Ingrown Toe Nail (Onychocryptosis)
What is an ingrown toenail:
An ingrown toenail (onychocryptosis) occurs when part of the nail penetrates the skin, which can often result in an infection. The ingrown nail can also apply pressure in the nail fold area without penetrating the skin - this is not technically an ingrown toe nail, but can also be painful (a corn/callus is also common down the side of the nail and is a reaction to this pressure, rather than the nail actually penetrating the skin).
What does an ingrown toe nail look like:
Usually the side of the nail penetrates deep and it is difficult to see the edge of the nail. The severity of appearance of the nail will vary. Some will just have a nail that appears deeply embedded down the side or sides of the nail. In some the corner or a small spike of nail may penetrate the skin, just like a knife. This can result in an infection and the development of proud flesh (granulation tissue). The toe will then be red, inflamed and painful.
What are the symptoms of in ingrown toenail:
Pain is the main symptom of an ingrown toe nail - usually just starting as some minor discomfort. This may be just the pressure from the side of the nail or it may be because the nail has actually penetrated the skin down the side of the nail. The toe is not necessarily infected, but this can develop after the nail penetrate the skin to become ingrown. The infection can spread, making the toe red and inflamed (paronychia). A collection of pus may also develop.
What causes an ingrown nail:
Poor cutting of the nail is most commonly blamed as being the cause of an ingrown toe nail, but this is not necessarily the case. The following factors are involved in the cause of ingrown toenails (onychocryptosis): the primary risk factor is the shape of the nail - a nail that is more curved from side to side rather than being flat is more likely to become an ingrown nail (incurvated nails). Some nails go down the side into the nail fold area for a relatively large distance. A large portion of the nail is almost vertical rather than being horizontal. The most severe of these types of nail is called a 'pincer nail' in which both side of the nail are very curved. The shape of the nail is usually inherited (congenital), but it can be influenced by trauma and/or shoe pressure. poor cutting of these types of nails can leave a sharp corner (or if worse, a small spike) that will initially cause symptoms by putting pressure on the skin and then later penetrate the skin. Trimming too far down the sides is a common cause of an ingrown toe nail. footwear that is tighter is more likely to increase pressure between the skin in the nail fold and nail, increasing the risk on an ingrown nail. previous trauma to the nail may alter the shape of the nail, making it more prone to becoming an ingrown nail pressure from the toe next to the nail that has ingrown can sometime be a factor a 'chubby' or fleshy toe is more likely to have a nail grow into it. Those whose feet swell are a lot are more prone to having this happen.
Self treatment of the ingrown nail:
The cornerstone of self treatment and prevention of ingrown toe nails involves cutting the nail straight across to allow the corners to protrude, so that they do not penetrate the skin. Cut the toe nails straight across without tapering the corners. However, this can be difficult if the nail is very curved down the side. In this case DO NOT 'dig' down the sides - seek professional help for this (see below). It is a myth that a V should be cut in the end of the nail to treat an ingrown toe nail. The apparent reasoning behind this is that if you cut a V in the nail, the edge of the nail will grow together as the nail grows out. This does not happen - the shape of the nail is determined by the growing area at the base of the toe, not the end. Avoid wearing shoes and socks that are too tight. Keep feet clean to prevent the ingrown nail from becoming infected. Those with poor circulation or diabetes should not do any self management of ingrown toenails but see a Podiatrist.
Podiatric treatment of the ingrown nail:
Initial treatment of the ingrown nail (onychocryptosis): Antibiotics are often used to treat the infected ingrown toenail, but don't forget that the cause of the infected (the ingrown nail) is still there, so there is not a lot of point in treating the infection while the cause remains. Sometimes antibiotics are used to help the infection clear after the nail has been removed. A skilled Podiatrist can easily remove the corner or spike that has penetrated the skin, often with relatively little discomfort. If the ingrown nail is too painful, a local anesthetic may be needed to do this. Don't forget that unless the offending piece of nail that is causing the ingrown toe nail is removed, the infection is likely to persist. After this some antiseptic dressing for a few days is all that is needed to clear up the infection, especially if you are healthy and have no healing problems. Antibiotics and/or prolonged period of dressings are needed, especially if there is a problem with wound healing or if the circulation is poor or if you have diabetes. Occasionally, after the above treatment if the pain persist - this may be due to there being another spike of nail deeper down causing the ingrown toenail. Ongoing treatment of the ingrown toenail (onychocryptosis): Ingrown toe nails have a great tendency to happen again. They happen in the first place because of a number of reasons - the most common of those reasons is the shape to the nail. Generally, this is if the nail is curved down the side. With good self treatment (see above), it may be possible to prevent it reoccurring. Regular treatment by a Podiatrist can often be needed, as a conservative approach to prevent the nail becoming a problem is can be recommended. Surgical treatment of the ingrown toe nail (onychocryptosis): if the ingrown nail is severe, or if conservative care is difficult, or if the ingrown toenail does not respond well to conservative care, then minor surgical intervention is a good option. Minor surgery is a relatively simple procedure and is very successful for long term relief that is permanent. a number of different minor surgical procedures can be used by a Podiatrist to treat an ingrown toe nail. Almost all of these are done in the office under a local anesthetic. the most common procedure is the removal of a portion of the nail down the side of the nail that is causing the problem. In the worst case of a total nail which is curved, it may be necessary to remove the entire nail. After a nail or part of the nail is removed, it will grow back as the growing cells at the base of the nail are still there, unless something is done to remove them. Most commonly an acid is used to destroy the growing cells to prevent regrowth. Other options to prevent it growing back include, surgically debriding the growing area or using a laser. For some reason a few percent do reoccur. Generally, after the surgery you will need to keep your foot elevated for a few hours and rest is advisable. The following day, you can return to work or school. It is advisable not to take part in vigorous activities, such as running for 2 weeks after the surgery. The use of an open toe shoe, so that there is no pressure on the area also facilitates healing.

Plantar Warts

Treatment Overview

Not all warts need to be treated. They generally go away on their own within months or years. This may be because, with time, your immune system is able to destroy the human papillomavirus that causes warts.

You may decide to treat a wart if it is:

• Painful.
• Embarrassing.
• Easily irritated.
• Growing or spreading to other parts of your body or to other people.

The goal of wart treatment is to destroy or remove the wart without creating scar tissue, which can be more painful than the wart itself. How a wart is treated depends on the type of wart, its location, and its symptoms. Also important is your willingness to follow a weeks- or months-long course of treatment.

SOURCE:

Healthwise

Plantar Warts 

Warts are a result of the most common viral infection of the skin.  Plantar warts grow on the plantar surface, or the sole, of the foot. They can be found anywhere in this area but tend to produce symptoms in areas of pressure and friction. The virus that causes warts, the human papillomavirus, infects only the superficial layer of skin, producing a thickened callus-like growth that, if located in an areas subjected to pressure, can become quite tender.

Although warts characteristically resolve spontaneously, it may become necessary to treat warts that negatively affect an individual's ability to walk. The incubation period (the period of time between infection and the production of the visible skin lesion) is unknown but has been estimated to vary from months to years. Historical evidence is of little benefit in attempting to determine how one's wart was acquired. There are at least 120 different types of human papillomavirus (HPV), and only certain types are responsible for skin warts. Certain virus types tend to infect specific anatomical areas, like the plantar surface of the foot.  Warts are ubiquitous infections, with least one-half of adults infected during their lifetime. The current prevalence of plantar warts in adults is unknown, but it is a fraction of the estimated 7%-10% of adults with all types of wart infections.

• Plantar warts are seen in all age groups, but they are most common among children 12-16 years of age and rare in the elderly.
• Risk factors for the development of plantar warts include
• Use of public showers
• Skin trauma
• Weakened immune system because of certain medications used or illness.
• For more information regarding plantar warts or to schedule an appointment please call our office @ (302) 623-4250!!!!!

The Diabetic Foot

Learn about products that provide immediate pain relief for the Diabetic Foot.

Definition

Diabetes is a serious disease that can develop from lack of insulin production in the body or due to the inability of the body's insulin to perform its normal everyday functions. Insulin is a substance produced by the pancreas gland that helps process the food we eat and turn it into energy.

Diabetes affects approximately 16 million Americans and is classified into 2 different types: Type 1 and Type 2. Type 1 is usually associated with juvenile diabetes and is often linked to heredity. Type 2, commonly referred to as adult onset diabetes, is characterized by elevated blood sugars, often in people who are overweight or have not attended to their diet properly.

Many complications can be associated with diabetes. Diabetes disrupts the vascular system, affecting many areas of the body such as the eyes, kidneys, legs, and feet. People with diabetes should pay special attention to their feet.

Neuropathy

Of the sixteen million Americans with diabetes, 25% will develop foot problems related to the disease. Diabetic foot conditions develop from a combination of causes including poor circulation and neuropathy. Diabetic Neuropathy can cause insensitivity or a loss of ability to feel pain, heat, and cold. Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores that they may not be aware of due to the insensitivity. If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation. Neuropathy can also cause deformities such as Bunions, Hammer Toes, and Charcot Feet.

It is very important for diabetics to take the necessary precautions to prevent all foot related injuries. Due to the consequences of neuropathy, daily observation of the feet is critical. When a diabetic patient takes the necessary preventative footcare measures, he or she reduces the risks of serious foot conditions.

Poor Circulation

Diabetes often leads to peripheral vascular disease that inhibits a person's blood circulation. With this condition, there is a narrowing of the arteries that frequently leads to significantly decreased circulation in the lower part of the legs and the feet. Poor circulation contributes to diabetic foot problems by reducing the amount of oxygen and nutrition supplied to the skin and other tissue, causing injuries to heal poorly. Poor circulation can also lead to swelling and dryness of the foot. Preventing foot complications is more critical for the diabetic patient because poor circulation impairs the healing process and can lead to ulcers, infection, and other serious foot conditions.

Treatment and Prevention

Footwear and orthotics play an important role in diabetic footcare. Orthotics designed with Plastazote� foam, the #1 material for protecting the insensitive diabetic foot, are usually recommended. Plastazote is a material designed to accommodate pressure �hot spots� by conforming to heat and pressure. By customizing to the foot, Plastazote provides the comfort and protection needed in diabetic footcare. Footwear constructed with Plastazote is also recommended frequently for the diabetic patient. Diabetic footwear should also provide the following protective benefits:

• High, wide toe box (high and wide space in the toe area)
• Removable insoles for fitting flexibility and the option to insert orthotics if necessary.
• Rocker Soles designed to reduce pressure in the areas of the foot most susceptible to pain, most notably the ball-of-the-foot.
• Firm Heel Counters for support and stability.

If you are a diabetic, you should be particularly alert to any problems you may be having with your feet. It is very important for diabetics with neuropathy to take necessary precautions to prevent injury and keep their feet healthy. If you have diabetes and are experiencing a foot problem, immediately consult your foot doctor.

Footcare & Diabetes

Proper footcare is especially critical for diabetics because they are prone to foot problems such as:

• Loss of feeling in their feet
• Changes in the shape of their feet
• Foot ulcers or sores that do not heal

Simple daily footcare can prevent serious problems. According to the National Institute of Health, the following simple everyday steps will help prevent serious complications from diabetes:

1. Take Care of Your Diabetes
   Make healthy lifestyle choices to keep your blood sugar close to normal. Work with your health care team to create a diabetes plan that fits your lifestyle characteristics.
2. Check Your Feet Every Day
   You may have foot problems that you may not be aware of. Check your feet for cuts, sores, red spots, swelling, or infected toenails. Checking your feet should become part of your daily routine. If you have trouble bending over to see your feet, use a plastic mirror to help. You can also ask a family member to help you. Important Reminder: Be sure to call your Podiatrist immediately if a cut, sore, blister, or bruise on your foot does not heal after one day.
3. Wash Your Feet Every Day
   Wash your feet in warm, NOT HOT, water. Do not soak your feet because your skin will get dry. Before bathing or showering, test the water to make sure it is not too hot. You should use a thermometer or your elbow. Dry your feet well. Be sure to dry between your toes. Use talcum powder to keep the skin dry between the toes.
4. Keep the Skin Soft and Smooth
   Rub a thin coat of skin lotion or cream on the tops and bottoms of the feet. Do not put lotion between your toes, because this might cause infection.
5. Wear Shoes and Socks At All Times
   Wear shoes and socks at all times. Do not walk barefoot, not even indoors. It is extremely easy to step on something and hurt your feet. Always wear seamless socks, stockings, and nylons with your shoes to help avoid the possibility of blisters and sores developing. Be sure to choose seamless socks that are made of materials that wick moisture away from your feet and absorb shock and shear. Socks made of these materials help keep your feet dry. Always check the insides of your shoes before putting them on. Make sure the lining is smooth and there are no foreign objects in the shoe, such as pebbles. Wear shoes that fit well and protect your feet.
6. Protect Your Feet From Hot and Cold
   Always wear shoes at the beach or on hot pavement. Put sunscreen on the tops of your feet for protection from the sun. Keep your feet away from radiators or open fires. DO NOT use hot water bottle or heating pads on your feet. If your feet are cold, wear seamless socks at night. Lined boots are good to keep your feet warm in the winter. Choose socks carefully. DO NOT wear socks with seams or bumpy areas. Choose padded socks to protect your feet and make walking more comfortable. In cold weather, check your feet often to keep your feet warm avoid frostbite.
7. Keep the Blood Flowing to Your Feet
   Put your feet up when you are sitting. Wiggle your toes for 5 minutes, 2 or 3 times a day. Move your ankles up and down and in and out to improve blood flow in your feet and legs.
   • DO NOT cross your legs for long periods of time.
   • DO NOT wear tight socks, elastic, or rubber bands, or garters around your legs.
   • DO NOT wear restrictive footwear or foot products. Foot products that can cut off circulation to the feet, such as products with elastic, should not be worn by diabetics.
   • DO NOT smoke. Smoking reduces blood flow to your feet. If you have high blood pressure or high cholesterol, work with your health care team to lower it.
8. Be More Active
   Ask your doctor to plan an exercise program that is right for you. Walking, dancing, swimming, and bicycling are good forms of exercise that are easy on the feet. Avoid all activities that are hard on the feet, such as running and jumping. Always include a short warm-up or cool-down period. Wear protective walking or athletic shoes that fit well and offer good support.
9. Communicate With Your Podiatrist
   Ask your Podiatrist to check the sense of feeling and pulses in your feet at least once a year. Ask your Podiatrist to tell you immediately if you have serious foot problems. Ask your Podiatrist for proper footcare tips. 

What causes Swollen Feet?

Swelling occurs in a condition where the ankles, lower legs and feet muscles have an excessive buildup of a fluid. Swelling can be simply defined as the situation in which thickness of the skin increases due to some systematic symptoms. It occurs as a result of some systematic conditions such as injuries, infections, fracture, diseases of joints etc. for example; arthritis. Swelling may also lead to an increase in the body weight in a short period of time.
The problem of swollen feet and legs medically is known as ‘Edema’. Problem of Swelling generally occurs in warm summer months. One possible reason for this can be continuous standing and walking for long hours. Persistent or excessive swelling may causes damage to the skin if proper medical treatment is not taken. It should not be taken lightly because excessive swelling may cause skin ulcerations.
Pregnancy may also be one of the reasons for the swelling of feet and lower legs. In fact swelling of feet and lower legs is quite common during pregnancy. But during pregnancy, water pills should not be used as treatment for swelling because it can be harmful for the health of mother and child. Swelling tends to resolve automatically after the birth of child. Sometimes, it may take few weeks for recovering. One thing must be kept in mind that sometimes excess of swelling may result into lot of urine output. Swimming is the best treatment for the pregnant ladies as the water pressure on the skin, forces the tissue fluid back into the veins which helps in recovering from swelling.

What Causes Swelling?
• Lack of nutrients, Having a poor diet, high in salt and carbohydrates
• Pregnancy
• Sodium Retention
• Muscle Injury and joint infections
• Allergic Reactions
• Trauma
• Drug Abuse
• Heart, Liver and Kidney Failure
• Fracture
• Mental Strain
• Less Blood Pressure – If the circulation of blood is slower than normal, it may result to swollen feet.
• Medications – swollen legs can also be caused by some of the medications such as birth control pills, steroids etc.

Excess Swelling can result into:
• High Blood Pressure
• Headaches and Strains
• Increased Urination
• Swollen hands and wrists
• Weight gain
• Feet Stiffness and pain
• Discomfort in walking

What Measures should be taken to Reduce Swelling?
• Eat less spicy food because it contributes to the fluid retention.
• Drink plenty of water
• Use support stockings as it promote blood circulation and limit the movement of fluid. Almost each drug store or medical shops carry these stockings.
• Do exercise regularly as it improves the circulation of blood.
• Avoid standing and walking for long period of time.
• Avoid continuous sitting for hours and keep your muscles active with help of suitable exercises.
• Review your medication with your doctors.
• Wear proper fitting of shoes and socks.
• Try to reduce excess weight.
• Mediation is also helpful in recovering.

Shockwave Therapy for Plantar Fascitis!!!

Shockwave Therapy for Plantar Fascitis!

Plantar fasciitis is a very painful condition where your heel may hurt, feel hot or swell. The pain is a result of inflammation or microscopic tears of the plantar fascia. The fascia is a thin layer of tough tissue supporting the arch of the foot.

Sometimes people refer to plantar fasciitis as “heel spurs,” but this is not generally accurate, since the heel spurs are a result of plantar fasciitis. Heel spurs are a calcification which forms due to the damage to the fascia.

Often when you have plantar fasciitis, the pain is at its most intense when you first get out of bed. Sometimes it is noticeable at the beginning of an activity and then gets better as the body warms up. Prolonged standing may cause pain, as well.

Severe plantar fasciitis pain can cause loss of time from work and
may lead to partial or total disability. Common surgical procedures used for the treatment of chronic plantar fasciitis may also lead to permanent disability.

The effects of Shockwave Therapy are best documented in areas of changes in tissue density, such as those where a tendon attaches to a bone (enthesiopathies) and where a bone attaches to a ligament (desmopathies). For this reason, it is very effective for painful connective tissue in the heels. Additionally, ESWT gives new hope by relieving pain, eliminating the risk factors associated with surgery and allowing people to resume their normal lives.

You may have plantar fasciitis if you experience:

• Foot pain that is very intense in the morning.
• Foot pain that gets sore after sitting.
• Foot pain that keeps you from doing the things you love.
• Burning in the sole of the foot near the heel.
• Tired, achy feet.
• Heel spurs.
• Heel pain after starting a new running, walking or
  exercise routine.
• Pain when you press the site where the fascia meets the
  heel bone.

 Please call our office @ (302) 623-4250 to schedule your appointment for Shockwave Therapy!!!

Runner's Common Foot Ailments!

With each of your feet pounding the ground some 800 times per mile, it's no wonder that they feel the occasional pang. Come here to diagnose and treat foot injury, including plantar fasciitis, heel spurs, flat feet and stress fractures.

It goes without saying that your feet take the brunt of the punishment on your run.   Each one pounds the ground some 800 times per mile. Any structural flaws in your feet or slight imbalances in your stride will eventually result in an ache here or there. Shoes that fit properly and are well matched to your foot structure are crucial, and many of the injuries described below are the result of simply wearing the wrong shoe.

General

> Blisters

> Corns

 

Toes and the front of the foot

> Black toenail

> Thick toenail

> Soreness under the ball of the big toe

> Bunions

> Hammer Toes

> Pain under your three smallest toes

> Neuromas (burning between the toes)

 

Body of the foot

> Metatarsal stress fracture

> Pain on top of the foot

 

Arch and heel

> Plantar fasciitis

> Heel spurs

> Flat feet

> Pain in the bottom and back of heel

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General

Blisters

Likely causes:
Blisters are caused by rubbing and irritation of the skin. Your shoes are almost certainly the culprit -- they either don't fit properly, or you have run too far in them without breaking them in adequately.

Remedy:
If the blister isn't causing any pain, leave it alone. But if it's interfering with your running, you should feel free to "operate" as long as you're careful to avoid infection. Sterilize a razor blade (boil it for 10 minutes), wash the area of the blister (preferably using an antiseptic like alcohol or Betadine), and make a small slit in the blister. Don't be squeamish -- because the skin of the blister "bubble" is dead, you won't feel any pain. Press the fluid out. Carefully clean the area, again using an antiseptic. Let the blister dry, without putting on any ointment, and cover the blister with gauze or a Band-Aid. Problem solved.

To avoid blisters in the future, there are four things you might do. First, make sure that your shoes fit. They should be snug so that your foot does not rattle around inside, rubbing against the shoe and causing blisters. Make sure that you have laced your shoes tightly enough that they form to your foot. They should not, however, be too tight -- particularly not too narrow or too short.

Second, some manufacturers, such as Thorlo, sell "blister-proof" socks. Give these socks a try, and in general keep in mind that nylon socks tend to be more abrasive than cotton.

Third, feel free to lubricate your feet to cut down on the friction that causes blisters. Rubbing some vaseline on your feet before runs can do the trick, but if you find that too goopy, talcum powder is a good substitute.

Fourth, if you are aware of specific blister problem areas, try protecting those ahead of time. Moleskin may work, but it often doesn't stick very well to sweaty feet. Duct tape, believe it or not, is often more reliable. Put it on before your foot becomes moist, and it won't come off until you want it to.

Corns

Description:
Hard, painful lumps on the skin.

Likely causes:
Constant rubbing and pressure from shoes that are too tight.

Remedy:
First off, get shoes that fit better. Very likely, the shoes you have are either too short, too narrow or both. Take some of the pressure off the corn by putting a doughnut pad on it. You can find doughnut pads at most drugstores; they're small pads with a hole in them that eases friction when fitted over the corn. With the right shoes and the pressure relieved, the corn will disappear in a few weeks. You can speed this process by giving the corn a few strokes with an emery board a couple times a week.

---

Toes and the Front of the Foot

Black Toenail

Description:
Your toenail is, well, black. It may be painful.

Likely causes:
Repeated pressure and impact on your toenail. It could be from running downhill, when your shoe stops short and your toe keeps slamming into the end of the shoe. Or the toebox of your shoe could be too large, and your toe keeps banging against the top (over long distances the cumulative effect of this can be miserable on the nail). Whatever the specific cause, the result is bleeding under the nail, thus the blackness.

Remedy:
The blood must be released to relieve the pressure. Some people will tell you that you can do this yourself with a razor blade or a hot needle, which you poke through the skin. That takes guts; you're probably better off seeing a doctor to take care of it. If you don't take care of it in the first couple of weeks, the nail will probably start to come off, and several weeks later it will ultimately drop off. Not to worry, while this is not a particularly attractive process, it's not painful or unhealthy either.

Thick Toenail

Description:
The nail is noticeably thicker than normal -- perhaps up to 1/2-inch or 3/4-inch thick. The pressure of the shoe probably makes the nail quite painful.

Likely causes:
A thick toenail is often the result of repeated trauma to the nail -- injury after injury. Maybe it's from constant pressure and impact within your running shoes, or maybe you've just dropped stuff on your toe a few times too many.

Remedy:
File the top of the nail, using an emery board to smooth it down. You'll likely find that the nail will grow back and thicken again, and you may have to file it again. NOTE: If your nail is also discolored and mottled with yellow and white, this may be fungus nail instead of a mere thick toenail. See a podiatrist about applying a fungicide.

Soreness Under the Ball of the Big Toe
(Bruised or broken sesamoids)

Description:
Tiny bones called sesamoids are located under the ball of your big toe (where the toe connects to your foot). These bones sometimes bruise -- it's a hassle, but it's also a warning system; they start aching before you damage the bones of your big toe. To see if you've bruised these little guys, press hard on the head of your big toe with your thumb. If you're howling in pain, that pretty much confirms that you've bruised, maybe even broken, your sesamoids.

Likely Causes:
Increased mileage, maybe new hillwork or speedwork. Whatever the cause, you are running too much on the balls of your feet. Also, it is possible that your running surface is responsible -- too much hard pavement. A final possibility is that you are doing nothing wrong at all, but you may have been betrayed by your own bone structure (i.e. you have bony feet without much fat padding).

Remedy:
Ice your foot, putting it on ice for ten minutes, off for ten minutes, and repeat. Do this often, maybe four times per day. This, of course, only treats the symptoms. You also have to treat the root cause and stop pounding the balls of your feet into pulp. Reduce hillwork and speedwork, and also take a look at your stride. Your heel should hit the ground first, rolling through the middle of your foot and then springing off from your toes. You should not be landing on the balls of your feet.

The problem can further be avoided in the future by padding around the ball of your foot to take pressure off of it. Get a piece of felt or foam rubber (try using a Dr. Scholl's heel pad, for example). It should be 1/4" thick and about 2" square. Cut a shallow "U" out of the pad so that it fits snugly behind (not over) the ball of your foot. Behind, incidentally, means on the heel side, not the toe side. The pad should fit right behind the painful area. You'll know you've got it right when you try it out and walk around -- the pressure will be off the bone, and the pain will be far reduced. Tape the padding to your foot and wear it in your daytime shoes as well as your running shoes.

You should be able to hit the road immediately, and the pain will likely disappear in about two weeks. If it does not, you may need custom orthotics. See a podiatrist, preferably one who is also a runner.

Bunions

Description:
A bunion is a swelling near the bone connecting to the big toe that sticks out at the side. Having a bunion is not necessarily a problem unless it begins to be tender and painful.

Likely causes:
Bunions may become enlarged if too much weight or shoe pressure is applied to them. If this has happened to you, your big toe is probably angled in and overlaps your second toe, causing a problem of weight distribution. As a result, extra weight is getting put on the ball of your big toe, possibly aggravated by the pounding of running. The ball has responded by growing larger in an attempt to handle the weight better.

Remedy:
Unfortunately, you can't undo this, with the exception of going under the knife to trim it down. You can, however, ease the discomfort. First, be sure that you are not wearing shoes that are too tight. Second, try to take pressure off the bunion. Your local drugstore probably sells bunion pads which will cover the bunion and pad the area around it to help take the pressure off the bunion itself. (You can also make your own out of foam rubber. Try a 1/4"-thick piece, and cut a hole to match the size and shape of the bunion). Finally, an arch support (available at most drug stores and running stores) may help to take some of the pressure off of the bunion. If you still have trouble, visit a podiatrist.

Hammer Toes

Description:
Your toes, or maybe just one of them, will not stay straight. With effort you might be able to get your toes to straighten, but they won't stay that way. The tops of the toes hurt when you run, probably from corns that have formed there (you may have also formed corns on the tips of the hammer toes). Any toe except the big toe can be a hammer toe.

Likely causes:
Your hammer toes are almost certainly caused by shoes that are too short. After extended use of ill-fitting shoes, the tendons on the bottom of your toes have actually shortened and now they won't stretch out again.

Remedy:
Wear shoes that are looser in the toes. If you do have corns on the tops of your toes, wrap lamb's wool around them; you can find lamb's wool in the footcare section of your local drugstore. It lasts for three or four days of straight use. If you have a corn on the tips of your toes, try putting some padding in the arch beneath the toes to lift them up. This should stop the tips of your toes from pounding into the sole of your shoe.

Pain Under Your Three Smallest Toes

Description:
Pain under your three small toes. If you press with your fingers between the toes and balls of your feet, you feel pain.

Likely causes:
Too much pounding. You're probably coming down too hard on this area of your foot when you run. As a result bursitis may have developed, with your foot building a cushion called a bursa to protect the area. The pain you feel is the bursa getting irritated.

Remedy:
Take the pressure off of this area with some foot pads. You can probably find some metatarsal pads in the footcare section of your drug store, but a piece of felt or foam rubber will do the trick, too -- about 1/4" thick, two or three inches long. The idea is to put padding behind the balls of your feet so that you won't pound them so hard. Bend your toes back and press until you find the spots that hurt; tape the padding to the area just behind (that's on the heel side of the pain, not the toe side). This should take care of the symptoms, but the cause itself is probably due to an imbalance in your foot. Visit a podiatrist, preferably a runner, to see if orthotics may help.

Neuromas (burning between the toes)

Description:
A neuroma is a bundle of nerve endings whose covering has become inflamed. Probably between the third and fourth toes, you feel a burning sensation, maybe more like an electric tingling or a shooting pain, possibly with some numbness. Whatever the exact sensation, it is no doubt excruciating. There is no swelling, no bumps. The pain may come on at odd times, even when you are not being particularly active.

Likely causes:
This problem is apparently fairly common for people with a "loose foot," where there is too much movement between the metatarsals, the bones that connect to the toes.

Remedy:
Ice the foot for ten minutes, then ten minutes off, and repeat five times to bring down the inflammation. Take pressure off of the neuroma by putting some padding right behind where the toes meet your foot. Bend your toes back and press on the bottom of your foot to find the most painful spot. Put the padding right behind that (that's on the heel side of the pain, not the toe side). Use some foam rubber or felt, about 1/4" thick. Tape the padding to your foot, or glue them into your shoes.

You will probably always have to use this padding to run since the source of the problem is in your foot structure. Rest assured, though, that even though the nerve bundles will always be there, they won't hurt so long as you're wearing the padding. If, however, you continue to have pain, it's time to see a podiatrist. Hopefully, she can fit you with appropriate padding, but surgery may be a necessity in the long run to remove the neuroma. (As surgery goes, this is said to be not terribly disabling; most can start running again two or three weeks afterward).

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Body of the Foot

Metatarsal Stress Fracture

Description:
Pain in one of the long thin bones that run along the top of your foot and attach to your toes (the metatarsals). There may be a little redness or swelling, and if you touch this area the pain will practically knock you over. Press along the shaft of the bone toward the outside and then toward the inside, and you feel a stabbing pain.

Likely causes:
The metatarsals can be broken or bruised under the stress of running, particularly for long distances. You're running harder and longer than your feet are able to take.

Remedy:
This is not a do-it-yourselfer. Stop running and see a podiatrist or an orthopedist immediately. Under a doctor's care, you should be back to running in about six weeks.

Pain on Top of Foot

Likely causes:
If your symptoms do not match those listed above for a metatarsal stress fracture, the pain is probably caused by either a bone spur or simply shoes that are too tight. A bone spur is an enlarged bone; you'll see it as a bump on top of the foot. The bone has probably grown as a result of pressure being applied to it.

Remedy:
Try wearing larger shoes and don't tie your shoe laces quite so tight. (Remember when buying shoes that your feet swell when you run, especially over long distances). In the case of a bone spur, try taking some of the pressure off of the bone. Cut a piece of foam rubber (about 1/4" thick) to make a doughnut-shaped pad that fits over the bone spur. Either put it on before running or glue it to the tongue of your running shoe.

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Arch and Heel

Plantar Fasciitis
(pronounced fa-shee-eye-tiss)

Description:
This is among the most common of foot injuries and is signaled by pain on the front of the heel or all along the arch. You probably have a lot of pain when you first get out of bed -- it's probably murder just to walk out of your bedroom. Ditto on standing up after a long time of being seated. The pain may range anywhere from a vague pull along the arch to the impression that your arch is ripping in half (don't worry, it's not actually doing that). To make sure it's plantar fasciitis, as opposed to a heel spur (see below), press your thumb up hard on the middle of your heel. If you feel pain, it's plantar fasciitis.

Likely causes:
Fascia is the stuff your body uses either to separate muscle groups or to connect separate parts. In your foot, fascia form the arch, connecting your heel bone to the balls of your feet. In the ideal foot with the ideal stride, your weight during your stride rolls efficiently from your heel, through your arch, and off of the ball of your foot. The arch flattens a little bit to absorb your weight and then springs back. Of course for most of us, it's a bit much to ask for both an ideal foot AND an ideal stride. Plantar fasciitis is the all too common result of your weight moving improperly through your arch so that it is overstretched. In more extreme cases, the arch loses its flexibility altogether so that it no longer springs back (in which case you have a fallen arch, see flat feet below). The injury is aggravated, like most injuries, by running too much. It also doesn't help much to run on hard surfaces or run on the balls of your feet (for example, when running hills or doing trackwork).

Remedy:
First, ease off on the miles and cut out the hills and speedwork. When you do run, make sure your calves and hamstrings are well stretched.

Plantar fasciitis is essentially an inflammation of the fascia. Give it ice immediately after running -- ten minutes on ice, ten minutes off, and repeat. Take anti-inflammatories to reduce the swelling. For that early-morning pain, avoid getting out of bed barefot. Put on some thick socks or slippers first.

To get at the source of the problem, you have to give your arch some help and support. Try wearing an arch strapping. This will add support to your arch. If the strapping does not provide enough relief, pick up some arch supports. You should be able to find them (probably by Dr. Scholls) at a drug store. They raise the arch and shift burden off the heel. By wearing these you also give the fascia a little slack -- the arch doesn't have to stretch as far. If the strapping and the arch supports together are not enough, try adding heel pads. You can buy these, or just use make-up sponges (you're looking for 1/2-inch sponge rubber).

Also, tight calves can add strain to the fascia. Spend some extra time stretching your calves with wall pushups.

This kind of home treatment is usually fairly successful for plantar fasciitis. Give it a try, it's a lot cheaper than orthotics. But if after two weeks you still have pain, see a podiatrist who treats athletes (and who is preferably a runner herself). Orthotics may be necessary. If so, they should solve the problem for good.

Heel Spurs

Description:
The symptoms of heel spurs are nearly identical to those for plantar fasciitis (above). There is pain in the front of the heel and possibly in the arch. The pain probably seems particularly acute when taking your first steps of the day or walking after a long period of sitting down. When you have a heel spur, unlike with plantar fasciitis, you will feel pain when you press the front of the heel, at the intersection of the heel and the arch, pressing up and backward toward the heel. This is where the heel spur has formed -- it's a pointy extension of the heel bone.

Likely causes:
As with plantar fasciitis, you may have strained the fascia that form the arch of your foot. In doing so, some of the fascia may have actually been yanked off of the heel bone, leaving some blood behind. Over time these little droplets, sitting on your heel bone, calcified and actually formed an extra little piece of bone, the heel spur. The pain you feel is not the spur itself (that's bone), but the flesh and fascia around it which are now taking an extra pounding from the new arrival in your skeletal neighborhood.

Remedy:
There are some things you can do to ease the discomfort and possibly even cure the problem. Keep in mind, though, that home treatment very rarely does much for these little guys but that your friendly neighborhood podiatrist can fix you up with very little fuss.

First the home treatment. Ice your heels (cool your jets, etc) right after running. Apply ice for ten minutes, take it off for ten, then repeat. This will help take down some of the swelling and ease the pain.

Try wearing heel pads when you run, too. You can buy commercial heel pads at the drugstore, or simply use makeup sponges or any piece of sponge rubber, about 1/2-inch thick. These will absorb shock and shift your weight somewhat away from the front of the heel where your heel spurs are. Arch supports (also found in many drugstores) may help, too. Try wearing an arch strapping to give your arch further support.

While there is a chance that doing these things will make your problem go away, don't count on it, it hardly ever happens. If your pain continues, and certainly if it increases, go to see an orthopedist or a podiatrist. She will likely fit you with orthotics which should take care of the problem, which is essentially a problem of weight distribution. She may, however, recommend surgery to remove the spur, though you will probably still have to wear orthotics anyway.

Flat Feet
(a.k.a. fallen arches, or weak foot syndrome)

Description:
There are a variety of symptoms for flat feet, and not everyone will experience all of them. Symptoms might include tired, sore feet (particularly on the bottom); lower back pain; pain in the arch; or tired legs. Your feet probably feel better when you roll your feet toward the outside. To confirm whether you have flat feet, press on the arch at the highest point. If you have weak foot, you will find this fairly painful. Another test is simply to look at your feet. When standing, you pronate; your weight falls toward the inside of your foot, and your arch almost disappears entirely.

Likely causes:
You may have simply been born with a very low arch (just because you are born with low arches, by the way, does not necessarily mean that you will ever have the symptoms of "flat feet"). On the other hand, your arches may have fallen. This happens when the flexible bands (the fascia) that form your arch become overstretched. This is usually the result of an imbalance in your foot. Your arch loses its flexibility and no longer springs back.

Remedy:
You need to give your arch some extra support. Wear an arch strapping until the pain is gone, probably about two weeks. You should also wear an arch support, both in your running shoes and your regular shoes. You can probably buy these supports in your local drugstore, and you should continue to wear them even after the pain goes away. If you do not, you run a serious risk of inviting back the pain. If these steps do not solve the problem, see a podiatrist to find out if orthotics might be necessary.

Pain in the back and bottom of the heel
(Apophycitis of the heel)

Description:
This injury happens to runners under twenty, most commonly to children around eleven. The pain dances up the back of your heel, and if you grab the heel and squeeze, you'll be howling in pain.

Likely causes:
Right through the teens, the heel bone is in two pieces which eventually fuse after adolescence. If you are under twenty and you have been running very long distances, you may have jarred and separated these bones.

Remedy:
Try a heel strapping, using 1-1/2 inch adhesive tape. It's easy to do: Put one piece around the bottom of the heel toward the front, then another around the back of the heel toward the top -- from the inner ankle bone to the outer ankle bone. Then put another piece at the bottom, just behind the first piece of tape and overlapping by 1/2 inch. Do the same with another piece of tape at the back of the heel. Continue to add pieces of tape alternating between the bottom and the back of the heel until the last tape around the back of the heel borders the sole of your foot.

Also be sure to wear heel pads -- try inserting makeup sponges in your running shoes. Be patient: the injury will probably take about six months to heel, and during this period you should avoid all running and jumping. It's tough medicine, but to do otherwise will risk making the injury worse.