March 2023

Running may seem like a simple to do. However, running is actually a complex movement that puts stress on the ligaments, bones, and joints of the body.  Selecting the correct running shoe is important for increasing performance and avoiding risk of injury.  Running shoes should be selected based on your foot type.  Considerations such as trail versus road shoes are important. Your foot type dictates the degree of cushioning, stability and motion control you require.  The most accurate way to learn your foot type is to visit a local shop that specializes in running shoes.  Professionals can measure your arch type, stride and gait and help you with your shoe needs.

The design of running shoes is created around the idea of pronation.  Pronation is the natural rolling movement of your ankle from the outside to inside when your foot strikes the ground.  If you run properly you strike the ground on the outside of your heel and roll in the direction of your big toe before pushing off once more.  Pronation is beneficial because it assists the lower half of your body in absorbing shock and storing energy.  Those considered neutral runners pronate correctly and do not need running shoes that help correct their form.  Neutral runners can choose from a wide variety of shoes, including barefoot or minimal types.  However, those who have arch problems or who adopt an incorrect form while running may experience too much or too little pronation. They may require running shoes that offer additional support.

Those who overpronate experience an over-abundance of ankle rolling.  Even while standing, those who severely overpronate display ankles that are angled inward.  It is not uncommon for them to have flat feet or curved legs.  The tendency to overpronate may cause many injuries.  Areas that tend to become injured are the knees, ankles, and Achilles tendon.  If you find that you have a tendency to overpronate, you should look at shoes that provide extra stability and motion-control.  Motion-control shoes are straight and firm. Shoes of this type do not curve at the tip.  The restricted flexibility along the middle of the shoe prohibits the foot from rolling too far inward as your foot strikes the ground.

A less common problem is underpronation.  Underpronation, also called supination, is when the feet are unable to roll inward during landing.  Those who underpronate have feet that lack flexibility and high arches.  This prevents any kind of shock absorption, even though it does place less rotational stress on ankles and knees.  This added force can cause fractures, ligament tears, and muscle strains because the legs are trying to compensate for the impact.  Those who underpronate need shoes with more cushioning and flexibility.  If you have a tendency to underpronate, selecting stability or motion-control shoes may cause you more problems by continuing to prevent pronation.

Fungal infection of the toenail, or onychomycosis, typically appears as a gradual change in a toenail’s texture and color that involves brittleness and darkening.  The fungal infection itself occurs beneath the surface of the nail.  Aside from discoloration, other symptoms include the collection of debris beneath the nail plate, white marks on the nail plate, and a foul odor emanating from the nail.  If ignored, the infection can spread into other nails and the skin; in severe cases, it can hinder one’s ability to work or walk. 

The toenails are particularly vulnerable to contracting infection in moist environments where people are likely to be walking barefoot, such as around swimming pools, public showers, and locker rooms.  Fungal infection may also be more likely to occur in nail beds that have been injured, and sufferers of chronic diseases such as diabetes, circulatory problems, or immunodeficiency conditions are particularly prone to developing fungal nails. 

Fungal nails can be primarily prevented by practicing proper hygiene and regularly examining the feet and toes.  Carefully washing the feet with soap and water and thoroughly drying the feet afterwards are essential.  Other tips include wearing shower shoes in public areas, changing shoes and socks daily, keeping toenails clipped at a short length, wearing breathable shoes that fit properly, wearing moisture-wicking socks, and disinfecting home pedicure tools and instruments used to cut nails.

Fungal nail treatment may vary between patients and the severity of the condition.  Your podiatrist may suggest a daily routine of cleansing that spans over a period of time to ease mild infections.  Over-the-counter or prescription antifungal agents may also be prescribed, including topical and/or oral medications.  Debridement, or the removal of diseased nail matter and debris, may also be performed.  In more severe cases, surgical treatment may be needed.  In some instances, the temporary removal of the fungal nail allows for the direct application of a topical antifungal to the nail bed.  In other cases, a chronically painful fungal nail that has not responded to other treatments may be permanently removed; this allows the infection to be cured and avoids the growth of a deformed nail.  

Heel pain can be difficult to deal with, especially if you do not know what the underlying cause is. If you ignore your heel pain, the pain can magnify and potentially develop into a chronic condition. Depending on the location of your heel pain, you have developed a specific condition.  

One condition is plantar fasciitis.  Plantar fasciitis is caused by the inflammation of the plantar fascia, or the band of tissue that connects the heel bone to the base of the toes. The pain from this condition is initially mild but can intensify as more steps are taken when you wake up in the morning. To treat this condition, medication will likely be necessary. Plantar fasciitis is often associated with heel spurs; both require rest and special stretching exercises.

There are various options your podiatrist may suggest for heel pain.  Treatment options for heel pain typically include non-steroidal anti-inflammatory drugs (NSAIDS), which may reduce swelling and pain. Other options are physical therapy, athletic taping, and orthotics. In severe cases of heel pain, surgery may be required.

Preventing heel pain is possible.  If you are looking to prevent heel pain from developing in the future, be sure to wear shoes that fit you properly and do not have worn down heels or soles. Be sure to warm up properly before participating in strenuous activities or sports that place a lot of a stress on the heels. If you are experiencing any form of heel pain, speak with your podiatrist to determine the underlying cause and receive the treatment you need.

Sever’s disease, also known as calcaneal apophysitis is a common bone disorder that occurs during childhood. The disease is defined as an inflammation of the growth plate in the heel. When a child has a growth spurt, his heel bone grows faster than the muscles, tendons, and ligaments in his leg. This disease is a result of overuse. The people who are most likely to be affected by this disease are children who are in a growth spurt, especially boys who are from the ages of 5 to 13 years old. 60% of children with Sever’s disease have both heels involved.

Symptoms of this disease are heel pain that intensifies during running and jumping activities. The pain is typically localized to the posterior part of the heel. Symptoms may be severe, and they can easily interfere with daily activities. Children who play soccer, baseball, and basketball are more likely to develop Sever’s disease.

Your doctor will diagnose your child based on his or her symptoms, x-rays are generally not helpful in diagnosing this disease. Your doctor may examine both heels and ask your child questions about his or her activity level in sports. Your doctor may then use the squeeze test on your child’s heel to see if there is any pain. Nevertheless, some doctors might still use x-rays to rule out any other issues such as fractures, infections, and tumors.

Sever’s disease can be prevented by maintaining good flexibility while your child is growing. Another prevention method is to wear good-quality shoes that have firm support and a shock-absorbent sole. Sever’s disease can be treated by ceasing any activity that causes heel pain. You should apply ice to the injured heel for 20 minutes 3 times a day. Additionally, orthotics should be used for children who have high arches, flat feet, or bowed legs.

If you suspect your child has Sever’s disease, you should make an appointment with your podiatrist to have his or her foot examined. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen to relieve pain. In more severe cases, your child may need a cast to rest his or her heel. Fortunately, Sever’s disease does not cause long-term foot problems. After treatment, your child should start to feel better within two weeks to two months.