Are You Ready to Train?

Are_You_Ready_to_Train_Here’s a common scenario some of you may find yourself in this spring: It’s been a few months since you last pulled on your athletic shoes and you’ve been wearing cold weather footwear that, though it keeps your feet and toes warm, is kind of constricting. There is a big annual walking or running event coming up in the not-too-distant future that you always participate in, or you’ve found a new event or long hike that you’re just dying to try. But you’ve got a nagging foot problem that started over the winter and you’re wondering if you can begin your training. If this is the situation you find yourself in, this article is for you!

The question at the heart of this discussion is this: “When is it appropriate for me to begin training in earnest for a race, walking event, or multi-day hike if I have a foot problem that is causing me pain or discomfort?” As fellow runners and walkers, we understand the urgency that comes with preparing for a big race or event, and we also understand how frustrating it is to wait out a foot problem before ramping up our training volume and intensity (or even to miss an event due to a foot injury). We’ve been there, and we sympathize with your situation. But trying to train with an existing foot problem is not an appropriate course of action, as it usually ends up compounding your problem and leading to a more deeply entrenched foot issue.

The pain or discomfort associated with plantar fasciosis (commonly mislabeled ‘plantar fasciitis’), interdigital neuromas, bunions, and other foot problems is your body’s way of telling you that something is wrong and needs to be corrected. Perhaps it’s an impediment to natural foot health that needs to be removed (think conventional footwear) or a longstanding foot or lower extremity issue that was never properly addressed. Whatever the issue, it’s important that it gets resolved before you start any serious weight-bearing exercise routine. We know this may sound unappealing, but don’t despair, as there is every reason to believe that your foot issue can be helped in a timely manner, if you allow your foot to function the way nature intended.

The answer to most common foot problems, including the ones that keep you from participating in the activities you love, is elegantly simple and universally applicable. The first step in restoring natural foot health is understanding what shoe features deform your true foot shape and alter the dynamics of your feet and toes. Heel elevation, toe spring, toe box taper, and rigid soles are all injurious design features found in most conventional footwear. Using shoes that are flat from heel to toe, flexible in the sole, and widest at the ends of your toes allows your feet and toes the freedom to act as nature planned. Many people also benefit from using our toe-spacing device, Correct Toes, to realign their toes to the splayed position commonly seen in the healthiest feet in the world—the feet of barefoot or unshod populations in Africa, Asia, and Latin America.

Many patients find that their foot pain or problem dissipates once the barriers to natural foot health are removed and proper toe alignment is restored. How quickly this occurs depends on numerous factors, however, including the tissue types involved (e.g., nerve, muscle, tendon, ligament, etc), the mobility of the involved tissues or structures, and how long you’ve been experiencing the problem. Most people will experience at least some immediate relief from performing these simple actions, with additional beneficial results occurring over several weeks, with good compliance.

Some light training may be appropriate during this initial recovery phase, as long as your foot pain or discomfort is not made worse with weight-bearing activity or does not alter your gait. Compensating for a foot injury by changing your gait can lead to problems in other parts of your body and further downtime away from your passion. If you are limping, have severe pain, or your pain increases as you walk or run, you should avoid walking, running, and hiking. Consider getting on your bike or into the pool for your workout instead.

So, are you ready to train? Regardless of your current situation (free of foot pain or currently experiencing foot problems) we encourage you to carefully consider your footwear and how it can help or hinder natural foot health. For more information about how you can restore foot health and anatomy to treat and prevent common foot health problems, we encourage you to meet with a naturally minded podiatrist or other foot care expert. You can also visit the Northwest Foot & Ankle and Correct Toes websites, which contain plenty of helpful information about how best to achieve lasting foot and toe health.

Enjoy the spring, and happy training!

Robyn Hughes, N.D. & Ray McClanahan, D.P.M.

About the Authors:

Dr. Robyn Hughes is naturopathic physician; the Director of Medical Education for Correct Toes; a foot health educator in Asheville, North Carolina; and the co-founder of NaturalFootgear.com. She is an avid cyclist, trail runner, and yoga student.

Dr. Ray McClanahan is a sports podiatrist; the founder and physician of Northwest Foot & Ankle in Portland, Oregon; and inventor of Correct Toes. He’s a former elite cross-country racer and regular participant in various running events throughout the Pacific Northwest.

Bursitis (Infracalcaneal)

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Photo credit: Organic Blog

Infracalcaneal bursitis is inflammation of a bursa—a fluid-filled sac—below your calcaneus, or heel bone. Bursae are situated in various locations throughout your body where friction between tissues commonly occurs, and these sacs are designed to help reduce this friction and prevent pain. Repetitive movements or prolonged and excessive pressure are the most common causes of bursal inflammation, though traumatic injury may also cause this painful problem. Indeed, your body sometimes creates bursal sacs in response to trauma or tissue damage. Infracalcaneal bursitis can sometimes be difficult to differentiate from plantar fasciosis—another condition that causes pain below the heel. The key difference is that infracalcaneal bursitis tends to be worse at the end of the day whereas plantar fascia pain tends to be worse in the morning, immediately upon waking.

Condition Information

Infracalcaneal bursitis can significantly affect your quality of life and your ability to perform your activities of daily living, due to pain and impaired gait. Inflammation of the bursal sac under your heel bone occurs because the bursa is abnormally stressed or strained in some way or bears excessive pressure for prolonged periods. Constant pressure and friction from footwear is a common cause of this health problem, and any treatment plan addressing infracalcaneal bursitis should include recommendations for footwear to avoid or use. Infracalcaneal bursitis may be diagnosed in several ways, including palpation, or light pressure applied to your affected area. If your heel pain has existed for an extended period, X-ray imaging studies may reveal localized calcification in your infracalcaneal bursa, though this is not always the case. MRI images are sometimes used as a diagnostic tool for this health problem, though MRI studies are considered unnecessary for diagnosis in many cases.

Causes and Symptoms

Your feet are extremely resilient and are designed to stand up to the pressures of day-to-day living. In some cases, though, foot structures may break down when subjected to chronic stress associated with prolonged periods of weight-bearing activity on concrete, asphalt, or other hard surfaces (especially when your footwear does not allow for appropriate weight distribution). Foot problems, including infracalcaneal bursitis, are often exacerbated by poorly designed footwear, and pressure, impact, and shear forces can damage your feet over time. Bursal sacs are intended to minimize this damage, but sometimes the bursa itself becomes inflamed. A rapid increase in physical activity levels or thinning of the heel’s protective fat pad are factors that may contribute to infracalcaneal bursitis. Other possible causes of infracalcaneal bursitis include blunt force trauma, acute or chronic infection, and arthritic conditions.

The following factors may increase your risk of experiencing bursitis, including infracalcaneal bursitis:

  • Participating in contact sports
  • Having a previous history of bursitis in any joint
  • Poor conditioning
  • Exposure to cold weather
  • Heel striking when running, especially in conventional running shoes with heel elevation

Common signs and symptoms associated with infracalcaneal bursitis include:

  • Pain or ache in the middle part of the underside of your heel
  • Pain or discomfort that increases with prolonged weight-bearing activities
  • Pain and swelling under the heel
  • Redness under the heel

Treatment

One of the most effective treatments for infracalcaneal bursitis is to temporarily avoid weight-bearing activities that put stress or strain on your heel bone. PRICE (protection, rest, hot/cold contrast compresses, compression, and elevation) is another good acute management technique for this foot problem. Changing your footwear is an effective long-term prevention and treatment tool for infracalcaneal bursitis. Footwear that possess a flat support base, a sufficiently wide toe box to accommodate natural toe splay, and a flexible sole are best for preventing and managing infracalcaneal bursitis. An integrated approach to this problem usually involves the use of padded socks that help reduce pressure, friction, and inflammation in your affected area. Natural anti-inflammatory agents can also be helpful in quelling inflammation, reducing pain, and improving treatment times for infracalcaneal bursitis. In rare cases, more aggressive treatment methods may be required, such as cortisone injections or surgery to drain the bursal sac.

-Dr. Ray McClanahan, DPM, Northwest Foot and Ankle