Home About Us Contact Us


Achilles Foot & Ankle
 - Podiatric Library

New Patients Welcome

Complete Podiatric Care for the Entire Family

Most Insurances Accepted

Office Hours By Appointment/ Walk-ins Welcome

Specializes in Diabetic & Wound Care Treatment

Diabetic Shoes

Hospital Consults

Housecalls

Protecting Patients' Private Information
 - HIPAA
 - Patients' Bill of Rights


Site Search

Fracture in Runners

Just as one checks out the various auto fluids prior to a trip, so too should the jogger follow certain precautions before a run.  After a while, these clearance procedures will become habit and require no thought in performing.  However, at first it is a good idea to establish some sort of a routine in evaluating the feet.  Believe me, a few short moments spent in checking out this area can be extremely well spent. 

       

Proper nail hygiene prior to jogging is absolutely essential.  Excessively long or abnormally thickened nail plates are an open invitation to injury and subsequent complications.  As opposed to most textbook sources, I recommend that the nail should be trimmed to conform to the fleshy end of the toe rather than straight across.  I find that this approach can be readily preformed and seems to reduce the incidence of problems.  Care must be exercised in not cutting the edges of the nail too far in order to to prevent ingrowns and skin infections.  It is surprising how frequently patients are seen at the office who have merely failed to trim the nails prior to a lengthy run.  The majority of these problems could well have been prevented if this simple precaution had been followed.

       

The foot should be checked for chronic pressure areas indicated usually by well-developed diffuse calluses.  A thin section of non-medicated adhesive moleskin applied to these areas for the run significantly reduces friction and relieves a good deal of discomfort.  If the calluses are punctate or deep with cores in their center, then proper podiatric care should be sought and these lesion sites reduced professionally.  There are commercial products available for the self-reduction of thin calluses following bathing and soaking.  These are usually abrasive in nature and relatively safe in use.  In no way should a cutting instrument such as a knife or razor blade be utilized to reduce the build up.  Although the procedure appears simple enough, the frequency of problems and subsequent complications indicate only too well the apparent danger.

       

Corns, or lesions on the upper or outer surfaces of the toes are often times not painful in the jogger and thus, in my estimation, require no specific preparation.  In those cases where the lesions are reddened and irritated or just painful, either prior to or during the run, I suggest protecting the site by band-aid covers or other bandage material.  A good protective covering available at most podiatric offices is that of tube foam.  When cut to size and fit, one has a removable, nylon lined foam cover, which will last quite a long time before requiring replacement. 

 

Soft corns are those painful skin lesions occurring between the toes.  Temporary comfort can be attained by the use of foam pads, cotton inserts, or band-aid covers, since any attempt at reducing pressure and friction usually affords relief.  It is recommended that these lesions receive professional care in order to prevent subsequent complications. 

       

An additional area to check for on the feet prior to jogging is what we refer to as, “hot spots.”  These are the areas where friction has produced heat with burning sensations and occasional redness.  In actuality, it is usually a precursor to blister formation and should be treated in order to prevent its development.  Lubricating ointments such as A&D, petroleum jelly, and others are effective in reducing the friction produced.  Hot spots are also frequent annoyances to basketball players and racquet enthusiasts. 

 

Powdering the foot is a useful measure in that it absorbs perspiration thereby cooling the skin.  Some runners find powder an effective means of preventing blisters although padding and insole use is usually more common.  Of course, medicated powders are also available for the prevention and treatment of various fungus (athlete’s foot) conditions.  In those cases where maceration, redness or signs of drainage are present, professional care should be immediately sought. 

       

The use of two or multi-layered socks is an interesting issue in jogging.  In principle, the extra thickness provides more cushioning and protection from pressure and friction.  In reality, I have been less than satisfied with the results and in several cases, have encountered problems with its use.  It seems common that when trying on a comfortable running shoe at the store, either a thin dress sock is being worn or a single pair of athletic socks is used. When a second pair is worn and along with the normal foot expansion during running, we often encounter excessive pressure areas and pain.  In addition, the synthetic properties of the multi-layered sock often encourage a sliding effect with associated burning sensations.  One important consideration to keep in mind regardless of the choice of sock is that any and all creases or wrinkles in the covering of the foot should be eliminated if possible.  This reduces the incidences of blister and callous formation. 

       

Thus, we see that a few short moments devoted toward an evaluation of the foot prior to a pleasurable run can indeed, be well spent.  Prevention is truly the best medicine while self understanding and management is a close second.  When these measures seem to fail or an existing condition poses a threat to one’s comfort or function, then appropriate professional care must be received.  Jogging, after all, should be healthful, pleasurable, and as free of stress as possible.   

Just as one checks out the various auto fluids prior to a trip, so too should the jogger follow certain precautions before a run.  After a while, these clearance procedures will become habit and require no thought in performing.  However, at first it is a good idea to establish some sort of a routine in evaluating the feet.  Believe me, a few short moments spent in checking out this area can be extremely well spent. 

       

Proper nail hygiene prior to jogging is absolutely essential.  Excessively long or abnormally thickened nail plates are an open invitation to injury and subsequent complications.  As opposed to most textbook sources, I recommend that the nail should be trimmed to conform to the fleshy end of the toe rather than straight across.  I find that this approach can be readily preformed and seems to reduce the incidence of problems.  Care must be exercised in not cutting the edges of the nail too far in order to to prevent ingrowns and skin infections.  It is surprising how frequently patients are seen at the office who have merely failed to trim the nails prior to a lengthy run.  The majority of these problems could well have been prevented if this simple precaution had been followed.

       

The foot should be checked for chronic pressure areas indicated usually by well-developed diffuse calluses.  A thin section of non-medicated adhesive moleskin applied to these areas for the run significantly reduces friction and relieves a good deal of discomfort.  If the calluses are punctate or deep with cores in their center, then proper podiatric care should be sought and these lesion sites reduced professionally.  There are commercial products available for the self-reduction of thin calluses following bathing and soaking.  These are usually abrasive in nature and relatively safe in use.  In no way should a cutting instrument such as a knife or razor blade be utilized to reduce the build up.  Although the procedure appears simple enough, the frequency of problems and subsequent complications indicate only too well the apparent danger.

       

Corns, or lesions on the upper or outer surfaces of the toes are often times not painful in the jogger and thus, in my estimation, require no specific preparation.  In those cases where the lesions are reddened and irritated or just painful, either prior to or during the run, I suggest protecting the site by band-aid covers or other bandage material.  A good protective covering available at most podiatric offices is that of tube foam.  When cut to size and fit, one has a removable, nylon lined foam cover, which will last quite a long time before requiring replacement. 

 

Soft corns are those painful skin lesions occurring between the toes.  Temporary comfort can be attained by the use of foam pads, cotton inserts, or band-aid covers, since any attempt at reducing pressure and friction usually affords relief.  It is recommended that these lesions receive professional care in order to prevent subsequent complications. 

       

An additional area to check for on the feet prior to jogging is what we refer to as, “hot spots.”  These are the areas where friction has produced heat with burning sensations and occasional redness.  In actuality, it is usually a precursor to blister formation and should be treated in order to prevent its development.  Lubricating ointments such as A&D, petroleum jelly, and others are effective in reducing the friction produced.  Hot spots are also frequent annoyances to basketball players and racquet enthusiasts. 

 

Powdering the foot is a useful measure in that it absorbs perspiration thereby cooling the skin.  Some runners find powder an effective means of preventing blisters although padding and insole use is usually more common.  Of course, medicated powders are also available for the prevention and treatment of various fungus (athlete’s foot) conditions.  In those cases where maceration, redness or signs of drainage are present, professional care should be immediately sought. 

       

The use of two or multi-layered socks is an interesting issue in jogging.  In principle, the extra thickness provides more cushioning and protection from pressure and friction.  In reality, I have been less than satisfied with the results and in several cases, have encountered problems with its use.  It seems common that when trying on a comfortable running shoe at the store, either a thin dress sock is being worn or a single pair of athletic socks is used. When a second pair is worn and along with the normal foot expansion during running, we often encounter excessive pressure areas and pain.  In addition, the synthetic properties of the multi-layered sock often encourage a sliding effect with associated burning sensations.  One important consideration to keep in mind regardless of the choice of sock is that any and all creases or wrinkles in the covering of the foot should be eliminated if possible.  This reduces the incidences of blister and callous formation. 

       

Thus, we see that a few short moments devoted toward an evaluation of the foot prior to a pleasurable run can indeed, be well spent.  Prevention is truly the best medicine while self understanding and management is a close second.  When these measures seem to fail or an existing condition poses a threat to one’s comfort or function, then appropriate professional care must be received.  Jogging, after all, should be healthful, pleasurable, and as free of stress as possible.   

       

In discussing the relative frequency of an injury type, actual fractures in the runner are less common than what one might expect. When they do occur, they can most often be attributed to abusive training, improper shoe protection, and/or improper foot function. Certain areas of the foot and leg tend to be more susceptible to fracture-type injuries. The most common of these include the following and appear in the order of decreasing incidence or frequency:

 

1.    The typical "stress" or "march" type of fracture is the most common fracture encountered in the runner. It usually affects the middle portion of the metatarsal shafts numbered two, three, and four. Stress fractures have a unique characteristic of being frequently missed by the attending physician. The reason is that the diagnostic x-ray signs often do not appear for ten days to two weeks after the injury. Thus, repetitive radiographs are often necessary to identify such a fracture. In addition, the runner is often times unable to distinguish an isolated incidence of injury. The presenting complaint is most often disabling pain in the forefoot area with frequent, mild to moderate swelling on the top of the foot.

 

        2.  A second fracture encountered with some frequency in the foot is at the base of the fifth metatarsal. This area, which normally protrudes and can usually be felt along the outer part of the foot is somewhat susceptible to injury. The runner so afflicted is usually unable to continue in the activity and has pinpoint tenderness in the fracture site area. In addition, swelling and discoloration often accompany the problem. Care must be taken in this injury to prevent displacement or movement of the fractured bone segment in order to prevent subsequent complications.

 

3.    In those cases involving resistive and persistent types of shin splints, we must consider the possibility of stress fractures in the tibial or fibular long bones of the leg. Repetitive x-ray studies of the leg will occasionally reveal these injuries and an adequate rest period is usually necessary for proper healing to occur. Micro-fractures due to impact shock and repetitive stress can occur in these areas and are often  extremely difficult to distinguish on x-ray.  Specialized diagnostic tests can be utilized to identify a fracture in these cases.

 

4. A final fracture site, which, although is the least frequent, is still encountered and is extremely disabling. Beneath the first metatarsal head area, you will notice two small bones referred to as sesamoids. Occasionally, the inner most one (medial or tibial sesamoid) is injured and a painful fracture results. This type of injury usually results from an acute impact or twist to the foot as opposed to repetitive stress. Continued running is out of the question until healing occurs, and in fact, regular walking with normal weight bearing is frequently quite difficult.

       

In closing, fracture injuries in runners are presented in terms of their relative frequency to one another. These injuries are often times difficult to diagnose and yet must be distinguished in order to manage properly and prevent healing complications. The runner's awareness of the probable locations and symptoms will aid in the patient’s understanding and case description to the attending specialist.



Home  About Us  Contact Us  

Compliance with HIPAA Regulations