SUN RUN Training Tips

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Selecting A Running Shoe

Running or walking shoes should be selected carefully. Factors to weigh when looking for a new shoe include:

If you have been having no problems with walking, running or racing, it would be hard to recommend a change of shoe. It is difficult, if not impossible to improve upon a situation in which all is going great. I would advise getting a few pairs of what seem to be your favourite shoes before the manufacturer changes the shoe. Historically, unannounced changes are often made by manufacturers. This can vary from a subtle change in the cushioning around the heel to a major structural midsole change. Manufacturers have sometimes discontinued a model of shoe, only to resume production a few years later with a line of shoes boasting the same name, but with completely different characteristics.

One of the best means of finding out information about running shoes is to locate a good running shoe store that maintains an excellent reputation among your local running community. They can help you not only with fit but also review desired shoe characteristics with you. They can also alert you to changes that may occur in the manufacturing of your favourite shoe. If the soles of your shoes have been wearing too quickly they might recommend another model with better wearing shoes. More likely, however, you have probably been wearing your old shoe for too long. Failing to replace worn shoes is a major cause of running & walking injuries. Estimates vary, as do individuals, as to when is the best time to replace your running shoes. The usual estimates place the mileage at somewhere between 500 and 800 kilometres. This means that many individuals should be replacing their shoes before they show major wear. In spite of the lack of wear the shoe will be gradually losing its shock absorption capacity as well as possibly starting to loose some of its stability.

Definitions:

Last:

The template or model upon which the shoe is built. Different manufacturers use different lasts.

Outer-Sole:

The outermost part of the sole, which is treaded. On running shoes the tread is designed for straight-ahead motion. Court shoes and cross trainers have their tread optimized for lateral or side-to-side activities.

Upper:

The uppermost part of the shoe. This part encompasses your foot and has the laces.

Midsole:

The portion between the upper and the outer-sole. This is the area whose major contribution to the shoe is cushioning, shock absorption and support. It is also usually quite important that the midsole be stable from the heel until the distal third of the shoe where it should be flexible at the point where your toes attach to the foot and bend.

Sock liner:

This is the liner inside the shoe that has a bit of an arch and usually some shock absorbing material incorporated into it.

Counter:

A rigid piece surrounding the heel that provides some stability.

Check Out Your Old Shoes

Examine the soles of your shoes. Note where wear has occurred. Most people seem to be amazed that their shoes wear at the rear outer corner. Most rear foot strikers will wear at this part of the shoe. The reason for this is that for most heel strikers it is the point of first contact of the shoe with the ground. Most people walk and run with their feet slightly rotated from centre. Runners, however, also have what is called a narrow base of gait. A narrow base of gait means that the feet contact close to the midline of your body. This creates additional varus (tilting in) of the limb. This results, for the rear foot striker, in the first point hitting the ground being the outer corner of your shoe. Forefoot wear may point to an individual who is a sprinter, runs fast, contacts the ground with the forefoot first or all of the above. Uneven forefoot wear may show where one metatarsal bone is lower (plantarflexed) relative to the others or where one metatarsal bone may be longer than the others. In the presence of significant forefoot wear, you are at risk of stress fractures.

Next put your shoes on the table and look from the back of the shoe to the heel. If the counter of your shoe is tilted in, or bulges over the inner part of your shoe, you might be one who excessively pronates. If this is so, you may want to look for a shoe with more stability or replace your shoe a bit sooner next time.

If your shoe tilts to the outside, you may have a high arched foot. This in some cases can lead to ankle sprains and also increased transmission of forces to the leg and back. Sometimes individuals with this type of foot may have lateral knee pain, low back pain and outer leg pain. It will probably be important to make sure that your shoe has a fair amount of shock absorption and is not excessively controlling.

Looking at the top of your shoe, you should note if you can see the outline of your toes in the upper or either your large or small toe on either side. If you do and have discomfort in these areas or have had “black toe” you should consider wider or longer shoes or both wider and longer. Sometimes a “black toe nail” can be caused from a shoe being too big or too long, so proper fit is very important.

If you have a flexible and pronated foot, you might do better with a board lasted shoe. But looking for a good counter and a sole that is rigid until the point where your toes attach is an easier empirical way to find a good shoe. This offers resistance to torsion and inhibits pronation. Slip lasted shoes are frequently good for high arched feet. Combination lasted shoes are supposed to offer the best of both worlds: stability in the rear foot and flexibility in the forefoot.

Trying On The Shoe

Go to a running shoe store that has a good reputation. Make sure you try on both shoes. Most good stores will allow you to run or walk up and down the block, outside a few times. This is the only way to experience what walking or running will feel like. You should also keep the shoe on your foot for about 10 minutes to make sure that it remains comfortable. Make sure that nothing pinches and that you like the feel of the shoe and your stride.

Once you have purchased a new and comfortable shoe, don’t put them to the test with a 10-km run or decide it is time for speed work around a track. Probably an easy 5 km run will be sufficient. Run easily in the shoe and for only a short stance during the first 100 km you spend in the shoe. Do not ever wear a brand new shoe in a marathon. You’ll be doomed to sore feet, blisters and perhaps worse. It is amazing how many people make this mistake every year, no matter how many times this simple fact is stated. Just don’t do it!

After your careful and wise selection of your brand new running shoe. Bring it home, put it on and enjoy your walking or running! Don’t forget to stop and change your shoe, before you’ve gone too far though.

Metatarsalgia (Forefoot Pain)

Metatarsalgia is pain in the forefoot, or ball of the foot, in the area of the metatarsal bones (the bones that connect to your toes). Although the pain can feel like it is across the entire ball of your foot, most often it is only under one of the metatarsal heads. You can easily find out which one by pushing up underneath each metatarsal head with a thumb or finger until you feel the one that is painful. You may also feel a callus there. Metatarsalgia may also feel like a bone bruise, or as if you are walking on a pebble.

Causes:

This is usually caused by either an alignment problem with the bones, whereby the one that is painful is generally lower than the others, or by a functional problem with the foot, whereby over-pronation causes excessive pressure on one or more of the metatarsal bones.

Treatment:

The best way to treat this condition is to reduce, or eliminate, the pressure on the affected bone(s). This can be done one of several ways: a metatarsal pad can relieve some forefoot discomfort if placed properly inside the shoe. A hole cut in the shoe insole directly under the painful metatarsal can help relieve pressure. The best alternative usually involves custom orthotics to help control the over-pronation, with or without pads, along with proper running shoes.

Prevention:

Wearing well-cushioned running shoes with soft insoles are important. Some over-the-counter insoles may be helpful.

Activity Restrictions:

You shouldn’t run if it is painful. Doing so may lead to a worse injury, such as a stress fracture.

Blisters

Blisters are the accumulation of fluid between the inner and outer layers of the skin. They are rarely a serious concern, but can become infected and more problematic if not treated correctly.

Causes:

Blisters are caused by prolonged friction between your foot, socks and shoes.

Treatment:

A blister should be opened as soon as possible. The skin layers will then stick together and allow for a speedy return to activity. If conditions permit, first swab the blister with an antiseptic solution and then prick it with a clean needle that has been heated in a flame. Drain the blister, but leave the skin. Cover the area with a bandage and antibiotic cream or ointment. You should be able to expose the dried-up blister to air again in approx. 48 hours. If blisters are excessively painful, persistent or infected see your doctor or podiatrist for treatment.

Prevention:

Dual-layer or blister-free socks will minimize friction and moisture and help keep you less susceptible to blister formation. (Breathable synthetics are excellent for keeping your feet dry). Neoprene insoles may also help reduce friction. Break in new shoes gradually, and make sure that your shoes fit your feet properly, in both length and width and are also correct from a biomechanical point of view. This is important as too much foot motion can cause friction leading to blister formation.

Activity Restrictions:

None, but let comfort be your guide.

Black Toenails

Black ToenailsA blood blister underneath the nail usually causes a black toenail. The collection of blood under the nail discolours it and in some cases can cause pressure and pain. The toenail may or may not fall off.

Causes:

A black toenail occurs when the toe becomes bruised due to repetitive bumping against the end of your shoes or sneakers. This can happen if you do a lot of downhill running or if your shoes are too small or too big. Usually, someone who has a second toe that is longer than the first toe (Morton’s foot type) is most susceptible to bruising his or her second toenail.

Treatment:

If there is pain due to the increased pressure, you need to drain the blood to remove the pressure. The sooner this is done the better. Normally it is best to have this done by your family doctor or podiatrist. However, to do it on your own, start by swabbing the toenail with alcohol. Next, take a paper clip, or another sharp narrow object, heat it in a flame, and then slowly push it through the toenail. Drain the blood and apply an antiseptic or antibiotic cream and cover with a bandage.

Prevention:

The best way to prevent black toenails is to ensure that you have proper fitting shoe gear. The toe box should be wide enough and the shoes long enough so that your toes don’t bump against the sides or end of the shoe. There should be approximately ½” (1.25 cm) between the longest toe (not necessarily the big toe) and the end of the shoe. Wearing blister-free socks might help prevent friction as well.

Activity Restrictions:

Usually symptomatic. If the toe throbs and is painful, it is best to take a few days off and let the toenail heal.

Heel Pain -Plantar Fasciitis

Plantar Fasciitis Plantar fasciitis is one of the most common complaints among active individuals. It usually begins as a tenderness or mild discomfort on the sole of the foot, in the heel or arch area. Gradually, as it progresses, it becomes more severe, and localizes usually to a spot under the heel. Most people find the discomfort is worse first thing in the morning or upon getting up after sitting or resting for a while. It often feels better after walking around for a few minutes. It will be painful after running or being very active.

Causes:

The plantar fascia is a tough ligament-like band, or sheet, of tissue that runs from your heel, through the arch area and out to the ball of the foot. This band helps try to maintain an arch to the foot. If you have “flat feet”, or if you over-pronate (feet roll in), the plantar fascia becomes strained, with most of the stress occurring at the heel.

Treatment:

You either need to reduce the amount of over-pronation, support the arch, or both. Motion-control running shoes with firmer mid-soles can often help. Over-the-counter insoles or orthotics may also provide some relief. Supportive taping by a physical therapist, podiatrist or trainer may provide temporary relief. If the pain persists seek out professional help – the sooner the better. Sometimes physical therapy, massage therapy, anti-inflammatory pills or injections are indicated. Most often though, custom orthotics fabricated by a sports medicine oriented podiatrist are the best long-term solution. The orthotics can be custom made to suit you and your level of activity. If your heel pain continues to be chronic and unresponsive to other conservative measures, you may be a good candidate for Extracorporeal Shockwave Therapy. Rarely is surgery indicated.

Prevention:

Stretching your calf muscle before and after running or exercising is often helpful. If you over-pronate wear firmer, motion-controlled sneakers.

Activity Restrictions:

It depends on the amount pf pain or discomfort. Generally, you can run with a mild case of plantar fasciitis.

Achilles Tendonitis

img01The Achilles tendon runs down the back of the leg and connects the calf muscle to the back of the heel. In can become inflamed due to overuse or inflexibility. Younger people tend to strain the Achilles just above the heel, whereas when people age the strain is felt higher up, closer to where the tendon connects to the calf. An inflamed Achilles may feel tender and stiff.

Causes:

Running or over-exertion will tighten the calf muscle. When the muscle becomes too tight, it disrupts normal foot biomechanics and the Achilles becomes strained and inflamed. Increasing your level of activity or running hills too quickly can lead to inflammation of the tendon. If this level of activity is maintained despite the pain, the inflammation can result in a partial tear of the tendon. In time, a portion of the tendon will die and the remaining, now weakened tendon can easily rupture.

Treatment:

Reduce or stop any aggravating activities. Take an anti-inflammatory, such as ibuprofen, two or three times a day. Massage the Achilles with ice several times a day. In some cases a 1 – 2 cm heel lift will reduce the tension in the tendon. If the pain persists after 10 – 14 days you should see your doctor, a sports-oriented physical therapist or podiatrist. If your Achilles tendonitis continues to be chronic and unresponsive to other conservative measures, you may be a good candidate for Extracorporeal Shockwave Therapy.

Prevention:

Since tight calf muscles and tight tendons lead to Achilles tendonitis, stretching is essential. It is best to stretch your tendon after your activity (e.g. running). This way the tendon is warm and much more receptive to a slow and gradual stretch. Never stretch to the point of pain. Consider switching to a firm, motion-control shoe in order to limit rear foot motion and over-pronation, and make certain that there isn’t any pressure or rubbing from your shoes on the Achilles tendon.

Activity Restrictions:

You do not want to run through Achilles tendonitis. Even the mildest strains can turn into a partial or complete rupture, which could lead to permanent damage.

Neuroma

NeuromaPain, numbness or tingling in the forefoot, usually between and extending into the third and fourth toes, almost always indicates a neuroma. A neuroma often hurts more when you’re wearing shoes and feels better when you take them off and massage the feet. Neuromas slowly become more painful with time if left untreated.

Causes:

A neuroma is caused by pinching or irritation of one or more nerves in the forefoot. This is usually the result of poor biomechanics and/or over-pronation. If you over-pronate, the metatarsal bones can have excessive movement which in turn can cause irritation, by a tight ligament, to the nerve which runs between the metatarsal heads. The result of this direct irritation is inflammation and pain. If a neuroma is left untreated the nerve can become chronically scarred, creating even more pain.

Treatment:

You can try using a metatarsal pad under the affected area. This should reduce some of the excessive motion of the metatarsals and hopefully reduce the pain. Exact placement of the pad is important. Custom orthotics are often used to control the over-pronation. They often incorporate a specialized metatarsal pad within them and can occasionally provide more relief. If this doesn’t work a podiatrist should be consulted to assess the degree of nerve damage. An injection may be warranted. An excellent new option is a minimally invasive nerve decompression (MIND) procedure. This is a simple in-office procedure, which provides very effective, long-term relief of the chronic pain from neuromas. As a last resort, open surgery might be indicated to remove the damaged nerve. This will solve the problem, but will lead to permanent numbness between two toes.

Prevention:

Since over-pronation is very often the culprit, switching to running shoes with more motion control should be helpful.

Activity Restrictions:

None really, but it is best to wait until the pain subsides or is treated before engaging in long runs or lengthy activities.

Sesamoiditis

Underneath the big toe joint in your foot are two small bones called sesamoid bones. These bones can become bruised, inflamed or even broken, and can make you feel as though you are walking on a rock or pebble. The pain is usually quite sharp and the area hurts whenever you touch or step on it.

Causes:

Sesamoiditis usually occurs in very (supinated) high-arched, rigid feet, which don’t pronate to absorb shock. Also, if you have a bunion, you are more prone to sesamoiditis, since as the bunion deformity progresses it can lead to more pressure on the sesamoid bones.

Treatment:

You need to relieve the pressure on these bones. This can be done several ways: Change your sneakers or running shoes from firm to softer mid-soles. You can cut a hole in the insole directly under the sesamoid bones. Custom accommodative orthotics are often used in order to treat and prevent recurrent sesamoiditis. If the sesamoid bones are broken or fractured then prolonged non-weight bearing is often needed. If the pain doesn’t respond to simple rest, see your family doctor or a podiatrist.

Prevention:

Make sure that your shoes have adequate cushioning and shock absorbing capabilities, and are not too old.

Activity Restrictions:

None really, but if the pain is too much, take a break. You shouldn’t run if it is painful. Doing so may lead to a worse injury, such as a fracture.

Ingrown Nail

Ingrown Toe NailIngrown toenails almost always occur on the big toe. They can cause significant pain, and as well have the potential for infection.

Causes:

An ingrown nail can result form a number of factors, ranging from; tight shoes, poor or improper nail care, and genetic predisposition.

Treatment:

There are two steps to treating an ingrown nail: 1) clear up any infection that might be present, 2) remove the part of the nail that is growing into the toe. Cutting the nail on your own can be very painful, and could promote infection if not done properly. Having a podiatrist do it, under local anesthesia if necessary, is the best way. Soaking the toe 2 – 3 times per day in warm salt water can help to reduce any infection. Antibiotics are rarely needed. If the condition is chronic, a podiatrist can permanently remove all, or part, of the nail root so that the ingrown toenail never recurs.

Prevention:

Cut your toe nails regularly, but cut them straight across. Never round the corners or edges. Make sure you wear shoes that have adequate width and depth, and are not too tight.

Activity Restrictions:

None. But don’t let an ingrown nail sit unattended too long. Prevention and early treatment are the best solutions. These can be painful.

Stress Fractures

Stress fractures are partial breaks, or cracks in a bone. In the feet, stress fractures usually occur in the second, third or fourth metatarsals. It will hurt to touch or squeeze the affected area. Walking or running will be painful, whereas generally there will not be pain during rest periods. There may or may not be redness and swelling. Stress fractures are always painful.

Causes:

They are usually considered an overuse injury. This can be the result of over-training, switching running surfaces (soft to hard), or wearing shoes that provide inadequate support.

Treatment:

If you suspect a stress fracture see your family doctor or a sports-oriented podiatrist. You will probably need one or both of an x-ray and a bone scan. Do not run at all for six weeks. Often crutches, and sometimes casting is needed. It takes six weeks for the bone to heal adequately. If you try to run sooner, you will only prolong the healing time, or develop a real fracture. The good news is that stress fractures usually heal without complications. Early diagnosis and proper treatment are the key.

Prevention:

Some type of overuse almost always causes stress fractures of the foot. If you notice a dull ache or sharp pain in your foot, cut back the intensity of your activity. Try to find a softer surface to run on. If you do have a stress fracture you will most likely have to alter your training in order to prevent a recurrence. Consider changing your sneaker or running shoe to one with more shock absorption.

Activity Restrictions:

You should not run with a stress fracture.

Posterior Tibial Tendonitis

The posterior tibial tendon runs behind the inside of the ankle an attaches near the middle of the foot. Posterior tibial tendonitis is an inflammation to or along this tendon due to undue strain placed upon it, usually due to excessive rolling-in (pronation) of the affected foot. The normal function of this tendon is to aid in the holding-up or support of the arch of the foot. If this tendon is not functioning properly, the foot will roll-in excessively (pronate), resulting in ‘flat feet’, and an excessive strain on this tendon. This tendon dysfunction can also lead to other conditions, such as heel pain, arch pain, or arthritis.

Causes:

Posterior tibial tendonitis is caused by years of overuse of the posterior tibial muscle, in the back of the leg, and a chronic strain of the associated tendon between the muscle and the foot bones it attaches to. Years of over-pronation can lead to posterior tibial tendon dysfunction or tendonitis. Initially the pain and swelling may be intermittent, but eventually it can progress and become consistent and in some cases disabling.

Treatment and Prevention:

There are generally two approaches to treating posterior tibial tendonitis: reduce the swelling and pain, and then control the foot long term to prevent recurrence. Treatment is usually non-surgical. This usually includes wearing a custom orthotic with the proper posting to support the rear foot and arch of the foot, in order to reduce strain on the posterior tibial tendon, and prevent excessive stretching through the bottom of the foot. The orthotic should also have some shock-absorbing qualities to it. Wearing shoes that also provide cushioning and shock absorption is helpful. Sometimes long-standing cases of posterior tibial tendonitis can result in painful arthritic conditions within the foot, and if so, surgery might be indicated as a treatment alternative.