Now that we have that bit of blaspheme out of the way, let's talk There is no such thing as an "injury-free" sport. The good news is that if you do choose to take up regular walking, you can expect to achieve a combination, or perhaps all of these benefits, just to name a few.

Decreased blood pressure. Decreased total cholesterol. Decreased LDL cholesterol. Increased HDL cholesterol. Lower resting heart rate. Increased stroke volume of your heart. Increased lean body mass. Decreased body fat. Increased physical strength. Increased physical endurance. More balanced blood glucose levels. More even moods. Increased ability to think creatively. Improved sleep patterns.

There's also no such thing as an "injury-free" daily life. If you're like me, there's been at least one occasion this year when you've whacked your knee on your desk or smacked a doorjamb with your forehead or found absolutely no humor in hurling your funny bone unceremoniously into an immovable object like a wall!

Likewise, there are some predictable bumps and boo-boos you could expect from a regular walking program. The most benign of these are things like corns, callouses and blisters. For the most part, these are irritating but manageable. They are relatively easy to treat, may only occur under certain conditions such as, hot or rainy weather and pretty unlikely to interrupt your training for long if at all.

Other injuries are more complex. These include a range of conditions from plantar fasciitis to bunions to fractures. These all have the potential to sideline weight bearing activity for a few days to weeks. Typically, if your training results in one of these, you can point to one of four causes:

1. Training errors, including trying to do too much too soon,
2. Inadequate equipment such as, overused shoes,
3. An underlying biomechanical problem or,
4. Trauma--i.e.: you twisted your foot on a trail.

With proper diagnosis and treatment designed with the goal of returning to activity as soon is it is sane to do so, all of these injuries can be overcome. Armed with information on how to identify and treat those conditions which may surface periodically in your training, you may be able to implement strategies that will allow you to treat the problem quickly enough to avoid losing any training time. --EJH

What: A blister is simply a separation of tissues in the outer layer of the skin that becomes fluid-filled. Blisters may occur superficially or deeper within the skin, and are the result of repetitive friction on the skin.

Probably Cause: Heat and moisture, thought sometimes unavoidable, make the skin more susceptible to blistering. Improperly fitted shoes, socks with bulky seams or socks made of materials that don't adequately which moisture away from the skin are common causes of blisters. Thick callouses may cause irritate of the deeper skin, resulting in a blister below the callous/. Finally, excessive motion of the foot during walking, as may occur in a walkers whose feet roll inward (pronate) excessively with each step, may be an underlying cause of recurrent blisters.

Prevention: Make sure you have at least a half-inch of room beyond your longest toe when fitting walking shoes. Socks that contain materials with special wicking properties (e.g., Coolmax® or polypropylene) tend to reduce the likelihood of blistering. 100% cotton socks are not a good choice as cotton tends to retain a significant amount of moisture and hold it against the skin surface. Choose socks that are seamless or have flat seams. Use a pumice stone after bathing or showering to keep thick callouses under control.

Treatment: Leave the roof of a blister intact if possible, since an intact roof makes the blister less painful and less susceptible to infection. You may drain the fluid from a blister while leaving the roof in place. First, clean the blister well with soap and water. The, sterilize a needle by heating the tip over a flame until it is red, and allowing the needle to cool. Gently puncture the roof the blister near the edge with the sterilized needle. After draining the blister, apply an antibiotic ointment and bandaid. Never apply adhesive moleskin or felt directly over a blister, as this may cause it to enlarge. A doughnut-shaped pad around a blister or a moist dressing, such as, 2^nd Skin®, is often helpful. Seek professional care if redness around the blister or cloudy drainage occurs, or if you feel uncomfortable treating the blister yourself.

What: Corns and callouses are a thickened outer layer of skin, and commonly occur on the toes and sole of the foot. Corns generally refer to this condition when it occurs to the toes while callouses occur anywhere else on the foot.

Probable Cause: Poor-fitting shoes may cause pressure points on the toes, and are a potential cause of corns. More commonly, corns are caused by toe deformities called hammertoes. Hammertoes appear as "buckles" or "bent" toes, causing pressure points and ultimately corn on the toes. This may occur even in properly fitting shoes.

Callouses on the feet are not necessarily problematic unless they are excessively thick, painful or cause cracking of the skin. Remember that everybody's feet are a little different and points of pressure and friction during walking will vary between individuals.

Prevention: The best weapon in the battle against corns and callouses is a comfortable, well-fitted, quality walking shoe. Use moisturizers to keep the skin more supple and use a pumice stone after bathing to help keep callous formation to a minimum.

Treatment: If corns or callouses are present but not painful, no treatment is necessary. If corns or callouses become problematic, use of a pumice stone or callous remover after bathing may be helpful. Professional treatment by a podiatrist may involve: gentle shaving of the corns or callouses, custom foot orthoses (shoe inserts) to reduce pressure and friction, or surgical correction of the underlying foot or toe deformity.

What: An ingrown toenail is a painful condition that occurs when a nail presses into the adjacent skin causing a break in the skin. Infection often follows. Telltale signs of an ingrown toenail are: tenderness, redness or puffiness of the skin adjacent to the involved nail.

Probable Cause: Ingrown nails occur for various reasons. Two common causes are shoes that are too short or too narrow and, improper cutting of toenails. Variations in the shape of toenails can predispose some people to recurrent ingrown toenails.

Prevention: Make sure your walking shoes provide adequate room for your toes. You should be able to comfortably wiggle your toes inside your shoes. It is best to trim your nails straight across. Avoid cutting down into the corners of the nail.

Treatment: Self-treatment may consist of soaking the affected foot in warm water with Epson salts and applying an antibacterial ointment to the affected toe. Professional treatment for persistent or recurrent ingrown nails may involve partial removal of the side border of the nail which is usually very effective in resolving the pain and discomfort quickly.

What: Plantar fasciitis (pronounced: "plant-er fashy-it is") is a common condition resulting from inflammation of a ligament-like structure, the plantar fascia on the sole of the foot. Common symptoms include: pain on the under surface of the heel or arch of the foot, often at its worst when arising out of bed in the morning or, after activity.

Probable Cause: Inadequate shock absorption from worn-out shoes, shoes with inadequate support, a sudden increase in training (either mileage or intensity), weight gain, hard walking surfaces or work requiring long periods of standing are all common causes of plantar fasciitis. Often it is difficult to identify a single definite cause.

Prevention: Replace walking shoes before they are worn out, preferably on a regular schedule. Learn what type of shoe is best for your particular foot type. Some foot types require more shock absorption and others require more support. Follow the "10% Rule" and limit increases in your walking program effort (mileage or intensity) to no more than 10% per week. Try to vary the surface on which you walk. Trails with even terrain are easiest on your feet. Asphalt offers more shock absorption than cement.

Treatment: Treatment involves both reducing inflammation and providing support and cushioning for the foot to minimize further stress on the plantar fascia. To reduce inflammation, use an ice pack on your foot following exercise. Over-the-counter anti-inflamatories such as, ibuprofen may be helpful. Replace worn-out shoes if necessary and wear quality, supportive shoes as much as possible during the day. Over-the-counter arch supports are sometimes helpful. If you don't notice improvement with these courses of action, seek professional care. A podiatrist may prescribe athletic taping, foot orthoses, physical therapy and/or more effective anti-inflammatory medications.

What: A deformity of the big toe joint, a bunion, appears as a bump along the inner border of the foot, and deviation of the big toe towards the adjacent second toe. Common problems with bunions include pain or irritation over the bump, tired, aching feet and difficulty fitting shoes.

Probable Cause: The exact cause of bunions has been debated for decades. Heredity, foot type and an imbalance of muscle forces acting at the big toe joint during walking largely influence their development. Poor shoes may contribute, but are no longer believed to be a primary cause. Bunions progress slowly over many years, and are not always symptomatic.

Prevention: Since heredity plays a major role in the development of bunions, prevention is difficult. If you have "flat feet" and a family history of bunions, supportive shoes and prescription foot orthoses may help slow the progression of bunions. This has not been proven conclusively, however, in long-term studies.

Treatment: If you have bunions but experience no discomfort during or after activity, treatment is not essential. Treatments of symptomatic bunions may vary from simple shoe padding to alleviate discomfort to surgical correction. This is the suggested first course of action. Because bunions are a structural problem, surgery is the only form of treatment that actually corrects the bunion. Bunion surgery should only be performed by a physician/surgeon who specializes in the foot.

What: A Morton's neuroma is an enlarged, inflamed nerve bundle that causes pain in the ball of the foot. Symptoms vary, but usually include either 1) burning, aching or sharp radiating pain in the ball of the foot or, 2) numbness, tingling or pain affecting one or two adjacent toes or, 3) a sensation of "fullness" in the ball of the foot.

Probable Cause: Repetitive injury to a nerve from adjacent bone and ligament is believed to be the underlying cause of Morton's neuroma. Repetitive impact on the ball of the foot, as may occur with sports such as basketball, and shoes ore hosiery that constrict the front part of the foot can aggravate a neuroma.

Prevention: The best way to minimize your chances of developing a neuroma is to wear shoes that are comfortable and that fit well. Avoid narrow, tapered shoes, as these are the most common culprits with this condition.

Treatment: Identify those shoes that seem to consistently aggravate your symptoms and avoid them. If this is not effective, professional care is recommended to rule out other conditions and to treat the nerve inflammation. Surgery is sometimes necessary to remove the inflamed nerve bundle.

What: A stress fracture is a small crack in the outer layer of a bone. These occur when a bone is unable to keep up with the demand placed upon it. Any bone may be involved, but most commonly involved are the long bones of the foot. Pain and swelling in the front part of the foot that worsens with activity suggest the presence of a stress fracture.

Probable Cause: Stress fractures most commonly occur when training is incr4ased too rapidly with inadequate rest. Repetitive impact on hard, unyielding surfaces or inadequate shoes makes stress fractures more likely. Certain foot types or biomechanical variations may predispose an athlete to recurrent stress fractures despite good training techniques.

Prevention: Increase training gradually to allow your body time to adapt to the increases in mileage or intensity. Follow the "10% Rule: --increase effort by 10% or less of total walking per week. Replace walking shoes before they wear out, preferably on a regular schedule. Cross training or varying your activities may make overuse injuries such as stress fractures less likely.

Treatment: Professional diagnosis is required, followed by rest to allow the bone to heal. A cast or healing shoe may be necessary. All impact activity (walking, running, aerobics, etc.) should be avoided to prevent the stress fracture from progressing to a complete fracture. Continued activity will only lead to more pain and potential complications. Non-impact activities such as swimming may be substituted to main train cardiovascular fitness during the recovery period as long as you have the blessing of your physician. Custom foot orthoses may be prescribed when stress fractures are a recurrent problem.

 

Guidelines for Seeking Medical Attention To Self-Doctor or Not-to-Self-Doctor? Early recognition of minor injuries and self-care can be very beneficial. In some cases, though, professional treatment is not only wise by necessary.

1. If you sustain a sudden injury followed by swelling, pain or difficulty walking, seek professional treatment as soon as you can.

2. In the meantime, follow the simple rule of R.I.C.E.--Rest, Ice, Compression and Elevation. Stay off the injured foot, apply an ice pack to the injured area and use an elastic wrap to minimize swelling. Keep the injured foot elevated.

3. Any injury that causes difficulty walking and does not improve with initial self-treatment, regardless of whether it was a sudden injury or not. Should be evaluated by a professional. If treatment is delayed, secondary injuries resulting from compensating for the initial injury may occur.

4. If redness, swelling, cloudy drainage or red streaks occur as a result of a blister or ingrown nail, professional care is a necessity. These usually indicate that infection is present.

5. Finally, people who are diabetic should take no chances with their feet as simple problems have the potential to become major problems when diabetes is present. Ingrown nails, blisters, a physician should evaluate swelling or pain involving the foot as soon as possible.

Dr. Turcic
currently practices in the Department of Podiatric Medicine,
Kaiser Permanente, Portland, Oregon.

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