How podiatry can
help you achieve a better PB
With all the advice that’s around, sometimes it’s easy to
feel a bit over-whelmed! As a MSK podiatrist, I’d like to share some insights
as to what podiatry is and how a podiatrist may be able to help you.
Information is power… you can then use the knowledge you have to act in a way
that meets your needs and to do what feels right for you!
What is a podiatrist
and how can a podiatrist help a runner?
Podiatry is a field of medicine which focusses primarily on
the feet and lower limbs. Some podiatrists, however, will consider problems
further up the body, including the back, when addressing symptoms.
There are many branches of podiatry which most registered
podiatrists study whilst completing their university degree. Some of these
Routine care (you may be familiar with what a
MSK otherwise known as musculoskeletal (it’s a
bit of a mouthful, hence we refer to MSK!)
Most people will appreciate that if you have a sore foot, it
can seriously hamper your training. The two branches of podiatry that are of
most relevance to runners are routine care and MSK. Since I am an MSK
podiatrist, this article will focus mainly on that, however I will firstly
touch on routine care podiatry.
When cutting your nails, make sure they are short and follow
the contour of the nail. Don’t cut down the sides but also don’t cut straight
across since this can leave sharp corners which can pierce the flesh.
Deal with any signs of infections such as pus or open
lesions by soaking your feet in salty water and applying antiseptic with a dry
dressing. Your feet sweat a lot – running shoes are the perfect breeding ground
for micro-organisms so don’t let small infections get out of hand.
If you have a corn, it will feel like a small stone. Corns and
hard skin occur over areas that are subjected to a lot of pressure. This
pressure may be due to shoes, but it can also be due to poor foot mechanics
(i.e. the way you walk). If you have a corn, do not use a corn pad – these pads
contain an acid which can burn the healthy skin as well as the corn itself.
Verrucae, on the other hand are simply warts that occur on
the feet. These are caused by a virus and will therefore not necessarily occur
in places that are subject to pressure. They tend to have little black dots in
the centre and can be painful if squeezed. Sometimes verruca do not cause any
discomfort and may disappear by themselves. If you think you have one, keep an
eye on it… if it gets bigger, get it treated since they can be very painful and
difficult to treat when they are bigger.
If you have a skin or nail problem that’s troubling you or
has the potential to get out of hand, go and see an HCPC registered podiatrist.
Try also to figure out why you have a particular problem and deal with the
cause to ensure it doesn’t reoccur.
MSK podiatry concerns itself with the mechanics of the lower
limbs. A person’s foot has many bones, muscles and other soft tissues which all
work in harmony with each other, allowing the foot and ankle to move in
different directions during the walking or running cycle.
Little groups of these bones and muscles work together to
move in precise directions during walking or running. Each joint has a
particular range of motion. If these particular movements do not occur when
expected, or if a joint is very stiff and can’t achieve its full range of
motion, an individual will compensate for this problem. This is done by
engaging and over-working other muscles and joints. These other muscles and
joints that are being over-worked may not complain to start with, but
eventually aches and pains occur!
Many people go to see an MSK podiatrist when they are in
pain, but other people like to seek advice before problems occur in an attempt
to avoid injury. An assessment usually involves checking the range of motion at
different joints and using an electronic scanner to determine how the foot
moves and how pressure is distributed. Sometimes other technology including
videos and treadmills are used.
If the foot is moving in a direction that it shouldn’t be,
medical insoles called orthotics may be prescribed. In some instances, footwear
or lifestyle changes do the trick and orthotics are not necessarily required.
It’s worth noting that if orthotics are recommended, it can take up to three
months for them to work properly. Whilst they are starting to do their job,
there are, of course, other things that can be done to help alleviate pain. Many
people feel frustrated that there is no instant ‘quick fix’ – this is just how
the body works.
Why do aches, pains
and injuries occur?
Many experienced runners can run for years injury free then
suddenly develop problems. Often, analysis of this person’s lower limb
mechanics will reveal that their feet naturally have a tendency to move too
much in a particular direction when they walk. The fact that this excessive
movement has not created any problems in the past will likely be due to the
fact that other muscles and joints have happily compensated.
Aches and pains often occur when ‘something’ changes. That
‘something’ is often:
A new pair of running (or other) shoes
A change in training regime
A new job
Returning to training too soon after injury or
Physiological changes that naturally occur in
the body due to ageing
The first three points mentioned i.e. the new shoes or
change of routine are the most common culprits. Often, however, any change may
not evoke symptoms immediately – it can take weeks, sometimes a couple of
months for the aches and pains to appear.
Individuals who increase their distance too quick or who
introduce a regime that their body is not used to, are particularly prone to
injury. First time marathon runners often get into difficulty a month or two
before the big day. Often by that stage their injuries force them to deviate
from their training plan – sometimes having to pull out of the race altogether.
The place for orthotics
and other treatments
It’s important that a runner can make an informed decision
when it comes to support and rehabilitation. As someone who understands the
power of orthotics and how they can aid (or even hamper) an athlete’s progress,
I believe it is important to explain how they work.
Basically an orthotic is an insole that has thicker bits
stuck on at the front or back (or shaped into the insole itself), bits cut out,
bumpy bits added or softer bits added in particular places. They are more expensive
than shop bought insoles, ranging from £120-£320. This is not because the
finished product is expensive, but because the professional prescribing the
orthotic has an in-depth knowledge of lower limb mechanics and knows exactly
where the additions should be added. To look at them, they may not look like
much, but the subtle differences in thickness of only a few millimetres can
make a huge difference. People who have endured pain for years suddenly find
they are symptom-free.
As previously mentioned, it takes a few months for orthotics
to work. Whilst they will change lower limb mechanics, if worn regularly,
alleviate symptoms and reduce the incidence of injury – they are not a cure.
You cannot ‘cure’ bad foot mechanics. Just as you would lose tone and fitness
if you were to stop running for a few weeks, your bad foot mechanics would
return if you were to stop wearing your orthotics for a period of time.
If you wear orthotics that have additions added in the wrong
place, this can cause longer term detrimental effects that may not be obvious
to start with. It is therefore important to seek advice, not only from an HCPC
registered podiatrist, but a podiatrist who specialises in MSK conditions.
When it comes to the material of the orthotic, there are various
options. Many orthotics are made out of harder plastics which, although are
very efficient and tolerated in walking shoes, tend not to be tolerated as well
in sports shoes. That said, since walking and running gaits (cycles) are quite
different, it may be that one may have orthotics in their work or walking shoes
but they are not required in their sports shoes.
My preferred choice of material is EVA – ethyl vinyl
acetate. It is softer, compresses with the heat from your foot yet offers the
required support for two to five years. Many top athletes in the U.K. wear
orthotics made from this material in their sports shoes, since they are
When looking at treatment options, don’t just rely on one
professional. Many people call the physio in the first instance, but MSK
podiatry also has its place. Other people rely solely (excuse the pun!) on
their orthotics to do the job, but a combined approach, including treatment
from other health professionals often helps to achieve the best results. It’s
best to seek advice from a registered professional who works within a
multidisciplinary clinic and is open to bouncing ideas off of different team
For example, since I know that orthotics take a while to
work, I call upon my physio colleagues to help rehabilitate patients in the
meantime. My physio colleagues, on the other hand, often seek advice with
regard to specific lower limb problems of which they have no experience in
dealing with. They also refer patients they have treated for symptomatic relief
since they understand that the orthotics I prescribe have longer term
benefits. No health professional knows
everything – a team approach is always best!
What can you do to
See an MSK podiatrist for an in-depth mechanical
assessment of your lower limbs. A lot of running shops offer similar
assessments. Whilst they can be beneficial, staff in these shops lack the
professional expertise and in-depth knowledge that an MSK podiatrist has
Find a brand of shoe that works for you and stick
with it. If you’ve been running for a while, have worn the same brand and style
of shoe and have avoided injury, my advice would be to stick with that
particular shoe. If you do suddenly encounter and injury, it will likely be due
to one of the reasons mentioned previously. Go and seek professional help –
don’t ignore a niggle since it could lead to something worse. Taking two or
three days off of training is surely better that being out of action for two to
Don’t try to go from zero to hero overnight.
Setting yourself unrealistic goals could hinder your progress longer term since
you’re more likely to injure yourself. Increase the distance gradually and
incorporate different physical activities such as weight training and yoga into
your weekly routine
Finally… ask questions and be
realistic. Understanding a bit about how your feet work and what you can do
will enable you to have happy healthy runs and achieve that PB you’ve been