By all accounts, 1997 was to be the year Bob Kennedy's face found its way onto a Wheaties box. The year before, at 26, he'd broken an 11-year-old U.S. record in the 5,000 meters, becoming the first person not from Africa to run the event in under 13 minutes. In an all-out effort to close in on the event's top dog, Kenyan Daniel Komen, he upped his mileage and shed some weight by switching to lighter shoes. Then came the pain. At first it felt like little more than a bruise — understandable, given that his feet pounded 100 miles of pavement each week. After several months more of training, he could hardly walk at all.
Kennedy had strained his left plantar fascia, a band of tissue that runs along the bottom of the foot, and would be sidelined until it healed. "I think athletes can be really stupid about their own bodies," says Kennedy, somewhat sheepishly. "If a friend had come to me and said, 'I'm having a little heel pain,' I would have told him to get it checked out. But it was me — I guess I thought I could run through it." Ten months would pass before he could run without pain, and it wasn't until last fall that he was back up to full speed.
Perhaps it's surprising that such an inglorious ailment sneaked up on a professional athlete like Kennedy. But it doesn't bode well for the rest of us, who pay even less attention to our crucial yet oh-so-vulnerable feet. Indeed, they are the athlete's most commonly injured anatomical feature, with roughly 3,000 things that can, and often do, go wrong. And that's not counting ramifications for the legs, hips, and back. The most prevalent problem is injuries of overuse, which can manifest themselves in a host of debilitating ways, such as shinsplints, stress fractures, Achilles tendinitis, and yes, plantar fasciitis.
The good news, however, is that such injuries unfold gradually, so if you nip them in the bud, you can easily get back on track. "Most people pooh-pooh foot pain," says William Olson, a podiatrist who treats players for the San Francisco Giants. "I'm always surprised when someone shows up in my office and they've only had pain for two weeks. But the length of time you've been in pain is directly proportional to the amount of time it's going to take to heal."
The Underlying Problem
Despite their propensity to undermine our most lofty athletic ambitions, the lowly feet are an engineering marvel. Possessing 56 bones, 66 joints, 214 ligaments, 38 muscles, and six arches, our two humble locomotors do a considerable amount of work as part of their daily routine. The average person takes nearly 10,000 steps a day — enough to chalk up four laps around the globe over the course of an average lifetime. And when running, the force of each step can equal four times your body weight. Yet cruel as the joke may seem, the same intricate architecture that makes our pedestals so sturdy leaves them unduly prone to injury.
For Kennedy, trouble started innocently enough, with an overly cushiony pair of new running shoes that changed the angle of his footfalls ever so slightly. His case gets at the core of all overuse injuries of the foot: biomechanics. A normal foot will strike on the outside of the heel; roll in, or pronate, about five degrees; and then roll back out slightly for the toe-off. If your foot is aligned as it should be during the toe-off, the bones and ligaments tighten as if they were conducting an electric current and provide an unfalteringly firm platform. But any misalignment at this moment shifts the burden of support to the muscles, tendons, and ligaments along your lower legs and knees, sending strain rippling up toward your lower back.
Like 75 percent of us, Kennedy's feet roll too far toward the centerline of his body — a biomechanical misstep called overpronation. "If you overpronate, it basically unlocks your foot so you have to recruit all the structures on the inside of your leg to compensate," says Perry Julien, podiatry coordinator for the 1996 Atlanta Olympic Games. The nastiest upshot of this is plantar fasciitis. If the foot's rolling causes the arch to collapse, the band simply gets stretched too far and tears where it connects to the heel bone. At first you'll get the bruising feeling that Kennedy ignored; later, you'll get larger problems. Treated promptly, plantar fasciitis can be a slight annoyance rather than a crippling malady. The best advice, says Julien, is to slip on a pair of athletic shoes before you hop out of bed in the morning: The plantar fasciae tighten at night, so if you step flat on the floor first thing, you run the risk of re-straining them. As for treatment, try gently rolling your heel on a golf ball for a few minutes every day.
If you don't overpronate, you might have the opposite problem: oversupination, the foot's inability to rotate enough. These unlucky few — 4 percent of the population — have arches so high that they're virtually incapable of absorbing shock. Aside from plantar fasciitis, oversupinators suffer the same host of problems as overpronators — tendinitis, stress fractures, strains — but in different areas of the feet. There's little the medical world can do for these ailments, so the first-resort treatment is to follow the old rule of rest, ice, compression, and elevation (RICE). Give your feet a week of TLC, and if you're still hurting, see a doctor.
Whatever the origin of your biomechanical woes, it's crucial to know what you're dealing with. So take a closer look at your trotters. To find out whether you overpronate or oversupinate, self-administer something called the wet test. Douse the bottoms of your feet and tread on a grocery bag (paper, not plastic) or a section of newspaper. If your footprint shows the full-width outline of your paw, you overpronate. If the print looks like it's had a bite taken out at the arch, you have a normal foot. And if your footprint leaves an archipelagolike impression, with the ball and the heel separated like two distinct islands, or with only a thin isthmus connecting the two, you oversupinate.
Your best defense is to get the right shoes. Overpronators should bypass any shoe with a significantly curved last in favor of a straighter-soled, stable model with "motion control" features. You want dual-density midsoles (with soft rubber at the outside and firmer stuff under the arch), reinforced heel cups, firm carbon-rubber outsoles, and a last that's either full- or three-quarter-length fiberboard. Beware of extra cushioning as well, for as great as it may feel, it can cause your feet to slop around. Oversupinators, however, need all the cushioning they can get, since their problem is dead shocks. And regardless of what problems your feet have, you need to make sure your athletic footwear fits properly (see sidebar at left).
While it's always worthwhile to invest in good shoes, some people will need orthotics to correct their biomechanics. "It doesn't hurt to start with the orthotics they sell at the drugstore," says Julien. For an over-the-counter fix, he suggests that overpronators buy full-length arch supports made of neoprene or some other soft material. Oversupinators can go with any style, the only requirement being cushioning. "If you find that you still have pain," he says, "you probably need to get a custom pair made."
As for Kennedy, sturdy new shoes eased his affliction — but only after squandering an entire season. "Mentally it was very hard," he says. "The rest of me was ready to train, but my feet were down — which meant that everything else was down, too."
Legwork for Sturdier Feet
Conditioning your lowest extremities requires that you pay heed to muscles beyond those that fit into your socks — namely, the hamstrings, calves, and their siblings in the legs, which are connected to points around the heels via powerful tendons. "You can't think of your feet as separate entities," says Lisa Schoene, a noted Chicago-area trainer and podiatrist who treats professional athletes at events such as the Chicago Triathlon. "They're like puppets, and all the muscles in your legs are pulling their strings." If those muscles are too tight or too weak, your feet don't stand a chance. Tight calves and hamstrings, for instance, inhibit the feet's range of motion and may cause them to overpronate. And if the leg muscles aren't strong enough to absorb the shock from the heel strike, the feet's smaller muscles and bones take the stress instead.
Thus a vigilant plan to fortify your feet includes stretching and strengthening the tiny, hard-working muscles of the feet as well as those that extend up the legs. The following set of exercises provides a complete regimen that you can do three times a week. Warm up for five minutes first — and of course, you'll have to remove your shoes.
This move asks a lot of both your hamstrings and calves. Stand with your feet spread at hip-width and keep your legs straight but not locked. Fold at the waist and place your palms down about three feet in front of you, just wider than your shoulders. Now, work to push your heels to the ground and drop your head. Hold for 30 seconds; repeat twice.
Sitting on the floor with both legs extended and your back straight, loop a rope around one foot. Flex the foot toward you, using the rope for gentle assistance at the finish of the stretch. Hold it for four seconds and then release; repeat 12 times with each leg.
Kneel on the floor with the tops of your feet flat against the ground and sit back on them. Using your hands, push against the floor to lift your knees and balance your weight on the tops of your feet to stretch the muscles within. Hold for 30 seconds; repeat twice.
Sitting in a chair, spread a towel in front of one foot. Using only your toes, scrunch the towel up under your foot, drawing it in toward you until you've reached its end. Now reverse the process, pushing it out from under your foot. Do three sets of 12 repetitions with each foot.
Sitting on the edge of a counter with your legs together, tie an exercise band around the tops of your feet (the tighter you tie it, the harder the exercise). Keeping your heels together, spread your forefeet apart, and then relax them. Next, tie the band around your feet with your ankles crossed. Push one foot out to the side, relax, and then repeat with the other foot. Do each exercise ten times.
Wearing shoes and standing at a table for balance, slowly raise up on your toes. Ease yourself slowly back to the floor. Work up to one set of 100 repetitions.
Brenda DeKoker Goodman is an oversupinator and an avid runner and swimmer.