Podiatry: London Marathon

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London Marathon

The approach of the London Marathon (has it really come around that quickly?) prompted me to look through my back copies of Runners World for this weeks article (some of you may know that I'm one of the Agony Aunts for the fitness column in this popular running magazine). Not too surprisingly, most of the queries fielded out to me were to do with foot problems and footwear. Last year there were three recurrent themes - these were:

• "My second toe is longer than my big toe."
• "I bought some expensive new shoes and I'm having blister problems that I didn't have with my old shoes."
• "I suffer from heel pain." - By far the most common problem in its various forms.

"My second toe is longer than my first toe."

Don't worry! Ancient Romans, or was it Ancient Greeks (I can never remember) considered this a sign of beauty, and it can be seen in statues of the period. It can cause problems if the foot is very mobile, or shoes are too short. If you experience bruising or pressure because of a long second toe - have your feet measured standing up. This will provide the correct measurement for your foot, which can elongate by half a size, maybe more, when you walk or run.

"I bought some new shoes and I'm having problems with blistering in the arches."

A golden rule is never to buy a more expensive shoe simply because you assume it will be better than your original, comfortable running shoes. Once you find a model which suits you - stick with it. Updating the same make and model is infinitely more sensible than jumping from one make/model to another.
In this case there are two possible scenarios:

1. The shoe is too hard and has a built-in arch support which is causing pressure under the arch at each step.
2. The runner has a very mobile foot which is flattening at each step.
   In reality the probability is a combination of factors. The solution? Ditch the shoes and go back to a new model of the previous, comfortable shoes.

As a footnote (no pun intended!) to this example, I know of several instances where something as simple as a blister on the foot was responsible for a chronic knee injury. Have you tried running 26 miles with a painful foot? Your body can, and will, accommodate to lift pressure from the blister, and its perfectly possible to strain structures in the knee while doing so.

"I suffer from heel pain."

A common, common problem, and here are two actual case histories to illustrate possible and actual causes and remedies:

1. "I have developed a heel spur. It's very painful, especially in the mornings. Running was making it worse so I've stopped." This is plantar fasciitis (go to www.ortho-pedclinic.com for a detailed explanation). There may be a bony spur on X-ray, but the pain is from the attachment of the plantar fascia into the heel bone, not the spur. See a podiatrist, who will fit foot orthoses and arrange a cortisone injection if necessary.
2. "I'm an overweight beginner who can now run three to four miles every other day at a steady pace. A few years ago I suffered with fallen arches and my GP suggested arch supports to cure the problem. Since I stopped wearing the supports the pain is back, but now in my left heel and worse after running."

This sounds like plantar fasciitis again. Fallen arches? Not a diagnosis at all in the true sense, but probably strain in the arches (where the plantar fascia lies). My feelings are that here is a runner who has aggravated his chronic plantar fasciitis (which was helped but not cured with arch supports).

The same advice applies - see a podiatrist. Hopefully, the feet can be helped without the runner losing his hard-won fitness.

Please feel free to use the enquiry form at www.ortho-pedclinic.com for all foot-health and foot-related matters.
David Holland BSc(Hons), MSc(Dunelm), MChS
Consulting Podiatrist.