Walking Injuries

Walking can result in a variety of foot injuries, but most can be avoided by following the advice below. We've broken this information down by each part of the foot.

The toes. If you begin a walking program wearing shoes that are long on fashion and short on comfort, your toes will almost certainly let you know what a mistake you've made. Most toe discomfort results from poorly fitting shoes.

The length, width, and shape of your feet can -- and do -- change. With age, the ball of the foot tends to widen and the toes tend to spread. Therefore, you should have your feet measured each time you shop for shoes.

The size marked on a shoe doesn't really tell you whether it will fit your foot. Some manufacturers' sizes run large, while others run small. Select a design that matches the general shape of your foot as closely as possible. One way to do this is to trace your feet on a sheet of paper. Then, when you go to the store, compare your tracing to the bottoms of various shoes.

When you try on a pair of walking shoes, be sure they fit well in the toe area, too. One of your feet is probably larger than the other, and that bigger foot is the one you'll want to fit. Ideally, there will be a half-inch space between the end of the longest toe of your bigger foot and the inside end of the shoe.

Each shoe's "toe box" (the part of the shoe that cradles the toes) should be high, long, and wide enough to accommodate your toes comfortably.

Corns. Corns are small, round mounds of dead skin caused by friction. Hard corns, the most common type, are dry and found most often on the outside of the smallest toe or on top of the other toes; soft corns are moist and usually appear between the toes.

In some cases, you can relieve corns by opting for shoes with softer uppers and toe boxes that are wider, longer, and higher. Cushioned pads or insoles can also offer relief by shifting pressure away from corns. If these efforts do not provide relief, see a podiatrist. Never attempt to remove a corn yourself.

Ingrown toenails. Few things are more aggravating to a walker than ingrown toenails. Ingrown toenails are nails, usually of the big toe, that curve inward along the edges of the nail bed, causing pain, redness, swelling, and even bacterial infection.

To prevent ingrown toenails, you need to keep your toenails trimmed. However, be careful not to taper the nails or trim them too short in the corners. Instead, trim the toenails straight across with a nail clipper.

Ingrown toenails can be aggravated by toe boxes that are too tight, so switching to a shoe with a wider toe box may help to relieve discomfort. Soaking the affected toe in warm, soapy water may also provide temporary relief. If the area around the ingrown toenail is severely swollen and painful, see your podiatrist.

Bunions. A bunion is a deformity of the big toe joint in which the joint juts outward and the big toe angles inward toward the other toes. Although the tendency to develop this condition can be inherited, wearing pointy, high-heeled shoes or shoes that are too tight in the toe area can aggravate the condition. As the joint becomes more inflamed, the bunion grows and becomes more swollen, tender, and painful.

A podiatrist may begin treatment by having you wear wider shoes and by prescribing a custom-made shoe insert called an orthotic (also known as an orthosis). The orthotic is made to compensate for the abnormality in the foot's shape and to shift weight away from the problem area.

If the bunion is already very large and painful, and if it interferes with walking, then surgery is frequently the only way to relieve the problem. In bunion surgery, the toe joint is realigned and excess bone may be removed.

Hammertoes. Hammertoe is a deformity in which a toe (or toes) hooks downward like a claw. Although the tendency to develop this condition can be inherited, high heels or shoes that fit too tightly in the toe area can also cause the condition. If the toe is severely hooked and painful and interferes with walking, your physician may prescribe an orthotic to reposition your toe properly. A corrective surgical procedure can also be used to treat some cases.

More walking-related foot injuries, their causes, and prevention tips are included in the next section.

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There's no need for a walker to be plagued with foot problems. Taking good care of your feet and wearing properly fitting shoes can help ward off injuries like these.

Neuromas. A neuroma is an abnormal collection of nerves that becomes irritated and inflamed. Neuromas occur between the bases of two toes, usually the third and fourth ones. Again, tight-fitting shoes can aggravate this condition.

Neuromas can cause stabbing pain or a numb sensation. Soaking in warm water may help relieve the discomfort. Your doctor may prescribe an arch support or a special pad that can be placed inside your shoe to spread the nerve-pinching toes apart. Surgery to remove the neuroma can also be preformed.

Metatarsal stress fractures. The metatarsals are the long bones in your feet that are attached to the base of your toes. From the stress of walking, the metatarsals can develop fractures so small that they may not even be visible on an X ray. Often, they don't have to be splinted or put into a cast; they simply heal by themselves. But healing takes time, sometimes a month or two, and you'll probably have to suspend your walking program until this healing process is complete.

Blisters. These pockets of clear fluid or blood are common ailments. Regardless of the type of shoe worn and the protective measures taken, foot blisters continue to pose a problem for many people. They become a major problem only when they are severe enough to affect the quantity and quality of walking or when they become infected.

Foot blisters are caused by friction. The best way to prevent blisters is to prevent the friction that causes them. Here are some recommendations:

When a blister does develop, you can prevent infection by keeping the area clean. Do not puncture blisters. Leave them alone; bit by bit, they'll drain internally. If a blister ruptures, do not remove the skin; it serves as a protective covering. After a gentle cleaning with soap and water, place a pad of gauze over the blister.

Resting the foot will aid healing. Consult your doctor or podiatrist at the first sign of infection, such as redness or pus. If you have diabetes or circulatory problems, consult your doctor at the first sign of a blister, no matter how small; do not attempt to treat it yourself.

Calluses. A callus is a thickening of the skin that results from pressure or friction. A moderate amount of callus formation is normal; it's one way the foot protects itself. But when thick, hard calluses form, they can be painful. To help relieve pain, try switching to a shoe with softer uppers and a roomier toe box.

Cushioned pads or insoles, and orthotics, can help. A simple scraping of the calluses by a podiatrist can also yield dramatic pain relief. Never try cutting calluses off yourself.

Walker's heel. This is a term some people use to describe a group of heel problems that include bone bruises and heel spurs. The syndrome usually starts with pain at the base of the heel -- called plantar fasciitis, which involves inflammation of the tissues that attach to the bottom of the heel bone.

Bone spurs are painful bony growths on the bone itself. These ailments may be worsened by walking on a hard surface, stepping on sharp objects, or walking in poorly designed or worn-out shoes. These conditions don't lend themselves to a quick cure. Rest can be helpful, but it is not always convenient for the person who wants to maintain his or her aerobic conditioning.

A heel "donut" is often used to treat problems of the heel. This remedy is nothing more than a foam pad with a hole cut in it. The foam pad is taped over the bone spur, with the sensitive spot protruding through the hole.

Other modes of treatment include strapping the foot with an athletic bandage or switching to a shoe that has a springy rubber sole and a slightly higher heel. (This style of shoe helps shift the pressure of walking from the heel to the ball of the foot.) Soaking your feet in warm water can help relieve pain. If these measures don't work for you, see your physician or a podiatrist.

It's no surprise that the legs can be injured during walking. Next, learn about common leg injuries and how they might be prevented.

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Walking is a great way to strengthen the legs, but walking incorrectly can cause leg injuries. We've listed some common injuries below, along with their causes and self-treatment tips.

Achilles tendon injuries. The Achilles tendon is the thick tendon at the back of the leg that connects the heel and foot to the back of the calf muscles. It controls the hingelike action of the ankle.

Experts in sports medicine have identified three types of problems with the Achilles tendon. The first is tendinitis, which is an inflammation of the tendon. The second is a partial rupture, which is a tearing of some of the tendon fibers. The third is a complete rupture, or a complete break, of the tendon itself. The last two are not common to walkers, because walking seldom puts enough stress on the tendon to actually tear it.

Tendinitis can be caused by a sudden change in routine, such as abruptly switching to sharp inclines after habitually walking on level terrain or suddenly tackling a long hike without progressing gradually from shorter ones. Symptoms of tendinitis are pain and stiffness an hour or so following activity, tenderness, and slight swelling. Tendinitis makes walking very difficult and painful.

Tendons can also become inflamed as a result of ill-fitting shoes. The heels may be too low or too hard, the backs may be so tight that they irritate or strain the tendon, or the arch support in the shoes may not be adequate.

Choosing a walking shoe with a slightly higher heel or inserting a sponge pad in the heel section of your shoes can help prevent the pain of Achilles tendinitis and of heel spurs, according to Charles Gudas, D.P.M, professor of orthopedic surgery and rehabilitative medicine at the University of Chicago Medical Center.

The very act of walking often tightens the tendons even more. To prevent Achilles tendinitis from developing, make sure that you do plenty of stretching when warming up and when cooling down. Stretching exercises can limber up the calf muscles and counteract the tightening effects of walking.

Suggested stretching exercises include standing on the heels of the feet and drawing your toes up as far as possible or standing with your toes on a step and stretching your heels downward. Another good idea is to walk barefoot whenever possible--preferably indoors, so you won't have to worry about stepping on sharp objects.

Self-treatment of tendinitis is summarized by the acronym RICE -- rest, ice, compression, and elevation. If it hurts, stop the activity and rest. Place an ice pack (covered in a thin towel) or a cold compress on the affected area. Then wrap it in a flexible bandage (not too tight), and sit or lie down with your leg elevated. Remember, pain is a message that your body is sending to you. Don't ignore it.

Continue to the next section for information on painful shin splints and knee problems.

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Here are a few more leg injuries that walkers should look out for.

Shinsplints. If you have shinsplints, you will feel pain at the front of the leg, below the knee, when you put weight on your foot. You'll probably also find that your shin is tender to the touch. When you run your fingers along the shin, you may feel a roughened area along the bone.

Although the name implies damage to the shinbone, shinsplints may actually be caused by a variety of problems, including a muscle imbalance; improper body mechanics while walking; a hairline fracture of one of the bones in the lower leg; a muscle spasm caused by swelling of the muscle in the front of the leg; an inflamed or torn tendon in the lower leg; or irritation of the membrane between the two bones of the lower leg.

You can help prevent shinsplints by choosing your footwear and walking surfaces carefully. Sturdy shoes with cushioned soles are a must. If possible, switch from a hard walking surface to a soft one. (At a golf course or local park you can work out on the grass, which is much softer than pavement or track.) You may also want to put a sponge heel pad in the heel section of your shoe to help absorb some of the stress from walking on harder surfaces.

If you walk on a track (or on the side of a road, which, like tracks, tend to have a slight slant), vary the direction of your walks. In other words, instead of always going clockwise, walk counterclockwise on alternate days so that you're not always placing stress on the inside of the same leg.

Walking does a great deal to strengthen the muscles in the back of the leg, but it does less for those in the front. As a result, a muscle imbalance can occur. To compensate, you'll want to strengthen the muscles in the front. Flexing your foot up and down while wearing weights can help.

If you don't have weights to strap onto your feet, sit with your legs dangling, feet not touching the floor, and have a friend hold your feet while you try to pull your toes up. Do this for three sets of ten each day.

The knee. The two main bones that come together at the knee joint are the thighbone and the shinbone. Usually, knee pains are associated with the kneecap -- beneath it or along its sides. Sometimes the kneecap doesn't move smoothly against the lower end of the thighbone as it should, and the knee becomes increasingly irritated and swollen as you walk.

If you have this problem, you may have to limit your walking. But first experiment with different walking methods. Many doctors think knee problems may be caused or aggravated by the way your foot strikes the ground when you walk. (If you walk indoors on a banked track in one direction for long distances, say 20 to 25 laps, your knees may be headed for trouble. Even subtle slopes can cause knee problems.)

Many walkers and runners develop a painful affliction called runner's knee, in which the kneecap moves from side to side with each step. Runner's knee is most often caused when a foot collapses inward during walking (or running). When the foot collapses, the lower leg rotates inward and the kneecap moves to the inside. Repeated foot strikes will adversely affect the knee.

Treatment usually consists of inserting orthotics in the shoes. It's also important for the walker to do leg exercises to strengthen and stretch the muscles on the front of the thighs.

It's important to stretch correctly, however, to avoid injuring the muscles. Muscle problems, including spasms and cramps, are discussed in detail in the next section.

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Walking can cause or aggravate muscle pain. The pain can result from overstretching, poor conditioning, or a host of other sources. Fortunately, there are ways to reduce the discomfort and prevent injuries.

Muscle cramps and spasms. A muscle cramp is an involuntary, powerful, and painful contraction of a muscle. The contraction may occur at any time -- at rest as well as during activity. Cramps usually happen without warning.

Muscle cramps can be caused by fatigue; cold; imbalance of salt, potassium, and water levels in the body; poor blood circulation to the muscles; a sharp blow; and overstretching of unconditioned muscles. You may be able to reduce the odds of getting a muscle cramp by eating a well-balanced diet, by drinking plenty of fluids, by making sure you warm up properly before vigorous exercise, and by stopping activity before you become overly tired.

Once a cramp does occur, you can usually stop it by gently stretching the affected muscle. For instance, to relieve a cramp in your calf muscle, get hold of the toes and ball of your foot and pull them toward your kneecap. You may also want to try kneading the affected muscle firmly.

Usually, a sense of tightness or dull pain will follow a cramp. Applying heat or massaging the area may help relieve this discomfort. If you're plagued by frequent cramps, consult your doctor.

Sprains. Cramps and spasms are painful contractions of muscle tissue. In contrast, a sprain is a partial or complete rupture (tearing) of a muscle, tendon, or ligament, caused by overstretching. Small blood vessels in the area break, and pain develops when the surrounding tissue swells up and stimulates sensitive nerve endings.

To help prevent ankle sprains, you need to watch where you're going. Learn how to pick your way among the potholes and skillfully sidestep any debris in your path. If you do manage to sprain your ankle, you'll have to suspend your walking program until it is healed.

Again, RICE (rest, ice, compression, and elevation) will help bring down the swelling. If it does not improve after use of RICE, or if you are not sure if you have a strain, sprain, or break, see a doctor.

Muscle soreness and stiffness. Even people who have been serious walkers for years complain of some degree of regular soreness and stiffness. The pain is referred to as Delayed Onset Muscle Soreness, or DOMS, and it usually occurs within 24 to 48 hours of physical activity. Often the discomfort lasts for only a few days.

For walkers, the most commonly affected muscles are the calf muscles and front and back muscles of the thigh. DOMS may be the result of small muscle tears and the subsequent inflammation that occurs in the muscle tissue. Taking anti-inflammatory medication, such as aspirin or ibuprofen, or treating the affected area with ice may help ease soreness.

It is practically impossible to completely avoid muscle soreness and stiffness. But you can reduce the intensity of the discomfort by planning your walking program so that you progress gradually, especially during the early stages.

A slow, steady approach will allow the muscles of the body to adapt themselves to the stress placed upon them. If you become sore and stiff from physical activity, do some additional light exercises. Cooling down at the end of each and every workout and massaging the affected areas can also help.

Back pain is another issues walkers may face. Get the lowdown on walking and back injuries in the next section.

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Back pain can have a devastating effect on your walking program. Here are some of the causes of back pain and injuries, and tips you can try to keep your walking workout backache-free.

Back pains. Lower-back pain can signal a slipped or damaged spinal disc. Some lower-back pains result from exercising after years of relative inactivity. You will have to guess at the seriousness of these pains by the way you feel at the time; that is, by how intense they are, how disabling they are, and so on. If you have any doubts, however, see your doctor.

Couches and recliners can feel very comfortable; however, very few are designed with the health of your back in mind. Poor posture, such as slouched sitting, can place a great deal of stress on your muscles, ligaments, and discs. This stress can cause or increase back pain and make it more difficult for a sore back to heal. Choose furniture, positions, and postures that keep your neck and spine aligned and that support the natural curves in your back.

Many backaches are caused by mattresses that are too soft. In most cases, however, placing plywood beneath a soft mattress will not help. (Your spine won't get adequate support because there is still too much soft material between the plywood and your body.) What you should consider instead is a good orthopedically designed box spring and mattress.

Often, however, the cause of back pain is poor fitness -- specifically, weak abdominal muscles. At the pelvis, the weight of the upper body is transferred to the lower limbs. The pelvis, or pelvic girdle, is balanced on the rounded heads of the thighbones. It is held in place by numerous muscles, including the abdominals, the hamstrings, the gluteals, and the hip flexors. An imbalance or weakness in these muscles can lead to pelvic misalignment, which usually causes the pelvis to tilt forward or backward.

If the abdominal muscles are weak, the top of the pelvis will drop and tilt forward. Forward tilt of the pelvis leads to lordosis, or sway back.

In addition to abdominal weakness, a lack of strength in the gluteals and hamstrings can lead to forward pelvic tilt. While the abdominals stabilize the pelvis by pulling upward on the front, the gluteals and hamstrings offer stability by pulling down on the rear of the pelvis.

Exercises must be done to strengthen the abdominals and gluteals. Usually, walking gives the gluteals a good workout. But the abdominal muscles must be conditioned in other ways, such as through weight training or calisthenics.

If you have back trouble, or if you experience back pain when you walk, consult your doctor before beginning or continuing your walking program.

Side stitch. Side stitch goes by many names. It can be called a pain in the side, a stitch in the side, or a side ache. Sometimes it frightens people because it happens near the chest area. There appear to be two basic causes.

The first is improper breathing. This causes spasms in the diaphragm, the muscular wall separating the chest and abdominal cavities. To reduce this problem, "belly breathing" is suggested. That is, when you inhale, push your abdomen out. When you exhale, pull in your abdomen. It's just the reverse of what you normally do.

The second cause of side stitch is probably the most common. It's a stretching of the ligaments attached to the liver, pancreas, stomach, and intestines. These ligaments are put under stress when you walk vigorously. The bouncing action causes them to stretch, thereby causing pain.

One way to ease the discomfort of side stitch is simply to grip your side and push in. You should also avoid eating a heavy meal within the three hours prior to the start of your walk. During the attack of side stitch, bend forward, inhale deeply, and push your belly out. If the pain is intolerable or you have any doubt about the source of your pain, see your doctor.

Next, discover the different types of chest pain a walker should look out for, from simple heartburn to more serious conditions.

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Any pain in the chest while walking, no matter what its cause, can be troubling -- especially if you've reached middle age, when the risk of heart disease rises. Such pain may have nothing to do with your heart, however.

We are warned so often about heart disease that the slightest twinge in the chest area can conjure up frightening visions of permanent disability or even death. A seizure in the chest can be, and sometimes is, caused by cardiovascular disease. But more often it is caused by a simpler and less threatening ailment, such as heartburn or a strained muscle.

In this section, we'll explain some of the possible causes of chest pain. (Any chest pain or discomfort, no matter how minor, however, should be brought to the attention of your doctor.)

Muscular causes: Chest pain or discomfort can be caused by a muscle spasm. A pulled pectoral (chest muscle) or a strained intercostal (muscle between the ribs) can cause a great deal of pain. A pulled muscle produces pain that is felt near the surface, and movements such as swinging the arm across the chest can initiate or worsen the pain.

Bruised muscles and ligaments may cause pain during deep breathing. Pressure during sleep from a hand, mattress button, or even a wrinkled sheet may aggravate bruised muscles. Pain associated with this kind of condition usually happens only during a certain motion or when pressure is applied to the area. Rest and time are usually the best treatments. Consult your doctor to be sure.

Heartburn: The pain brought on by indigestion, or heartburn, is frequently confused with pain caused by heart trouble. But this pain has nothing to do with the heart. Acid from the stomach backs up into the esophageal (food) tube, causing contractions of the circular muscle of the esophagus. Milk or antacids may provide temporary relief, but a simple, well-balanced diet is the best prevention.

Angina pectoris: This type of chest pain or discomfort can occur when you're at rest, but it often develops during exercise or after a heavy meal. The condition is the result of a temporary failure of the coronary arteries to deliver enough oxygenated blood to the heart muscle. Such a failure is usually the result of obstructions to coronary circulation.

Angina usually isn't a sharp pain; it is usually a sensation of heaviness, as if the chest were being squeezed or crushed. The discomfort often spreads to the left shoulder, arm, or hand, where it may be felt as numbness. It may also be felt in the neck, jaw, and teeth. Pain or discomfort may occur minutes, days, weeks, months, or even years apart.

Angina is a warning sign. Your heart is telling you to stop. The problem is that the heart is not getting enough blood, and therefore, not enough oxygen. If you experience any pain or discomfort resembling angina, report it to your doctor immediately. Your doctor will probably want you to be very specific about where and when the discomfort occurs so he or she can more fully understand your condition.

The other pains or discomfort associated with heart disease are varied, yet similar to angina. They may be sharp, mild, or numbing. If you experience any of these pains, particularly a heavy sensation in the chest or a pain that radiates up the neck or down the arm, contact your doctor immediately.

The following symptoms may signal a heart attack: an extreme heaviness in the center of your chest, as if there was an elephant sitting there; an extreme tightness, like a clenched fist inside the center of your chest; or a feeling of stuffiness (something like indigestion) high in your stomach or low in your throat. Whenever you have a symptom that resembles any one of these, get emergency medical attention.

You may have gone through a stress electrocardiogram before you started a walking program and passed it with flying colors. If so, your chances of experiencing these symptoms are relatively small. But don't become cocky. A stress electrocardiogram, like most tests, is not 100 percent reliable. In the final analysis, your body, not somebody else's electronic equipment, has the final word. So listen to it.

If you're serious about walking, use the information presented in this article to familiarize yourself with the causes of common injuries and take steps to avoid them. Prevention is the key to keeping your walking program free from injury.

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ADDITIONAL CREDITS:

Peggy Norwood Keating, MA, Contributing consultant Rebecca Hughes, Contributing writer