Running Injuries Tips

Incorrect Orthotics Can Lead to Injury

Orthotics can be a runner's best friend, but when they are worn out or improperly fitted, they can lead to injury.

Each week or so, give your orthotics a close look. They will show signs of wear, but look for excessive cracking in the front that could affect how they feel when your foot lands. Also check for wear on the heel. When the orthotics aren't supporting your feet properly, they aren't doing their job and need to be replaced or refurbished.

If you are running less than 50 miles a week, you can probably get about 2 years of mileage from your orthotics. If you are running more than that, visit your podiatrist about once a year to have your orthotics assessed and repaired if needed.

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Help Kids Avoid Overuse Injuries

It's important to encourage kids to play sports, but it's also important to recognize the dangers of overtraining due to specializing in a single sport while the body is still developing.

A new public service campaign sponsored by several organizations including the American Academy of Orthopedic Surgeons and the American Orthopaedic Society for Sports Medicine, aims to curb the rising rates of overuse injuries in young althletes, so they can continue to enjoy sports and fitness into adulthood, when their days on the high school team are over.

Check out the website:

http://www.stopsportsinjuries.org/ The site includes resources for athletes, parents, and coaches. No one likes to be injured, including young athletes, and the more education about injury prevention that gets out there, the better.

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Ice With Veggies

Almost any running injury, major or minor, will feel better if you put ice on the area. You can buy commercial ice packs, but a bag of frozen peas is the most effective ice pack available because it conforms easily to the shape of your foot, leg, elbow, or any other injured area. You can reuse the same bag until it falls apart. Just make sure to label the peas with a marker of some sort so no one cooks and eats them by mistake!

The most effective way to ice an injury is to apply ice to the injured area at 10-15 minute intervals. After 15-20 minutes, the ice pack starts to warm up and lose its effectiveness, so return it to the freezer and ice the spot again in a few hours. Put ice on an injury as soon as possible after activity, or any time that is convenient.

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Sports Massage: It's Worth It

Whether you are a beginner or a seasoned marathoner, your body is adjusting to more stress of a different type than it has experienced before. A sports massage isn't medically necessary, but your muscles will thank you, and you may be preventing injuries by promoting circulation and reducing stiffness during your training. Also, sports massage can be helpful when you are returning to running after an injury. Any injury causes scar tissue to form, which makes the injured area less flexible. Massaging that area breaks up some of the scar tissue and promotes circulation, which promotes healing.

Some insurance companies will cover sports massage or reimburse you if you have a flexible spending account, so investigate. Ask a fellow runner or a sports medicine professional to recommend a massage therapist who has had experience with athletes. A one-hour massage ranges from $60-$80, depending on where you live.

Some therapists will do half-hour sessions that focus only on the legs, but I recommend a full-body massage a day or two before the marathon. Your upper body gets tight when you run, too, and why not give your muscles every advantage?

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The Heat is On: Are You Ready to Avoid Heat Exhaustion?

When spring turns to summer, runners might find themselves going from a 50-degree morning to a 75-degree morning without much warning. If that happens to you, pay attention to how you feel while running on those first hot mornings.

Most people need some time to acclimate to warmer weather. Be smart and don't push the pace, and start thinking about how you will have access to water on your long training runs.

Running in hot weather is its own challenge, but you can keep up with your training schedule if you stay smart and modify as needed. If you start feeling dizzy or chilled, stop and walk, and get into some shade if possible, and cut the workout short. There will always be a better weather day!

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Ease Achy Muscles

Not all running injuries are serious. Here are few tips to manage the minor aches and pains that are part of training for a marathon:

• When you feel especially stiff after a tough workout, fill a bathtub with warm water and add 3-4 cups of Epsom salt, which you can buy at most grocery stores or drugstores. Soak for 15 minutes, and you will notice a difference the next day.
• Muscle rubs such as Biofreeze and the arnica gels sold at health food stores can provide topical, short-term relief of minor aches. But if you have severe, persistent muscle pain, seek professional advice.
• Ice. You can rarely go wrong putting ice on a sore spot.
• Heat. Don't use a heating pad on an area that is red or swollen, but placing a heating pad behind your back or sitting on a heating pad at work can relieve low back or upper hamstring stiffness. But limit heating pad use to 15 minutes a few times daily to avoid skin irritation.

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Strassburg Sock: Is it for You?

Many treatments exist for that bane of runners: plantar fasciitis. In plantar fasciitis, the band of tissue along the bottom of the foot (the plantar fascia) becomes inflamed. This can be caused by incorrect footwear (including too much barefoot time), an increase in mileage, hard running surfaces, or all of the above.

Early morning pain is a common problem when dealing with plantar fasciitis because the injured tissue starts to heal in an unstretched position during the day, and then gets re-injured at night.

The theory behind different types of night splints for PF is that they will hold the plantar fascia in a stretched position overnight, which has been shown to help speed recovery.

A device called the Strassburg Sock is a knee sock with a strip of fabric running from the elastic band below the knee to the tip of the big toe. This piece holds the big toe in the position of pulled back toward the knee. This position stretches the plantar fascia.

If you have stubborn plantar fasciitis, the Strassburg Sock might be worth a try. It is inexpensive, noninvasive, and probably won't make your foot pain any worse. And the effectiveness of the Strassburg Sock has been studied. In a randomized trial of 160 plantar fasciitis patients, the half who wore the sock recovered after an average of 19 days, compared with an average of 59 days for control patients who didn't wear the sock.

Keep an open mind, and use your judgement, but remember that it's essential to determine what caused your plantar fasciitis, so you can keep it from coming back once you recover.

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Banishing Blisters

Runners get blisters. It's a fact. No matter how well your shoes fit, or what kind of socks you wear, sometime over the course of your running life, you'll get a blister or two.

Fortunately, most blisters go away on their own. Cover them with a Band-Aid before a run, and you shouldn't be too uncomfortable.

But for stubborn, painful blisters, you can drain them yourself. Swab the area with rubbing alcohol. Swab a pin with rubbing alcohol. Have a kleenex ready. Poke the fullest part of the blister and blot up the fluid that drains out. Then put a Band-Aid over the spot.

If you reguarly have painful blisters, you might be wearing the wrong type of shoes for your foot. Ask a specialist in a running store, or see a podiatrist who regularly treats runners to assess your feet and help you banish blisters.

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Rule #1: Be Sure Your Running Shoes Fit

Of all the injury-prevention techniques available, the simplest – and one of the most effective – is making sure that your running shoes fit properly. Here are a few tips to help make sure your running shoes fit:
• When you try on shoes, wear the socks you'll wear when running.
• Our feet swell as we walk around during the day, so try to shop later in the day or in the evening.
• The heel shouldn't be loose, but neither should there be any pronounced “pressure spots” – especially at the Achilles tendon.
• You should have about a finger's width of space between your longest toe and the front of the shoe.
• If you have to lace the shoe so tightly that there's noticeable pressure on the top of your foot to make it fit, the shoe is too big.

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Use Traveling as an Excuse to Cross Train

It's hard to change your running routine, but runners who travel might have a unique opportunity to help their running injuries along.

If you are struggling with an injury and having trouble making yourself rest, try to use a business trip as an opportunity to do some cross training. If you are in a hotel with a decent gym, make yourself bypass the treadmill and running, and do some stationary biking/pool running instead. Ideally, you can get over the hump of your injury and ease back to running when you get home.

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Plantar Fasciitis: Try Taping

Plantar fasciitis occurs when the band of tissue that runs along the bottom of your foot becomes irriated. This band of tissue is called the plantar fascia. Rest and ice are the first-line steps to treatment, but some runners also get some pain relief from taping the affected foot.

Of course, you need to figure out what caused your plantar fasciitis in order to cure it, but if you want to try taping while you're healing, here's one way:

-Start by taking a length of sports tape from the base of your baby toe down around the lower outside edge of your heel, and back up to where you started.

-Then make another loop, but this time start and end below your big toe. You will have a X-pattern across the bottom of your foot.

Note-make sure the tape is in contact with the bottom of your foot, not stretched so tight that it is suspended.

-Next, take small pieces of tape and place them across the bottom of your foot starting at the front of the heel (this is probably where it hurts the most) and working up the arch to where the ball of your foot starts. Ideally, you will feel that you have a bit more support for your sore foot.

But if your problem persists, see a podiatrist!

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Runner's Toe

Also known as “black toe,” this injury is a blood blister beneath a nail. The condition is uncomfortable, can be prone to infection, and usually results in the eventual loss of the nail.

The most common cause of runner's toe is tight running shoes, although jamming the toe running downhill can also cause the same problem. Your best prevention strategy is to make sure your running shoes fit.

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Achilles Tendonitis

Though technically not tendonitis, this malady is one of the legendary banes of runners. An Achilles tendon injury can linger for weeks or months… or even longer.

Achilles tendonitis is often associated with a sudden increase in training or the addition of speed and hill training to your workout schedule. Over-cushioned heels and a stiff sole are two running shoe design issues that can contribute to Achilles tendonitis.

However it starts, this problem requires immediate attention if you don't want months of discomfort. Cut back on training, and avoid stretching the affected area excessively. If you've been running hills or doing speed work, cut these back especially. Stay away from very flat shoes – like flip-flops and sneakers - and make sure your running shoes fit properly. Icing after a work out may also be useful.

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Plantar Fasciitis

Plantar fasciitis is caused by inflammation of the plantar fascia – a band of tissue connecting the heel to the forward part of the foot. It can also be characterized by stiffness and soreness along the plantar (bottom) surface of the foot. Typically the soreness and stiffness is worst at the beginning of an activity, and then subsides somewhat.

Stress on the arch of the foot, over-training and tight calf muscles are common causes of plantar fasciitis. Rest, icing after a workout, gentle stretching of the calf muscles and a reevaluation of your running shoes can help resolve the problem. If the arch of your current shoes doesn't fully support your instep, try switching to a running shoe with greater arch support.

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Runner's Knee

Runner's knee is a painful condition characterized by degradation of the cartilage behind the kneecap. Two major causes are overpronation and weak quadriceps muscles. Wearing pronation control shoes can control most cases of overpronation. Strengthening the quads can also help prevent this cause of runner's knee.

Modified step-ups are a good exercise to strengthen the quads. Use a platform, box or step that's at least 4” above floor level. Stand on the platform with one foot, while the other foot hangs off the side. Gently lower the hanging side by bending the supporting leg - till the toe nearly touches the floor. Gently straighten the supporting leg. Repeat ten times on each side, and build up to three sets of ten.

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Ankle Sprains

A sprained ankle is the most common injury to the foot or ankle. And a sprain can be serious. Running makes you susceptible to ankle sprains – and trail running especially so. The most important thing to remember about a sprained ankle is that it's not “just” a little sprain.

A sprained ankle is the result of an over-stretched or torn ligament. Tears are serious injuries and require medical attention. If there is significant swelling present, you're unable to walk on the affected joint, or if there is pain above the ankle or in the foot, see a doctor.

Self-treatment for ankle sprains should include an immediate cessation of training, and using “R.I.C.E.” – Rest, Ice, Compression, Elevation – for 24 to 48 hours. Work gently back into your training schedule to avoid aggravating the injury.

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Shin Splints

Shin splints is a catch-all term for pain along the front of the lower leg, and actually refers to a handful of mostly minor compalints. The most common causes of shin splints are running on hard surfaces and running on the toes, though overpronation can also cause shin splits.

If overpronation appears to be the culprit, a good pair of pronation-control shoes may be your simplest solution. In all cases, cut back on training and try to stick to soft surfaces like grass. An over-the-counter anti-inflammatory can be helpful if the cause is tendonitis.

Be cautious, though; more serious injuries – like stress fractures – can have the same symptoms. If your pain is significant or persists, see a doctor.

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Use R.I.C.E.

Many minor soft-tissue injuries, such as muscle pulls and sprains – respond well to a treatment regimen known as “R.I.C.E.” That's the acronym for “Rest, Ice, Compression, Elevation.” The first 24 – 48 hours after any injury are the most critical, and R.I.C.E. can help reduce both the severity of symptoms and the length of time the injury sidelines a runner.
• Rest. Take the weight or stress off the affected area, and give it some tie to start healing.
• Ice. An ice pack on the affected area can help reduce both pain and swelling. Don't leave an ice pack in place for more than about a quarter-hour at a time.
• Compression. Wrap the affected area in an ACE bandage – but not too tightly – to help keep swelling down.
• Elevation. Putting the injured area at a level higher than the heart helps reduce swelling.

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Rule #2: Buy a Running Shoe Designed for You

Understanding your feet will help you select the right shoe. Bio-mechanically, we're all a little different, but we all fall into three broad categories.
• Overpronators. Pronation is the natural tendency of the foot to roll inwards as it moves from heel to toe. Overpronation occurs when the foot rolls too far inward. Do this a few hundred thousand times, and injuries such as shin splints, fractures, plantar fasciitis and “runner's knee” could result.
Overpronators tend to have low insteps (“fallen arches”) and wear their soles excessively on the inner sides. Pronation-control shoes are designed to prevent the excessive inward roll of the foot. This is typically accomplished with a wedge of denser cushioning material on the inner (medial) side of the insole.
• Supinators have the opposite problem of overpronators: Their feet roll slightly outwards, which can result in ankle injuries.
Supinators tend to have high, rigid arches, and wear their soles excessively along the outside edges. Supinators and underpronators (whose feet don't roll inward enough, but also don't roll outward) should look for “cushioned” running shoes. Supinators may require additional arch support – and some shoe manufacturers include wedges for extra arch support with certain models of shoe.
• Neutral. Most runners have a normal arch, and their foot pronates about four to six degrees. This is considered a normal or neutral gait, and requires no correction. These runners should generally avoid motion control or “stability” shoes, and stick with a cushioned shoe. However, they generally don't need as much cushioning as supinators, unless they're heavy.

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Muscle Pulls

Pulled muscles are the most common sports injury, and are caused by a sudden over-stressing of the muscle. Runners frequently pull hamstring and groin muscles, but quadriceps, calf muscles and others are also subject to pulls.

Don't try to “work through” a muscle pull. This could result in worsening the injury – and lengthening the time you'll be sidelined. Instead, ice and rest the affected muscle. As soon as you reasonably can, gently stretch the muscle to help promote flexibility. Don't overdo it, though. Gradually return to your training program.

Severe pulls and muscle tears require a doctor's care.

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Got Toe Pain? Could be Sesamoiditis

I'm currently building up my marathon training again after some time of low mileage running. Unfortunately, I have since developed a bunion, and I've had some pain under the ball of my foot that I suspect is sesamoiditis. I had problems with that before, and some extra padding in my orthotics did the trick Eventually, as I build up mileage, my foot healed and adapated, so I expect that will happen again, but I'm going to the podiatrist to make sure I have the right kind of padding.

The sesamoid bones are small bones in the ball of the foot, below the big toe. If you have been increasing your mileage, or doing speed work or hill work, and you have pain here, sesamoiditis could be the cause. There won't be any visible redness or bruising, usually, and ice can help, but it's important to address whatever biomechanics are involved, so don't hesitate to see a podiatrist to make sure you get it right.

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Care for Calluses

All runners get calluses. They aren't anything to worry about, but they can be unsightly

Some callus care tips:

-File your feet: Buy one of those foot files from a pharmacy, or get a fancier one from a beauty supply store. File your calluses when your feet are dry, maybe before bed or before a shower.

-Use bandaids as needed: Sometimes a callus develops in the aftermath of a blister. If you have a blister on your foot, keep it covered with a band aid until it bursts, and then until it starts to dry up. If it eventually forms a callus, see the previous tip about filing.

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AAOS News: Knee Replacements Common, Protect Yours

Did you know that 4.5 million Americans have had total knee replacements? It's true, according to data presented at the 2012 meeting of the American Academy of Orthopaedic Surgeons.

Here's the press release from the AAOS website:

http://www6.aaos.org/news/pemr/releases/release.cfm?releasenum=1050

The technology of knee replacements has greatly improved, but runners should still take care to protect their knees.

To help keep your knees healthy, try strengthening your quadriceps with regular exercises that specifically target them.

Try this easy exercise, which you can even do at work:

Seated Quad Contractions

Sit on a chair and extend your legs. Let your heels touch the floor, and keep your knees straight.

-Tighten both thigh muscles and hold for a count of 10.

-Loosen the thigh muscles and relax for a count of 3.

-Do 10 repetitions to complete 1 set.

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Arthroscopic Hip Surgery Seems Successful

Data presented at the American Orthopaedic Society for Sports Medicine suggested that approximately 80 percent of athletes who had arthroscopic surgery to repair impingement in the hip socket were able to return to their sports of choice, including running, at an average of 9 months after surgery.

That's good news for runners, who are notoriously frustrated by injuries and layoffs. Nine months sounds like a long time, but hip surgery is a big deal.

Femoro-acetabular impingement, also known as FAI, occurs in some people who have a bump on the upper thigh that keeps the hip joint from moving freely. Doctors are becoming more aware of this problem, which is characterized by hip pain and reduced range of motion. If left untreated, hip arthritis can develop.

Here's a quote from Dr. Bryan Kelly, of the Hospital for Special Surgery in New York, NY, who presented the study at the meeting:

“Although technically challenging, appropriately performed arthroscopic surgery results in less soft tissue trauma, less blood loss, shorter hospitalizations, and likely provides a faster return to a full recovery,” Dr. Kelly said.

The idea of less invasive surgery is encouraging. If you have hip pain, whether or not it is due to running, do your homework and talk to specialists about your surgical options.

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The Psychology of Chronic Pain

This makes sense if you think about it, but a study published in the Journal of Pain suggests that pessimism about recovery is a significant predictor of chronic pain. In this study, researchers followed adults with traumatic, but not life-threatening orthopedic injuries. They found that patients who believed that they wouldn't recover soon were four times as likely to report pain six months later.

Being injured stinks, and it's ok to be angry when you get hurt. But you can help yourself by believing in your recovery. Put your energy into your physical therapy, and know that your running (or other sports) will be there waiting for you.

A tip for staying positive--plan your next race. Be realistic. If you have a broken foot, don't sign up for a 10K next weekend. But look a few months down the road and sign up for a race that sounds right to you, given your training level, whether it is a 5K or marathon. Having something to look forward to can help you stay positive and committed to a smart recovery.

For more about the pain study, here's the press release:

http://www.newswise.com/articles/psychological-influences-predict-chronic-pain-following-orthopedic-injuries

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Leg-Length Difference Can Cause Back And Hip Pain

Most people are not perfectly symmetrical, we have one leg that is slightly shorter than the other. But marathon training will introduce you to your biomechanical flaws.

When I was training for my first marathon and running distances longer than 12 miles for the first time, I developed severe pain in my upper left hip, just below the waist. I could barely walk. I called my podiatrist, who recommended a chiropractor or an orthopedist. I went with the chiropractor, but what you need is someone who can take an x-ray and determine whether you have a leg-length discrepancy. If you have a difference of a quarter inch (4-5 mm) or more, a heel lift in the shorter foot will solve the problem, although you may need to wear the lift of the same height in your everyday shoes as well as your running shoes to avoid re-injury.

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Painkillers: The Power Of Three

If you have an acute injury or a flare-up of a chronic problem, and ibuprofen doesn't both you, take 3 Advil 3 times daily for 3 days. I'm not a doctor, but my podiatrist recommended this regimen to me for an acute tendon inflammation that I suffered after a marathon, so I do have legitimate medical backing for this tip, as well as personal experience. After three days, the inflammation was significantly reduced. After three days, drop the dosage down to one or two Advil daily for another day or two, and then discontinue the Advil; it's not something to take daily for an extended period of time. If your injury doesn't seem to improve after three days, see a sports medicine professional.

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Prevention Is The Best Medicine For Marathon Training Injuries

Ideally, runners can build up their mileage and train for a marathon with no injuries. In reality, injuries happen, even to the most careful and well-conditioned runners. But you can reduce your risk of injury and reduce the severity of the injury with some preventive tips:

• Check your shoes (and orthotics): Don't train in worn-out shoes. Be sure to replace your shoes after 300-500 miles, depending on when you notice significant wear or any foot or leg pain. Even if you think that your shoes look and feel great, retire them at 500 miles. When you try on a new pair, you'll notice the difference. Many knee, hip, and back problems (as well as foot problems) are caused by poor foot alignment, which can occur when your shoes are worn out or because you need orthotics.
• Cross train: See the section on cross training tips for ways to keep your muscles strong and balanced.
• Rest: Don't forget to factor in a rest day each week so your muscles and joints can to recover from your tough training days.

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Your Ounce of Injury Prevention

It is much easier to avoid injury than it is to recover from it. While all injuries can't be prevented, there are things you can do – beyond making sure you have running shoes that fit your feet and biomechanics – to prevent injury.
• Warm up and cool down. Sudden stresses are more likely to cause injury. Work your way gradually into – and out of – workouts and races.
• Stretch. Tight muscles are more prone to injury than flexible ones. Gently stretch regularly. Yoga is an excellent way to ensure that your muscles are loose and flexible.
• Cross-train. Most sports – including running – use certain muscle groups more than others. To help keep your body in balance, cycle, swim, lift weights, or participate in other sports regularly.
• Take time off. Running streaks are points of pride for many runners. But they can also predispose them to injury. Like any vigorous physical activity, running stresses your body. Schedule rest days into your training plan to give your body a chance to recover.

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Non-Running Injuries: When To Run Through Them

You can run with a strain, but don't try to run on a sprain. A sprained ankle will be swollen and warm to the touch, and it will hurt much more than a strain. If you have a strain, you can run, but modify your training until it feels better. That may mean skipping speed work and sticking to short, easy runs, or trading the planned 17-mile weekend long run for a 13-mile run, but your training won't suffer. As always, listen to your body, and if the pain persists, visit a sports medicine professional to address the problem and take a day or two off from running.

Similarly, you can run with a mild head cold, and I have found that an easy run helps to relieve congestion. But if you are seriously ill, stay home. A good rule of thumb: If you are sick from the neck up, you can probably run, but if you are sick from the next down (a respiratory or gastrointestinal illness) stay home and recover, and see your doctor if necessary.

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Plantar Fasciitis Pain: A Runner's Bane

Plantar fasciitis is one of the most common injuries in runners. If you feel pain on the bottom of your foot at the front edge of your heel where it meets the arch, you may have plantar fasciitis. The fascia is a band of tissue that runs along the bottom of the foot. This band is flexible, and it flattens out and springs back with each step as you run. But if it is overstretched or if it rubs against something (like an ill-fitting shoe), it can become inflamed. Plantar fasciitis is caused by uneven weight distribution across that foot, which can arise from ill-fitting shoes or a lack of arch support. Running on concrete surfaces every day can aggravate the plantar fascia, too.

Start by putting an ice pack on the sore spot for 10-15 minutes at a time a few times a day, especially after you have been running or walking. Review your shoes with a podiatrist. Your running shoe may have too much motion control and you may need a shoe with more flexibility, or vice versa. Plantar fasciitis will usually resolve within a few weeks if you address the cause. Some runners find that ultrasound treatment relieves plantar fasciitis, but it's important to find the cause of the problem and solve it to prevent chronic pain.

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Consider Cortisone for Plantar Fasciitis

Cortisone shots can be helpful for a variety of running injuries, including plantar fasciitis. Some runners, and some health professionals, caution against this because of the risk of fat pad atrophy. But a good podiatrist can do this shot with minimal discomfort, and it just might help.

It's still important to keep up with icing and stretching of the calf, and wearing supportive, comfortable shoes helps, too. And rest (relatively, which for some runners means fewer hills and less mileage) can't hurt.

But don't rule out cortisone out of fear or horror stories that you read elsewhere online. Just make sure you get your shot from an experienced podiatrist.

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Recover Cautiously

Recovering from a running injury is about the hardest thing a devout runner of any experience level has to do. Especially when you are almost healed, it can be tempting to push the envelope. Obviously, you have to move forward as part of recovery, but try as hard as you can to take it slow. And sometimes there is a setback. If you felt pretty good on your Sat. long run and wake up extra achy on Sunday, take an extra day off, or cut short your plans. I had a plantar fasciitis flare-up after a 13-mile run, and made myself stop with only 3 miles the next day because it felt pretty bad when I woke up, so I settled for a short run "just to get the blood flowing" although it would have been just as wise to take the day off.

When you're recovering, think slow and steady. It's hard, but you'll get there. And when you're back to your regular routine, you'll barely remember how annoyed you were at the interruption.

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Plantar Fasciitis: Night Splint Savvy

If your podiatrist recommends a night splint for plantar fasciitis, give it a try. Based on my experience, I think it does help reduce the "first thing in the morning" pain. If you find that it rubs your foot (which is what happened to me), try wearing a sock instead of putting the splint over your bare foot.

That said, if you are coping with plantar fasciitis and wearing a night splint, don't stop stretching and icing the foot, and take Advil or an anti-inflammatory of choice to help with your recovery. Use all the tools you have!

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Neuromas: Surgery Is The Best Treatment

Surgery is a last resort for most running injuries. But if you reach a point where conservative methods fail and you want to continue running, surgery may be necessary. In some cases, a simple surgery is the easiest and most effective treatment.

A neuroma is a common foot injury for which surgery provides the most effective long-term solution. A neuroma occurs when the bones of the foot move in a way that causes a nerve to shear off and start forming a piece of scar tissue. Over time, the piece of scar tissue will become larger, and eventually it becomes large enough to press on the nerve and cause pain. You may have a neuroma if you notice a tingling sensation every time you step, but there are no outward signs of redness or swelling.

The most common site for a neuroma is between the third and fourth toes, although it can occur anywhere in the foot. Non-runners develop neuromas, too. Some people can get sufficient relief by wearing wider shoes or by getting an occasional cortisone shot, but the most effective treatment, especially for runners, is a short, outpatient procedure in which the foot surgeon uses a pair of surgical scissors to cut out the neuroma.

If you have surgery for any kind of running injury, get a recommendation for a surgeon who has experience in dealing with athletes, and pay attention to the surgeon's instructions about post-operative care. You can cross train by walking, biking, or pool running after many types of surgery, but be sure to return to running gradually. If you have dissolvable stitches (which are used in neuroma surgery), avoid excessive stress (such as running) on the area until the stitches have dissolved, which takes about 6 weeks.

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Basic First Aid Revisited

Most people know the maxim RICE: Rest, Ice, Compression, and Elevation. This basic first-aid principle applies to most running injuries.

From a runner's perspective, rest can mean no running, or it can mean a shorter run. Ice means putting ice on the sore spot, using an Ace bandage for compression and for holding the ice pack in place. Elevation may not be possible depending on the injury, but if you have a foot injury and you can spend 20 minutes lying down with your foot elevated above the level of your heart, you will promote circulation and help with healing. I would add an M to this acronym, for mobility. Once the swelling decreases, start some stretching exercises to increase the circulation to the injured area and cut down on the formation of scar tissue.

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Battling Blisters

Blisters may be the most common of all running injuries, but they are among the easiest problems to treat and prevent with no long-term ill effects.

If you have a small blister that is not too painful, cover it with a bandage and go on with your day. The blister will probably rupture on its own. But if you have a larger blister that is painful, you may need to drain it. If it is very large (more than an inch) and severe, you may want to see your podiatrist, but you can take care of small blisters yourself with these steps:

• Get some cotton balls, a safety pin, rubbing alcohol, and a band-aid.
  
• Clean the blistered area with rubbing alcohol using individual alcohol wipes or an alcohol-soaked cotton ball.
  
• Use another wipe or cotton ball to clean the pointy tip of the safety pin.
  
• Gently poke the pin into the edge of the blister where you feel the most liquid underneath and push on the area gently to coax as much fluid out of the pinhole as possible. Blot the area with a tissue or cotton ball and put a band-aid over it.
  

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