Care and Maintenance of Your Feet

Our feet power us through almost every sport imaginable, not to mention keeping us moving healthily throughout the day. In the December print issue of Austin Fit Magazine, you saw Dr. Martha Pyron’s handy guidelines for care and maintenance of your feet. Here’s a list of additional conditions, their prevention, and the treatments that will leave you putting your best foot forward.
 

Tendinitis

Any small injury, tear, or inflammation to the tendons, which are what connect muscles to bones on the front, back, and both sides of the foot and ankle.

Prevention: Tendons get injured with trauma (as in football) but are most often injured due to overuse, as in endurance athletes who are ramping up training. As athletes age, tendon elasticity changes, which often leads to injury. So, a slow gradual approach to increasing exercise will help avoid tendonitis.

Treatment: Rest from the types of activities which cause pain is the usual treatment, while physical therapy and injections are sometimes used. Surgery is rarely needed.

Rigid Toe

Stiffness of the big toe, usually due to some level of arthritis of the big toe.

Prevention: Arthritis is best avoided by staying active and keeping the muscles of the foot strong.

Treatment: Once arthritis has started, avoid sports and activities that cause pain and swelling, but otherwise continue to move the joint with exercise as much as possible. Stiffness may be improved by surgery if it is performed early enough. If the arthritis is bad enough, surgery may be geared toward a joint replacement.

Ankle sprain

Injury to the ligaments about the ankle typically from a twisting or turning injury, which can occur on the inside (medial), outside (lateral), and top (high) part of the ankle.

Prevention: Keeping the muscles around the ankle strong can help prevent ankle sprains. If you have had repeated ankle sprains, using a brace or taping the ankle can help protect it from future injuries.

Treatment: Mild sprains may only need rest and a minor brace to protect the area while it heals. More significant injuries may require surgery, casting, or using a boot for an extended period of time.

Ingrown toenail

Toenail grows into the skin, causing a deep abrasion or laceration, which gets infected.

Prevention: Cut your nails straight across so you can see the end of the nail all the way. Cutting them in a curved fashion leaves the corners deep, leading to the nail digging into the corner.

Treatment: Ingrown nails can be lifted up out of the area, which prevents further injury to the skin around the nail. Many times, these injuries also require antibiotics; seeing a physician for treatment is usually a good idea.

Fungal infections

Fungus growing on the skin, called “athletes foot.” Fungus grows in warm, moist places, such as the wet foot, the groin, and areas where skin touches skin such as the buttocks and under the breasts.

Prevention: Keep the foot dry as much as possible to prevent the warm moist environment that fungus loves.

Treatment: Over-the-counter antifungal spray/powder/ointment may work, but stronger prescription medication may be necessary. Get rid of old shoes, as the fungus may be in the shoe, and change out wet socks during long events and/or as soon as activity is finished.

Plantar Fasciitis

Injury to the ligament which runs along the bottom of the foot from the heel to the balls of the feet, producing pain which is worse in the morning or after standing/walking for longer periods.

Prevention: Flexibility and balanced strength of the feet and shins will help prevent plantar fasciitis of the foot. This is also typically an overuse injury, so gradual increases in activity and engaging in a variety of activity (instead of only one type exercise, like running) will help keep the muscles strong/balanced/and less likely to become overused.

Treatment: Typical treatment consists of physical therapy, a shoe insert, wearing a brace at night, and treating the calf to loosen the muscles. Sometimes injections are used; surgery is rarely needed.

Blisters

 Fluid collection between layers of skin due to friction from shoe or sock.

Prevention: Make sure shoes have plenty of room, double socks may help, change socks if wet, slowly break in shoes which will thicken the skin in any area of possible blister and prevent blister.

Treatment: Protect area from further injury, cover with antibiotic ointment and bandage to prevent infection, seek medical care if redness/pain/swelling worsen as these are signs of infection.

Callouses: Build up of thickened skin in an area of chronic friction.

Prevention: Proper shoe wear and proper running style. If your foot tends to land a certain way causing chronic friction to the area a callous will develop, so evaluating the foot landing and correcting abnormal motions will help prevent callouses.

Treatment: Use pumice stone or mild abrasive to rub off the dead thickened skin and wear proper footwear to avoid the chronic friction to the area.

Runners’ toenail

 Blackened nails caused by the nail hitting the front of the shoe with each impact.

Prevention: Proper shoe fit and avoiding a shuffled gait (the foot hits the ground and drags forward slightly before stopping), as this can cause the nail to hit the front of the shoe as the foot finally stops dragging forward on the ground.

Treatment: A physician should evaluate to make sure there isn’t something more serious, like a melanoma, under the nail. But, in general, the treatment relies on proper shoe fit and running style.

Skin

Abrasions: superficial scratch of the skin

Prevention: More likely to occur during barefoot running and trail running, so consider avoiding these activities or wearing high socks to cover the skin.

Treatment: Protect area from further injury, cover with antibiotic ointment and bandage to prevent infection, seek medical care if redness/pain/swelling worsen = signs of infection.

Lacerations: deep wound to the skin from trauma, such as a fall or glancing blow

Prevention: Wear high socks on trail runs and run carefully over rocky terrain.

Treatment: A physician should repair lacerations within six hours for best results, so go to an emergency room, Urgent Care facility, or your sports medicine physician’s office within this time frame.

Bacterial infections

 bacterial growth on and just under the skin, which results in a painful, red area with possible red streaks growing up the foot/leg (this can be an emergency situation)

Prevention: Prevent blisters, abrasions, and lacerations as well as monitor feet for wearing on the skin, which is vulnerable to infection.

Treatment: Antibiotics are needed for this type of infection, so see a medical provider as soon as possible.

Warts: a viral infection of the skin that causes a bump to form

Prevention: Don’t expose the foot to the virus; wear flip flops (shower shoes) in public showers, locker rooms, and around pools.

Treatment: The area of infection needs to be burnt, frozen, or chemically treated in order to kill the virus. If nothing is done, the body will eventually overcome the virus but the process may take two years or more. As long as the wart is present, it can spread to other areas of the skin and to other people.

Corns

A buildup of keratin in a specific spot of the skin (keratin normally covers the surface of the skin, but areas of constant pressure—such as the bottom of the foot—may cause a painful bump, called a keratin plug, to form), which may look like a wart

Prevention: Wear proper footwear to disperse equal pressure on the soles of the feet.

Treatment: Corns are treated by “digging out the plug.” To avoid infection or other potential side effects, have a medical professional perform this procedure.

Bone

Broken toe: fracture of the bones of any of the toes

Prevention: Avoid trauma to the foot. Run carefully on trails, especially when barefoot, as running barefoot on a trail run is more likely to result in a fracture than running with a shoe.

Treatment: A doctor will immobilize the area by taping the toe, using a special shoe or boot, and possibly using crutches. Breaking the big toe is more concerning. Broken bones should be treated by a physician who specializes in this area (such as a sports medicine doctor).

Stress fracture: an overuse injury to the bone that results in a break of the bone (stress fracture symptoms develop over days and weeks as opposed to regular fractures, which develop instantly upon injury)

Prevention: Avoid overuse. Slowly increase activity instead of jumping into a rigorous exercise program, and eat a healthy diet including calcium and vitamin D for bone strength.

Treatment: Stress fractures should be treated very carefully as they tend to heal slowly and sometimes recur or linger for many months. See a sports medicine doctor.

Midfoot fracture

Injury to the ligaments of the midfoot due to trauma, such as football players or other athletes unknowingly stepping into a hole or when the foot is trapped in a space and twisted, such as may occur in tackling sports

Prevention: Trauma from sports can’t always be avoided, but using cleats with a rigid midfoot will help protect this area. Watch where you run/walk to avoid stepping into a hole by accident.

Treatment: This injury is very serious and may require surgery to correct. A sports medicine doctor should evaluate midfoot pain for stress fracture or midfoot sprain. Some midfoot fractures will require wearing a special shoe, boot, and/or using crutches, while others will require surgery. These injuries should be followed closely to insure proper healing.

Bone Contusions

Bruising of the bone, most commonly in the heel

Prevention: Bone bruises in the foot are more likely in runners who run barefoot or in sports than involve jumping and landing. Being careful during these activities may prevent injury.

Treatment: A bruise of the bone is just one step away from a break, and so these need to be treated cautiously to ensure proper healing. Treatment may consist of using an insert in the shoe, wearing a special shoe or boot, and/or using crutches. Sometimes, the area just needs to rest to heal.

High arch

(also known a pes cavus)

Prevention: Use a soft shoe insert (such as those found in a grocery store or pharmacy; for example, gel pads) to prevent injuries associated with having a high arch, such as stress fractures or bone bruises.

Treatment: No treatment is necessary if there is no injury associated with having a high arch.

Flat foot

 (also known as pes planus)

Prevention: Using a rigid arch support to hold up the arch may prevent the calf injuries, such as stress fractures or muscle/tendon injuries, associated with have a flat foot.

Treatment: No treatment is necessary if there is not an associated injury.

Pronation: excessive motion of the foot, which results in rolling in of the foot and ankle commonly associated with flat foot

Prevention: Using a rigid arch support can help avoid injury associated with pronation. Specific exercises for the foot can also improve this situation.

Treatment: No treatment is necessary if no injury is present.

Supination:

Excessive motion of the foot resulting in rolling out of the foot and ankle commonly associated with having a high arch

Prevention: Using an orthotic, which keeps the foot from rolling out as well as improving foot strength can prevent injuries associated with supination.

Treatment: No treatment is necessary if no injury is associated.

Bunions

Abnormal angling of the big toe towards the other toes with a large bump forming on the side of big toe

Prevention: Wearing wide enough shoes and keeping the muscles in the foot strong may help avoid developing a bunion.

Treatment: Most bunions do not need surgery and the surgery, when done, may result in a toe that is stiff and still angles. The most common reasons to have surgery include the cosmetic look of the big bump, pain that interferes with sport or daily life, and not being able to fit in shoes. Athletes should approach surgery cautiously; while the outcome may result in a better appearance, the toe may be too stiff to use for running or other sports, such as soccer. Other treatment options include using an arch support, strengthening the muscles in the foot to support the area, and wearing properly fitting shoes.

Bunionette

 abnormal angling of the fifth toe towards the other toes and a large bump forming on the side of the fifth toe (basically, a bunion of the fifth toe)

Prevention: Avoid bunionettes by wearing proper shoes and keeping the foot strong.

Treatment: Surgery may be required for a painful bunionette and athletes tolerate this surgery better than bunion surgery. Other options include wearing wide enough shoes that don’t push the toe inward and keeping the muscles in the foot strong.

Hammer Toe: abnormal positioning of the toes (the middle of the toe is pointed upwards and the tip of the toe is pointed downwards), which results in callouses on the top of the affected toes

Prevention: Wearing shoes that aren’t too short, which allows the toes to rest in a straight position, as well as keeping the muscles and tendons in the foot flexible and strong can prevent hammer toe.

Treatment: Physical therapy and sometimes surgery is required to treat hammer toes.

Ligaments

Midfoot sprain: trauma from a tackling sport like football and inadvertently stepping into a hole (similar to causes of a midfoot fracture) can result in injury to the ligaments that hold the bones in normal alignment

Prevention: Trauma can’t always be avoided in contact sports but watching where you step can avoid accidents, such as stepping in a hole.

Treatment: As with a midfoot fracture, this injury is serious and sometimes requires surgery to fix.
 

Tendons

Tendinosis: a chronic, longer lasting injury to a tendon that typically results from tendinitis that is not allowed to heal completely

Prevention: Tendinosis can be avoided by treating tendinitis appropriately and quickly as well as waiting to return to an activity until tendinitis has completely healed.

Treatment: Like tendinitis, treatment consists of physical therapy and rest from painful activity but tendinosis treatment typically takes much longer than treating tendinitis. Other treatment options include special injections like prolotherapy or platelet-rich plasma injection. This injury is typically a much more frustrating, as it takes a long time to heal.

Ruptured Tendon

Achilles: the Achilles tendon, located on the back of the calf all the way down to the heel, can rupture or tear in half if tendinitis or tendinosis is present in the tendon and is not treated properly.

Prevention: Treating tendinitis and tendinosis properly to resolution can avoid a ruptured Achilles tendon.

Treatment: Treatment for a ruptured Achilles tendon requires either surgery or using a special brace and crutches for up to three months. This injury takes a long time to heal.

Tenosynovitis

Common injury to the foot and hand, which feels similar to tendinitis but there may be visible swelling and a Velcro-like feeling in the area during movement, caused by the tendon rubbing on the swollen sides of the “tunnel”

Prevention: Tendons attach muscles to bones and act as ropes, which the muscles pull on to move the body part. Many tendons are surrounded by a tunnel-like structure that may get inflamed, resulting in a diagnosis of tenosynovitis. Tenosynovitis is usually an overuse injury, so slowly progressing with increase in exercise will help prevent it.

Treatment: This is a more serious condition than tendinitis and may take longer to resolve. Treatments include icing, resting, using a brace, taking a steroid or getting a steroid shot, and physical therapy. Surgery is sometimes required.
 

Snapping of tendon

Peroneal: injury to the band of peroneal tissue, which may results in the tendon slipping over the bond on the side of the ankle, causing snapping and pain in that location

Prevention: There are actually three peroneal tendons, which run along the outside of the ankle and are held in place by a band of tissue that keeps them tracking against the bone. Injury to the band of tissue is caused by trauma and, in some cases, overuse. While trauma can’t always be avoided, slowly increasing activity can prevent overuse.

Treatment: Surgery is usually required to resolve this problem.