When to Worry About Swollen Feet and What You Can Do About Them

Posted by on Friday, September 28th, 2012

It’s normal for your feet to swell up a little during the day–after all, you spend most of your time putting weight on your feet by walking or allowing fluids to settle in them by sitting. In fact, we always advise shopping for shoes late in the day to make sure you buy shoes that will fit at 5:00 pm as well as 9:00 am. It’s also not unusual for your feet to swell more than normal if you’ve put extra stress on them, for example standing at an event for several hours, or hiking a long trail while on vacation. It’s certainly normal (though not pleasant) for your feet to swell during pregnancy.

However, it’s not normal for your feet to swell up a noticeable amount, enough that you really can’t fit into your shoes at the end of the day without pain. It’s not normal for the swelling to last a long time.

Six Tips for Runners’ Feet

Posted by on Thursday, September 27th, 2012

Running is one of the easiest forms of exercise you can do. I love it because all you need to do is put on a pair of running shoes and head out the door. No class schedule to try to fit into your schedule, no accessories to haul around, no big pieces of equipment. It’s just you and your feet.

Ah yes, your feet. Your feet take the most direct punishment when you run; they also have a huge effect on the rest of your body . Here are some tips that can help you get the most out of your feet when you go for a run:

  1. Don’t overwear your shoes We all have running shoes that we fall in love with, but just as in the world of romantic love, sometimes we love a little too hard and a little too long. While your old broken in shoes may be very comfortable, they can also hurt your feet, as all the support and stability measures of the shoe lose their effectiveness. Trust me, I had been having a lot of foot pain and it never occurred to me that my shoes were past their due date until I noticed that a chunk of the sole had worn out. I got new ones and it’s embarrassing how much better my feet feel. So take a good look at your shoes every so often to check if they’re worn out, especially if you notice some new foot pain. Quit your shoes a little too early rather than a little too late; some people even get new running shoes before their old ones are done and alternate them, so one pair is being broken in while the others are in their final days.
  2. Socks! When I first started running, I got huge blisters on my heels. I thought my new running shoes were the problem, so I went back to the store where I’d gotten them. The salesperson took a look at the slouchy, cotton socks I was wearing and asked, “Do you wear those to run?” I said yes, and there you go, the answer to my blister problem. It’s important to wear running socks that fit the shape of your feet so there’s no extra material to slosh around and rub your heels into blisters. Running socks also wick away the moisture that can make your skin vulnerable to blisters. I know, many of you are probably thinking, “Duh, of course,” but this really is a common rookie mistake.
  3. Point in the right direction Make sure your toes aren’t turned too far out or too far in when you run. This throws your body out of alignment and can lead to a variety of injuries. If you know you do this (and you probably do it while you’re walking as well), work on keeping your toes pointed straight forward. Contact a running coach if you’re having trouble correcting this on your own.
  4. Don’t overstep your bounds I know you’re trying to go faster, but taking longer strides isn’t the answer. Taking big strides where you’re practically throwing your feet out in front of will use up more energy than necessary and will actually slow you down. Keep your feet under you when you land; think more about bouncing off your feet than lunging forward with them. Running with too long a stride can lead to injuries like shin splints.
  5. Strike out on your own There’s been tons of talk in the past few years about the benefits of barefoot running or running in minimalist shoes, with much of it centered around the idea that running barefoot/minimalist encourages you to forefoot strike or run bouncing off your toes rather than heel striking or hitting the ground heel first as many have been encouraged to do for years. The barefoot running advocates are evangelists who are convinced they have found the right way; many heel strikers think there’s no reason to change what they’ve been doing. When some do and get injured, the barefoot runners just say they did something wrong. I’ve read lots and lots about this and went through my own experiment with forefoot striking. The verdict? I tried to ease into it as they always warn and still found myself suffering from forefoot pain (some of which lingers months later). Instead of going directly back to the heel striking I was taught long ago, though, I just stopped paying attention to how I ran until I realized I was striking the ground with my midfoot and it felt pretty good. So the verdict? If you’re (relatively) injury free and your feet feel good, don’t change what you’re doing. If you want to try something new, and it hurts, stop. Don’t pay attention to the peer pressure.
  6. Listen to your pain As we’ve said many times before, if you have foot, ankle, or lower leg pain, something is wrong. Don’t ignore it. Take a few days off and see if you feel better. If you don’t, visit a podiatrist at The Center for Podiatric Care and Sports Medicine (212.996.1900) to find out what’s going causing your pain. Feet are super-sensitive. Listen to them.

I think running is great in any season, but autumn is particularly wonderful. I hope you get a chance to go out for a run, or a good walk. Just pay attention to these tips so your feet enjoy the ride, too!

Black and Blue All Over: Foot and Ankle Bone Bruises

Posted by on Wednesday, September 26th, 2012

Do you remember when you were a wee little kid, just old enough to start really playing in a physical way? Maybe you were out in the yard or a park or just running around inside the house when the inevitable happened: you fell or banged into something. After what you would later have to agree was an excess of hysterical tears, you find that you have on your elbow or knee what some moms call a boo-boo or a black and blue mark. You know, a bruise. You’ve probably had many more since then and probably don’t think twice about them anymore unless they’re unusually colorful and you want to show them off to your horrified friends.

Those kinds of bruises are soft tissue bruises, where the trauma breaks blood vessels that then bleed into the layers of skin, causing the discoloration that we think of when we talk about bruises. There are, however, other kinds of bruises. No, I don’t mean a bruised heart, I mean a bone bruise–an injury that often affects your feet and ankles.

What is a bone bruise? A bone bruise is like a soft tissue bruise, except, of course, it affects a bone rather than the soft tissues. The most common type is a sub-periosteal hematoma.

That sounds fancy rather than common. What is it? Our bones are covered by a membrane called the periosteum. There are a lot of blood vessels in the periosteum, so when there is  a direct impact on the bone, some blood vessels can break, allowing blood to pool between the membrane and the bone. Space is tight in there, though, so the blood doesn’t haven’t much room to spread out as it can in the layers of skin. Instead, the blood in a bone bruise is confined to a small area, forming a lump under the periosteum.

Okay, what can cause a bone bruise? Like soft tissue bruises, they come from severe impact with a hard surface–falls, jumping and landing on a hard surface, a direct blow from someone or something. Extreme twisting can cause bone bruising when the surfaces of the bones in the joint clash hard. It’s not unusual to find bone bruises along with bad ankle sprains.

So let’s say that the top of my foot really hurts. How do I know if I have a bone bruise or a broken bone? Well, pain is a good indication, but unfortunately it’s an indicator for just about every other foot injury. Swelling is a symptom of a bone bruise, and there may be discoloration as well. The only way to find out for certain, though, whether you have a bone bruise is to see a podiatrist at The Center for Podiatric Care and Sports Medicine (212.996.1900) and have your foot or ankle fully examined; often an MRI is the only way to definitively diagnose a bone bruise.

You know, a player on one of my fantasy teams has a bone bruise on his foot and he’s been limping around and playing badly for weeks. When I have a bruise, it stops hurting in a day or two. Is this player just lazy? No, this is probably the biggest difference between soft tissue bruises and bone bruises. Like you said, a soft tissue bruise usually is gone in a few days, but bones heal more slowly than soft tissue. A bone bruise is only one step away from a fracture, so think more of the time frame for healing a fracture than a soft tissue bruise–that’s months, not days.

It’s important to take stress off the bruised bone; your podiatrist may put you in a walking boot or recommend crutches for a bone bruise on your foot or ankle. Icing the injured area can help bring down the swelling, as can anti-inflammatories such as ibuprofen or aspirin; for a natural pain reliever, you can try putting some arnica on the swollen area.

Unfortunately, the most important part of the treatment for a bone bruise are two things any active person hates: patience and rest. Yup, time to hit the pool

Bone bruises are frustrating injuries, but with the right care you can get through the healing process smoothly. Keep your feet safe and unbruised!

Five Great Stretches for Healthier Feet

Posted by on Tuesday, September 25th, 2012

If you run or do any other kind of physical activity, you’ve probably been told over and over to stretch, warm up, stretch, cool down, stretch, stretch, stretch. Most of these stretches target our legs, hamstrings, backs, triceps, or shoulders, but how about our feet? Foot muscles are muscles just like anywhere else in your body, and they can benefit from stretching, too.

Here are some stretches that can help your feet if you’re a runner, play a running-heavy sport, or even if you just wear high heels a lot:

  • Downward-facing Dog Yes, the old yoga standby. There are several ways to get into this pose, but I think this is the easiest. Get into a standard plank position, as if you were just about to begin a push up–hands in front of you, arms straight, back straight, legs straight, and toes bent, so  you’re on the balls of your feet. Then lift your hips so your body forms an upside down “V.” Keep your toes bent but push down with your heels so you feel a stretch in your calf muscles and the arches of your feet. Hold for about 10-15 seconds, then lower down to the plank, hold that for a few seconds, and then go back up to downward dog. Repeat three or four more times (and yes, my dog does this stretch all the time).
  • Towel Stretch Sit on the floor with your legs straight out in front of you and your feet flexed, toes pointed straight up. Take a small towel and hold one end in each hand. Loop the middle of the towel across the ball of one foot, and pull back gently so you feel the stretch in your calf muscles. Hold for about thirty seconds, then relax and switch to the other foot.
  • Step stretch Stand on a step and back up until your heels are hanging off the edge of the step (tip: you’ll know you’re facing in the wrong direction if you back up and just find more step rather than air; double tip: don’t back up so much you fall off). Push one heel downward so you feel a stretch in your calf. Hold this for about ten to fifteen seconds, then switch to your other heel. Do this about three to five times on each foot. I usually do this on the steps of my building when I finish running; you can also do it on a curb. Hold onto a railing, wall, or lamppost for balance if necessary.

(I know, you’re thinking, what’s up with all the calf stretching when this is supposed to be about foot stretches? Well, tight calf muscles can cause a variety of foot injuries, including plantar fasciitis and Achilles tendonitis. Stretching your calf muscles stretches while you stretch your foot is good for your feet.)

  • Foot rolls Stand with your toes pointed straight ahead, hip width apart. Shift your weight to your right heel, then roll your weight forward through your right foot along the outside edge of it until your weight is on your forefoot. Continue the roll back along the inside of your foot until you’re back on your heel again; it’s as if you’re rolling around an oval with your foot. Repeat on the other foot. Do about ten on each side this way, then do ten reversing the roll, starting at the heel and rolling into the inside of the arch.
  • Ankle stretch Stand with your toes pointed straight ahead. If you need some balancing help, rest a hand on a chair or table (I often need balancing help!). Cross your left ankle over your right ankle, and point the toes of your left foot down to your right, so the tips of your toes are just touching the floor. Bend your right knee so your right shin is pushing into your left heel,  enough to feel a stretch in your ankle and along the top of your left foot. Hold for 15-30 seconds, then relax and repeat on that side again. Then switch to the other side to stretch your right foot.

There you go, some stretches so your feet don’t feel neglected! Make them as much a part of your morning routine as a good cup of coffee and your feet will be on their way to better strength and flexibility. Keep in mind that these stretches should feel good; if you feel any pain in your foot or ankle while stretching or doing anything else, contact The Center for Podiatric Care and Sports Medicine (212.996.1900) to have your foot checked out. Feet hurt for a reason–find out why!


Pain On Your Foot’s Edge: Dancer’s Fracture

Posted by on Monday, September 24th, 2012

Just recently we talked about some of the most common injuries suffered by dancers, but those were of course, only the tip of the dancing injury iceberg (or the “pointe” of the iceberg? sorry, should have given you a bad pun alert). Today, though, we want to talk about another injury that doesn’t quite fall into the category of common, but happens enough that it has earned a stunningly appropriate name: “Dancer’s Fracture.”

Foot Pain? You Might Have a Sprain

Posted by on Friday, September 21st, 2012

If foot and ankle injuries were in high school, sprained ankles would be the most popular kids–not because there are so many of them, but because they get so much attention. Sprained feet, on the other hand, would be the quiet kid no one notices and no one remembers when he or she show up at the reunion.

But just as that kid does indeed exist and has a right to be noticed, so do our foot sprain friends. So let’s talk foot sprains!

What’s a foot sprain? Good question! But I think it’s helpful to start just by answering the question, “What’s a sprain?”

What’s a sprain? Great question, thanks! A sprain occurs when the ligaments around a joint are overstretched, resulting in tiny tears in the ligament. This usually happens when too much force is put on the joint, like when you take a bad step off a curb and end up landing on the side of your foot, bending your ankle sharply downward (sorry, had to use ankle sprains as an example because they’re the popular kid everyone knows).

Now what’s a foot sprain? As you would expect, it’s a sprain to any of the ligaments connecting the joints in the foot. There are thirty-three joints in the foot and one hundred ligaments, so you would think that the possibilities for damage are endless.

Then why don’t we hear about foot sprains more than ankle sprains? You just don’t bend and twist your foot on an every day basis the same way you do your ankle. To sprain your foot, you need to do a really specific type of twisting, bending motion, usually while putting weight on your foot. For example, it could happen during an awkward landing from a jump, such as a gymnast not executing a landing off a piece of equipment (or falling off a piece of equipment), or a sudden change in direction while running, like a football player trying to make a cut too quickly. It also could come from direct impact in a collision sport like football. Windsurfers are also likely to suffer sprained feet; their feet are strapped onto their boards, so their bodies can suddenly shift forward or to the side while their feet remain stationary, causing a twist that damages ligaments.

How do I know I have a sprained foot? I sure know when I have a sprained ankle. You’ll usually feel pain right after the event that caused the sprain, although sometimes you might not really feel it–I mean like, “Hey, this is more than a momentary blip on the pain radar”–until a few hours later, after the injury has had time to swell and stiffen more. Most sprains will be felt on the top or sides of the midfoot area. You’ll feel an increase in pain when you do activities that put pressure on the joint, such as walking up a hill, on uneven surfaces, or while running, jumping, kicking, or standing on your toes. The best way to confirm that your foot is sprained is to have it examined by a podiatrist at The Center for Podiatric Care and Sports Medicine (212.996.1900).

So let’s say I have a sprained foot. Now what? How do I make it better? You should ice the injured area as soon as possible to bring down the swelling. Then wrap it in a compression bandage and keep it elevated. Rest from any activities that cause pain in your foot until your foot stops hurting; this may even require a walking boot or time on crutches. The important thing is to try to take care of the injury right away. It’s like trying to crawl out of debt–the longer you leave it, the worse it will get.

As soon as the pain is manageable, you should start doing some exercises to help keep the foot from becoming stiff or weak. Your podiatrist can give you a set of exercises to do or refer you to a physical therapist. Depending on the severity of the sprain, it can take anywhere from two to six weeks to completely return to normal activity. Finally, if your podiatrist feels that some kind of biomechanical issue in your foot contributed to the sprain, he or she may suggest orthotics to provide extra support and stability for the future.

There you go, then, the oft-ignored sprained foot finally gets its moment in the injury spotlight! A sprained foot may not be as common as a sprained ankle, but when it happens, it’s just as annoying. Be careful of your feet and pay attention when they hurt!

Nine Simple Tips For Healthy Feet

Posted by on Thursday, September 20th, 2012

With autumn on the way, it’s easy to forget about your feet as you pack up your flip flops and sandals and put on socks and boots. There’s no time of year when you can forget about foot care, though–your feet always need your attention.

Here are some tips for keeping your feet happy for the rest of the year (and your life):

  1. Don’t ignore foot pain If your foot hurts, that means there’s something wrong; it’s as simple as that. Okay, if you’ve just run a marathon,  hiked the entire Appalachian Trail, or danced the night away at a wedding, then yes, it’s normal for your feet to hurt. If there’s no screamingly obvious reason for your foot pain, though, you should have your foot examined by a podiatrist at The Center for Podiatric Care and Sports Medicine (212.996.1900). It’s better to do something too early than too late. As the astronauts say, don’t let a problem become an emergency.
  2. Make sure your shoes fit I know we say this all the time, but it’s really important. Different shoe manufacturers size their shoes differently, so sizes often vary. Also keep in mind that your feet change size as you get older–just because you wore a size 7 last year doesn’t mean you’ll be wearing it this year. Always try shoes on!
  3. Keep them clean Wash your feet every day and make sure you dry them thoroughly, especially between the toes. If you picked up any bacteria or fungus on your feet, this will help nip that in the bud. I know, you’re thinking, “I take a shower every morning, my feet are clean,” but I think it’s always a good idea to wash them in the evening before you go to bed. I mean really, do you want to put your feet and all the accumulated sweat and dirt of the day in your bed? I don’t.
  4. Moisturize If your feet feel dry, use a good foot moisturizer or petroleum jelly on them every day to prevent cracking, especially in the heels. Don’t put moisturizer between your toes, though–it’s hard for moisturizer to dry there, and dampness between your toes can lead to fungal infections.
  5. Check them out Take a serious, good look at your feet on a regular basis. Changes in the color or thickness of your toenails can indicate a nail infection is developing. If your feet appear to be paler than normal, that could be a warning that you have a circulatory disease. Take that seriously and get checked by your doctor.
  6. Don’t dismiss the itch Itchy feet? That could mean you have a fungal infection. Try these home remedies to fight foot fungus, but if they don’t work, see a podiatrist to get it under control.
  7. Don’t do it yourself It’s okay for you to soak your feet in vinegar to try to get rid of athlete’s foot, but you shouldn’t try to remove a corn or callus yourself. If you have a corn that’s irritating you, buy pads to put over them and protect them. If they’re still painful, see a podiatrist to have them removed carefully in the office.
  8. Keep trim Cut your toenails regularly. They should be cut so they’re even with the top of your toe. Cut them straight across–don’t curve them downward as that can lead to ingrown toenails.
  9. Don’t overheat In winter you may be inclined to wrap your feet in super warm socks and stuff them in thick boots, but that can be overkill. Fungal infections love warm sweaty feet shut up inside dark enclosed places like boots. Wear moisture wicking socks to draw moisture from your feet. If you tend to have sweaty feet, pack a change of socks.

So there you go–these are all very simple things you can do to make sure your feet stay in top shape. Follow these tips and hopefully you’ll always be able to put your best foot forward (eek, bad pun alert!).

Gait Analysis: Foot Problems and the Way You Move

Posted by on Wednesday, September 19th, 2012

You’ve probably met them–people who say, “Oh, I haven’t missed a day of running in ten years.” You say something like, “Me too. Well, of course, other than when I had that sprained ankle, and my bad knee, the shin splints, and then my plantar fasciitis…” So what does the other runner say? “Really? I’m never injured.”

Now let’s just throw out the possibility (probability?) that this paragon of running virtue may be lying and consider something that is quite true: some runners are injured more than others. Sometimes this is because of factors that are in their control–they don’t choose good shoes, they run on bad or dangerous surfaces, they don’t take care of their overall health. Other times, though, it has a lot more to do with something you can’t control–the way you are built or the way you move.

Toe Issues: Hammer, Claw, and Mallet

Posted by on Tuesday, September 18th, 2012

Hammers, mallets, and claws all have their place in the world–for example, at a construction site, in a kitchen, or on a cat. They shouldn’t be on your toes, but alas, sometimes they show up there.

We’ve talked about hammertoes before, so today let’s examine how those stack up (or curl up ) against two similar conditions: claw toes and mallet toes.

Tips for Healthy Feet While Hiking

Posted by on Monday, September 17th, 2012

It’s not scientifically autumn for a few more days, but for most people, the beginning of September marks the real beginning of the season. Although some might think of summer as hiking season, I think fall is the perfect time, when it’s still warm enough outside to avoid heavy winter coats, but just cool enough so that you’re not pouring sweat the whole time you’re out in the woods. If you live in a region where the leaves change color, it’s an especially wonderful time to hit the trails in a national park or hike up a mountain.

Of course with all that walking, your feet can run into all kinds of trouble. Let’s talk about hiking and foot problems and what you can do to avoid them.

When you’re out hiking, you can suffer from sudden, traumatic injuries, such as:

  • Ankle sprains and fractures
  • Various foot bone fractures
  • Toe fractures
  • Heel fractures
  • Bruises

If you hike a lot, though, or suddenly find yourself off on a ten mile trek after a lazy summer poolside, you can also develop overuse injuries in your feet, including:

  • Shin splints
  • Calf strains
  • Blisters
  • Black toenail
  • Plantar fasciitis
  • Bursitis
  • Achilles tendonitis

None of these are fun, so here are some tips to keep your feet and ankles healthy when you hike.

Stop I don’t mean stop hiking, I mean if you’ve suffered some kind of traumatic injury, stop and get help or head home. Don’t tell your group, “It’s nothing!” and go on for the next five miles just because you don’t want to ruin everyone else’s good time. Putting weight on your injured foot or ankle  will just make the injury worse. Don’t ignore the pain–try to get off your ankle as soon as possible. If you have a first aid kit (and hopefully you or someone in your group does), stop and tape up your ankle. If you can find a big strong branch to use as a cane, that can help too (or a friend with a strong shoulder to lean on). Obviously if you’re far out on a trail and the only way home is to limp on both feet, then that’s what you’ll have to do. If you can do something to cut down on the time you’re on your injured foot or ankle, though, do it. When you get back to civilization, see a podiatrist at The Center for Podiatric Care and Sports Medicine (212.996.1900) to get your injury checked out and treated.

Shoes Choose the right kind of shoes or boots. Boots offer more support and overall protection, but they’re heavier and less flexible. Shoes for trails or hiking are lighter and often made of a breathable material. Think about what kind of hiking you usually do and choose accordingly. If you’re in a hot climate and walking on fairly gentle trails, then shoes might be better for you. If you’re usually in rougher terrain and colder or wetter weather, then boots might be right. A salesperson at a good outdoor sports store should be able to help  you make a decision. And of course, choose shoes that fit. Don’t just casually order online shoes in a size you’re “pretty sure” will fit. Go try them on, preferably late in the day when your feet are swollen. Also wear the socks you usually would wear while hiking. Shoes that don’t fit can cause all kinds of miserable injuries, including blisters from too big shoes that allow your feet to rub up and down against the heel and black toenails from shoes that fit too tightly at the toe (there should be about 3/8-1/2 inch between the longest toe and the top of the shoe). Finally, if you get new shoes or boots, don’t forget to break them in by wearing them around the house or on short errands for a few days before setting off on that twenty mile hike.

Socks Yes, socks are just as important as shoes. Choose moisture wicking socks so your sweaty feet will stay dry. Make sure they’re breathable. If you’re going to be out in cold weather, I find it’s better to wear a couple of pairs of thinner socks than suffocate my feet in heavy warm ones. Avoid socks with a seam across the top that can rub on the top of your toes and make sure they don’t bunch up around your heels or toes.

More socks Literally more socks, as in bring an extra pair, just in case you sweat through the ones you’re wearing or get caught in the rain or step in a puddle.

Keep ‘em dry Damp feet inside shoes are vulnerable to bacteria and nasty fungal infections; wet skin also blisters more easily. In addition to the aforementioned extra socks, you might want to sprinkle some foot powder in your socks to help absorb moisture. If you have really sweaty feet, try putting antiperspirant on them.

Keep ‘em wet Well, not wet, but moist. If you’re prone to blisters, you can cut down on the friction that causes them by putting petroleum jelly or any other lubricant on areas of your feet vulnerable to blistering. Don’t put on so much so often that your socks get gunky, though.

Take barefoot breaks I don’t mean walk barefoot, unless you have the tough feet of a Nepali sherpa. I mean take frequent breaks from walking where you can stop, take your shoes and socks off and elevate your feet. Give your feet at least fifteen minutes of rest every few miles, or more if the terrain is particularly rough. If you’re near a clean looking creek, pond, or riverbank, you can cool your feet off in the water. However–and this is super important–make sure they are absolutely 100% dry before you put your socks back on, or you’ll be at risk for the aforementioned blisters and fungal infections.

Don’t overload Make sure your pack isn’t too heavy for you to walk comfortably. An overly heavy pack puts more weight on your feet and can also put a strain on your calf muscles and Achilles tendons. I know everyone wants to look awesomely super strong, but you don’t look awesomely super strong if you’re limping.

Pack a first aid kit This is not what you should take out when you’re trying to lighten your pack. You don’t have to bring tons of things, just bandages, tape, antiseptic creams, duct tape (great for blisters), maybe ibuprofen. Many sports stores sell prepackaged ones, or here’s an example of what to include if you’re making your own first aid kit.

Hopefully these are some tips that will keep you healthy while you’re on the trail. Enjoy the lovely weather as long as you can!