turf toe, you may redevelop the condition – especially if you return to your sport too soon after injury. Once you’re ready to return to activity, you may want to ask your doctor about special inserts that you can wear inside of your shoes that will help to control the motion of the toe joint.

Sprained Ankles: “Sprained an-kles are the most common injury we see in sports,” says Kevin Varner, MD, Vice Chairman, Methodist Center for Orthopedic Surgery, and Head Team Physician for the Houston Ballet.

An ankle sprain is an overstretching or tearing of the ligament in the foot following a sudden sideways or twisting movement, such as occurs when coming down on an uneven surface. According to Varner, the ligament damage can range from a partial tear to the more serious “Grade 3” or complete tear. Symptoms include swelling, pain and bruising of the ankle.

What to Do: Many sprained an-kles can be treated with “PRICE” (protection, rest, ice, compression with an elastic bandage and elevation), says Varner. “But if there’s a lot of swelling and bruising and you’re unable to bear weight on the foot – or if the symptoms persist more than several days – see a doctor to rule out a broken bone.”

How to Prevent: Some athletes with sprained ankles end up with chronic ankle problems, often due to inadequate rehabilitation, says Varner. The best bet to prevent a repeat injury is to do range of motion and strengthening exercises for the ankle. Many athletes find that balance retraining using a balance board is helpful, too. “Some people find that a visit or two with a physical therapist can help them to learn the best kinds of ankle exercises,” he adds.

Plantar Fasciitis: This is a common overuse injury that occurs to the fascia of the foot (the tissue that connects your heel bone to the balls of your feet). Symptoms include pain on the bottom aspect of the foot, especially in the morning after first getting out of bed, when the feet are less stretched.

What to Do: “Plantar fasciitis doesn’t get better overnight,” says Varner. For best healing, you need to do routine daily concentric stretching exercises of the foot. (This is when the external load placed on a muscle results in shortening of the muscle, such as in a bicep curl.) In addition, you can get splints to wear at night that help to stretch out the foot and reduce morning tenderness.

How to Prevent: The best way to prevent plantar fasciitis says Levi, is to wear good athletic shoes and use an orthotic devise in your shoes. And if you’re a runner and training to increase distance, he adds, “Don’t increase your run more than 10 percent a week.”

Stress Fractures: These are small cracks in the bone that can develop from overuse, especially in high-impact sports like distance running or basketball, says Markinson. The most common site for a stress fracture of the foot is in the metatarsals (the long bones at the mid-foot area). You become prone to stress fractures when you increase your high-impact activity frequency, duration or intensity too quickly. And some stress fractures in women athletes occur because of underlying bone density problems.

What to Do: If you have foot pain that develops gradually, increases with weight-bearing activities and lets up with rest – especially if accompanied by swelling – you should check with a doctor, says Markinson. If ignored, stress fractures can develop into complete breaks, and become a chronic condition.

How to Prevent: The best way to prevent a stress fracture is to increase high-impact activities gradually; cross training with lower impact activities is good, too. It’s also important to check your athletic shoes and avoid wearing old or worn out footwear. And don’t forget to eat a calcium and vitamin-D rich diet to help build bone strength.

Achilles Tendonitis: This is an irritation and inflammation of the large tendon in the back of the ankle, which may occur with changes in training or changes in footwear. The main symptom of Achilles tendonitis is pain over the back of the heel, especially after a period of inactivity, such as when first walking in the morning. Pain can also occur during activities, especially when pushing off or jumping.
What to Do: Medical evaluation is important, especially if you’re experiencing swelling or a “grinding” of the tendon, says Varner. In some instances there may be a tear within the tendon that may require surgical treatment. But in most cases, a decrease in activity, aggressive icing and eccentric stretches (those that work to lengthen the muscle) will help to resolve the condition.

How to Prevent: The best way to prevent an Achilles tendon injury, says Varner, is to warm up, stretch and strengthen the Achilles tendons.

Many foot injuries can reoccur, so it’s important to take precautions to prevent this from happening. Stretching before activity, wearing properly fitting footwear, eating a good diet and getting the proper amount of sleep – as well as increasing your workout routine gradually – can go a long way to ensure happy and healthy feet. MS&F