The Runner’s Foot

Presented by: James Ratcliff, DPM
Podiatrist, Menlo Medial Clinic
August 6, 2009

Lecture Overview:

• The foot is subject to a wide array of strains, inflammations, and stresses. Many can be addressed by cutting back on running, using foot pads or orthotics, and giving the muscles and tendons a chance to rest.
• Replace running shoes every 300 miles or every six months.
• Don’t go barefoot for long periods indoors.
• Use common sense-when you feel pain, cut back on your running routine. See a podiatrist if the discomfort continues.

Exercise physiologists have found that professional runners take about 200 steps per minute. Because of its high-impact nature, all that contact can take a heavy toll. Injuries to the foot are an unfortunate, but all too frequent, malady for runners.

James Ratcliff, DPM, a long-time triathlete and a Stanford-affiliated expert in podiatry and sports medicine, discussed some of the more common runners’ foot problems at a Peak Performance Lecture at the 2009 Senior Games.

Metatarsal Stress Fracture
A stress fracture is a break in a bone caused by repetitive stress or overexercise that fatigues the bone. It is most common in the metatarsal bones but is difficult to diagnose because the damage does not usually show up on an X-ray until several weeks after the injury. The usual symptom is swelling on top of the foot, but the condition can get worse so it’s important to cut back on training to give the foot a chance to recuperate. Another common injury is an avulsion fracture, an injury to the bone where a tendon or ligament is attached.

Dr. Ratcliff suggested rest for about four to six weeks. “It’s an injury that takes a long time to heal because the foot is always in use,” he said. “One way to avoid injury is to replace your running shoes every 300 miles, or every six months.”

Achilles Tendonitis
Tendons, like other tissues in the body, become less flexible, more rigid, and more susceptible to injury as people age. Achilles tendonitis is often caused by doing too much too soon. It’s a common overuse injury that can lead to small tears within the tendon if not addressed. Runners often develop symptoms of Achilles tendonitis after increasing their mileage or changing their terrain.

The condition can also be caused by recent changes in footwear. “I see more of this in the summer when people start going barefoot or wearing flip-flops,” Dr. Ratcliff said. “There’s no transition, and it causes the tendon to stretch. Use common sense, and don’t go barefoot too much indoors. The heel should be slightly elevated.”

The condition responds to ice, stretching, using heel lifts, and massage. Running should be replaced by swimming or biking until the damage is repaired. Dr. Ratcliff also uses a platelet-rich plasma injection, using the patient’s own blood to isolate the platelet’s growth factors which are then injected at the site to accelerate healing.

Plantar Fasciitis
Plantar fasciitis is one of the most common causes of foot pain. It involves discomfort and inflammation of the plantar fascia, which runs across the bottom of your foot, connecting the heel bone to the toes. If not addressed, over time the tendons can become chronically scarred, so it should be treated in the early stages of inflammation, Dr. Ratcliff said. Patients are treated with night splints to keep the foot flexed, and he suggested using orthotics or sole inserts (like SuperFeet). More advanced cases are sometimes treated with cortisone injections or radial shockwaves to induce an immune reaction.

Ankle Sprain
Ankle sprains are the second most common foot injury, often caused when the when the foot is inverted (turned inward) beyond the control of the ligaments or muscles. The excessive force may cause the ligaments and muscles to pull. “Sprains are often poorly treated, which can lead to more problems later on,” said Dr. Ratcliff. “It also affects the proprioception (the sense of balance), so don’t go back to your regular level of activity until you can stand on one leg for at least one minute. You need to get your balance back.”

Morton’s Neuroma
Morton’s neuroma is a thickening of the tissue around one of the nerves leading to your toes that can feel like you’re walking on a rock or a wad of gum. The weight-bearing part of your foot can develop scar tissue from being inflamed, so make sure your shoes are wide enough to accommodate your feet. If wider shoes or foot pads don’t bring relief, the condition can be treated with cortisone or alcohol injections.

Sesamoiditis
Sesamoiditis refers to an irritation of the sesamoid bones-the tiny bones within the tendons that run to the big toe. It’s most common symptom is pain in the ball of the foot, behind the big toe. It’s challenging to treat because of the location, but the first step is to stop running for about a month. It often requires an MRI to diagnose this condition properly.

About the Speaker
James Ratcliff, DPM, is a specialist in podiatric sports medicine and surgery at Menlo Medical Clinic and diplomate of the American Board of Podiatric Surgery. A long-time triathlete, he became interested in podiatry after recognizing a need for improved care for athletes. He received his medical education at the California College of Podiatric Medicine and did his residency at the VA Medical Center in Los Angeles.

 

For More Information:

Request a free information packet on this topic from Stanford Health Library

About Dr. Ratcliff
http://stanfordhospital.org/profiles/physician/James_Ratcliff/

Stanford Orthopedic Surgery & Sports Medicine
http://stanfordhospital.org/clinicsmedServices/COE/orthopaedics/

Menlo Medical Clinic
http://www.menloclinic.com/default

2009 Summer National Senior Games
http://www.2009seniorgames.org/