Filed under: Foot Care, Foot Care Products, Health, Sports
Recently a question about ankles was asked on an ultra email forum. Here’s an edited version.
“Rolling ankles seemed to be a weekly thing. So just wondering if there are any specifics to the alphabet drawing feet. Sitting, standing, flatfooted or pointed toes? One of these or all of the above? I have already been messing with it and: 1. I have very uncoordinated feet and 2. I can already feel a little “work-out” going on, so this is very promising! Any specifics would be much appreciated. Whatever that I can do to help my running while at the office is a major victory!”
Most athletes know the importance of strong ankles. Whether a runner, adventure racer, triathlete, hikers, or walker, you’ll benefit from making your ankles stronger. I responded with some basic advice.
“I’d suggest a wobble board or balance board. The best ones are round. They have a rounded ball on the bottom and when you stand on them, you are forced to work your ankles as you try to keep you balance. They are very good at strengthening ankles. Keep one at home and the office. You can always alternate standing on one foot with your eyes closed and arms out. Depending on your sense of balance, that works the ankles too.”
The reference to the alphabet in the question is about using your toes and feet to write the letters of the alphabet. The motion of the writing the letters works the ankle. It’s a very effective exercise.
I also like the simple and no-cost method of working your ankles by standing on one foot, arms out to the side, and then closing your eyes. This is harder than it sounds but is also effective at strengthening your ankles.
FitterFirst has a great line of wobble boards. Here is some text from a wobble board page on their website.
Regardless of your age or ability, daily use of a balance board or wobble board is an asset to your fitness, health and well-being. Our Professional series wobble boards are made of a durable 3/4″ Baltic Birch and feature our patented Tri-Level adjustment system, which allows for a quick and easy change to any of the three difficulty levels. Simply spin the sphere and select which setting suits your balance ability and in seconds you can be working towards better S.A.M. (Stability, Agility, and Mobility). A patented dual level fulcrum allows the board to adjust from basic to advanced with a simple twist of the wrist. Try our wobble boards for daily balance maintenance at the office, while talking on the phone, or while watching television.
You will experience:
- Improved balance & coordination
- Heightened sense of body awareness
- Increased core strength & stability
Athletes who are out in cold and wet conditions need to be watchful for frostbite.
Frostbite occurs when tissue actually freezes. Toes are particularly susceptible to this serious condition. Factors that contribute to frostbite include exposure to wind, wet skin (even from sweat), and tight socks and shoes that constrict blood flow.
Early signs of frostbite include numbness, a waxy or pale discoloration of the skin, the tissue becoming firm to the touch, and pain in the area. As the frostbite progresses, the skin gets paler and the pain ceases. Often frostbite will thaw on its own as the person keeps moving or gets into a warm environment and out of the wind, wet, and cold. As the tissue warms, there can be redness, itching, and swelling.
In severe cases of frostbite, the skin becomes immobile as it freezes with underlying tissue. Blisters can form with clear or milky fluid. Blisters filled with blood indicate deeper damage. While the skin may change color, or even darken, do not assume you will lose the toes. It may take weeks or months to know if amputation is necessary. Check with your physician as soon as possible to determine what care is necessary.
Be aware of moisture inside your shoes and socks in extreme cold conditions. Sweat and outside moisture can change to ice inside your socks, leading to frostbite.
Tips for Managing Frostbite
- Do not rub your toes to warm them—that causes even more tissue damage.
- Do not rub the frostbitten area.
- Unless absolutely necessary, don’t walk on frostbitten feet or toes.
- Get into a warm environment as soon as possible.
- Immerse the affected area in lukewarm—not hot—water, or warm the affected area with the body heat from another person.
- Do not use a heating pad, heat lamp, or the heat of a stove, fireplace, or radiator for warming.
- Do not rewarm or thaw frostbite unless you are sure you can keep the area warm. It is important to remember that thawing the tissue and then allowing it to refreeze can be devastating. Get professional medical help if possible.
- Dehydration will make you more susceptible to frostbite.
In choosing footwear, fit is everything. You may buy a new pair of shoes, not get a good fit, and use them for short runs or races without much problem. But the longer you’ll be wearing them at a time, the more important the fit.
Here’s a trick to help get ensure a good fit.
Rich Schick, a physician’s assistant and ultrarunner, shared that he believes the key to getting the proper size shoe is the insert – often called insoles. “If the foot does not fit the insert, then the shoe will have to stretch to accommodate the difference or there may be excessive room in the shoe, which can lead to blisters and other foot problems.” He thinks there is too much confusion about straight lasts, curved lasts, semicurved lasts, and so on.
Rick suggests, and I agree, that you don’t need to know any of this if you use the insert to fit your shoes. The same holds true for the proper width of shoe. Simply remove the insert from the shoe and place your heel in the depression made for the heel (in the insert). There should be an inch to an inch and a half from the tip of your longest toe to the tip of the insert. None of your toes or any part of the foot should lap over the sides of the insert. If they do, is it because the insert is too narrow or is it because of a curved foot and straight insert or vice versa? The foot should not be more than about a quarter inch from the edges of the insert either. This includes the area around the heel, or the shoe may be too loose. Check to see if the arch of the insert fits in the arch of your foot. Finally, if all the above criteria are met, then try on the shoe. The only remaining pitfalls are tight toeboxes and seams or uppers that rub.
Remember to take into a account the type and thickness of socks you’ll be wearing. If you are going to replace the stock inserts that come with the shoes, make sure to follow this tip.
A new study conducted by researchers at Saarland University Medical Center in Germany focused on patients suffering from chronic bone heel spurs. The study showed that radiation therapy provided relief.
With millions of American suffering from heel pain, commonly often diagnosed as plantar fasciitis, this could be a new form of treatment. Plantar fasciitis is a common problem for athletes – with some dealing with it for years and others never beating it.
Plantar fasciitis (PF) is best described as an inflammation of the thick tissue on the bottom of the foot running from the heel to the toes. Those with a severe case of PF often experience extreme pain and it often compromises their ability to walk and stand. It is often most problematic in the morning.
The Saarland study looked at 62 patients followed for one year. Twenty-nine received a standard dose ot radiation therapy, and 33 received a low dose. The radiation therapy used was external bean radiation that delivers radiation only at a specific part of the body.
The patients receiving the standard radiation dose found pain relief to be “highly significantly superior” and of the 29 patients receiving this dose, 80% had complete pain relief. The pain relief continued or improved for as long as 48 weeks after their treatment.
Dr. Marcus Niewald, a radiation oncologist at Saarland said that, “Radiation therapy has been used for its anti-inflammatory effect for more than 60 years.” Researchers are, “… extremely encouraged by the results of the study because evidence of improved quality of life for patients in clearly evident with the standard radiation dose.”
The study also found no acute side effect or long-term toxicity from the radiation therapy.
The study was published in the International Journal of Radiation Oncology.
If you suffer from chronic plantar fasciitis, ask your podiatrist or doctor to research this study and see if it could be beneficial for you.
I have always liked the prose “Foot Fetish” that Lisa BUtler, an ultrarunner, wrote about feet. I have included it at the front of each edition of Fixing Your Feet since the 3rd edition. It’s short, but relevant to those of us who love sports. Here’s what Lisa wrote:
My feet are runner’s feet;
a little rough around the edges,
with black nails on the toes where I have nails at all
Lovingly decorated with bright colors.
My toes are warriors, of a sort.
They carry the entire continent of my body on adventures
and rise to challenges that could crush them.
Some days they are worn and calloused,
but they are strong and fierce adversaries for the
rocks they overtake.
My arches are the springboard of my soul.
They give me lift with every step I take
and cushion all my landings.
They are always ready
when I want to jump for joy.
My heels respond when the shepherd
of my spirit nips at them to run.
They strike again and again,
to thwart frustration,
to redeem the day.
My feet are runner’s feet;
a little rough around the edges,
but they are strong
and they are willing
and oh, I love them.
~ Lisa Butler, Ultrarunner
In August I worked the Gold Rush Adventure Race in the California Sierras. Throughout the race I worked at three checkpoints. As racers needed foot care, I carried my lounge chair and foot care box to where their team was set up and did what I could.
Most racers had hot spots, blisters and sore feet. A lot of times, athletes tell me that have blisters and yet, after cleaning their feet, none are visible. They may have a very sore spot or a hot spot, but there is no blister. Sometimes I can tape over the area or place a Spenco patch to provide a bit of cushioning. I often add an Engo Blister Prevention Patch to their insole underneath the tender area on their foot.
A lot of the racers needed blister care and taping. My whole aim when patching feet is to get the racers back in the race. I do what I can to drain and patch blisters on any part of the foot.
One of the racers came into checkpoint where they were transitioning from bikes to foot. At this point, they had been on their feet for almost two days. They started with a long paddle, followed with a long bushwack up a canyon, and then a really long bike section. The team was near the end of pack. The four members sat and discussed their options and whether to continue. The next section was a long trek of about 36 miles.
The racer needing foot care took off his shoes. As he sat back in my lounge chair, I removed his socks. His heels were fine, however he had major problems with blisters at the ball of the foot where the toes started. Both feet were the same. I cleaned his feet and did an evaluation.
I wish I had taken a few pictures of his feet but I was too involved in getting his feet patched so the team could continue. At the base of each toe were blisters. Many extended to several toes. Some of the blisters extended up between the toes. The majority had blood in the fluid. There were blisters at the base of the toes from one side of the foot to the other side – on both feet. His feet were swollen so the blistered skin was stretched tight from the fluid. In addition, several of the toes had blisters on the bottoms or sides, several with blood inside.
The blood in the blisters was my major concern and that there were so many of them. I usually drain blood blisters and with clean skin and a dab of antibiotic ointment – in a 24-hour race, I’m comfortable doing that. I always ask the person if they are up to date with their Tetanus shots and give them instructions about infections.
I talked to the racer and gave him my honest opinion – that he not continue in the race. We talked and I gave him my reasons. The next section was about 36 hard miles of cross-country trekking. His feet would get wet, and this would soften the skin and lead to further skin breakdown. The blisters were in a hard area to patch and it would especially be one long patch at the base of all his toes. The swollen condition of his feet was not going to get any better. And most important, the blood in so many blisters, even with the blisters lanced and patch, would increase the chances of an infection. Plus, if his feet took a beating during the trek, the blisters would become a huge open unpatchable mess (for lack of a better term). And of course, his feet would hurt badly.
He took my advice and I wrapped his feet as shown in the photo.
I think I can count on my fingers how many times I have advised racers to stop because of foot problems. Sometimes your feet simply quit. They have had enough.
Could this have been prevented? Based on my experience, I have to say, probably. Changing socks, treating hot spots, earlier blister care, better socks, moisture controlling lubricants, airing feet at checkpoints, and better shoe fit. In a team event, such as adventure races, every member of the team must help the other members with foot care. Every team member must be honest with their teammates about the condition of their feet. In solo races where athletes are racing alone, they need to be constantly aware of their feet. And where there are crews, these important people must ask questions about the condition of the athlete’s feet.
There are no guarantees in a race of any length. Our feet propel us forward, but every so often, out feet quit.
Ball of the foot blisters are quite common. Often they are more common when runners change to walking. Let take a look at these blisters.
Challenges with Ball of the Foot Blisters
There are three problems with ball of the foot blisters that make them more problematic than blisters elsewhere on the foot. Look at the image and you’ll see the large amount of area it covers. And yes, there’s blood in the blister section between the big and first toe.
- They often extend up into the skin between one of more toes
- They can spread out to cover a large area side-to-side and further down to the mid-foot
- They can easily tear at the front most area at the base of the toes
Preventing Ball of the Foot Blisters
I have learned several things about preventing ball of the foot blisters
- Keep your feet as dry as possible.
- Pre-tape if you are prone to these blisters
- Check your insoles for rough surfaces and change to a smoother insole
- Make sure your shoes fit and you don’t have a lot of movement of the forefoot inside the shoe
Patching Ball of the Foot Blisters
- Drain any blister, with a slit cut where ongoing foot pressure during the foot strike will expel extra fluid out
- Patch the blister with your favorite product and tape
- Apply tape from up one side of the foot to up the other side – not too high but over the edge
- Use one or more strips to cover the problem area
- Cut a figure 8 out of a piece of tape and apply it first to the forward edge of the tape between two of the toes, and pull it between the toes, securing it on the top of the foot.
The larger these blisters, the harder they are to patch. Try to patch them before they grow into monster blisters.
Here’s a link to a page on FixingYourFeet.com about Taping for Blisters.
These photos are courtesy of Ron Jones and were taken as I patched a runner’s feet at Badwater.
Lisa de Speville, a journalist and adventure racer from Johannesburg, South Africa signs her emails, “It’s not just about sport. It’s about passion.” I met Lisa at the Primal Quest Expedition Adventure Race in Washington state years ago and we have kept in touch since. This past summer she ran the Trans Rockies Race, a multi-day race through the Colorado Rockies. One day on her blog she shared this picture. There was some sort of contest and this was her photo entry. Yes, it’s her foot. So for today, here is a photo that should make you smile. Thanks for the photo Lisa. I love it.
I’ll be back in a few days with the promised piece on 2nd Skin, I apologize for the delay. Busy life and busy at work.
There is a toe skill that I admire. Less you think I am kidding, I assure you that this is for real. If you are normal, you have already skimmed this post and looked at the photo.
Let me explain. Time after time, when I am patching feet, I ask the athlete to spread his or her toes. Usually this is when I am applying a figure eight patch between the toes, which I use to anchor a tape patch on the forefoot at the base of the toes. It is also important when trying to clean the skin or lance a blister between the toes. Yes, I consider this a toe skill – spreading your toes.
Sound easy? Try it and see how far you can spread your toes.
Truth be told, I have found few people that can really spread their toes. The toes in the photo belong to my granddaughter, Alyssa. Aren’t they great? See how far she can spread her toes? I love it.
When you are sitting around, reading, watching TV or a movie, taking in the sun, work on learning how to spread your toes. It really does help those of us who work on your feet.