Foot Pain/ Sprain?

Question
QUESTION: I got a bit carried away at a wedding 2 weeks ago and rolled my right foot while dancing. The pain was sharp, but I couldn't feel much at that time due to the wine, so I kept dancing on it. The next morning the pain was strong and I iced it and wrapped it for the following 2 days. I am training for a half marathon coming up in 2 weeks! My long run was supposed to be last weekend but I am afraid that If I push the miles now I might set myself back and miss the Race. The pain went away for a while but seems to come back after a 3 mile run. What should I do?

ANSWER: Sorry to hear about your injury.  All injuries take time to heal, and can be exacerbated if you push things too fast.  Fortunately, it doesn't sound like your sprain is too bad - after all, you were able to keep dancing afterwards.  A mild sprain like this might clear up in a couple of weeks... if you give it time to rest.  Therefore, your best bet for making your marathon may be to NOT train so hard.

On the other hand, ankle sprains can also be very severe.  It has been my experience that if any bruising shows up around the foot or ankle a few days after the injury, your sprain will take much longer to heal.  In these cases, complete healing can take months.  (Sorry.)  More than likely, your injured ankle will tire more quickly, become slightly painful, and slightly swollen each time you go running... possibly for the next several months.  The only injury I ever received during running was a bad sprain.  In this case, it was around 6 months before I could run without any swelling!

So basically, your prognosis all boils down to how severe the injury was.

Ideally, after a sprain you should immediately stay off of it and keep it iced for 24 to 48 hours.  After this time period, the next step is to apply heat and start performing gentle stretching.  For the heat, use either a heating pad wrapped around your ankle or immerse it warm/hot water.  Once your ankle is nice an warm, gently work out and stretch the tissues.  You or a partner can do this using your hands, or you can carefully use your body weight to apply pressure during stretches.  Ideally, do this twice a day.  If you have time, you can do it even more frequently.  Don't over-do the intensity though - you will need to judge for yourself based on how your ankle feels.  You also need to do strength-exercises.  Do these immediately after the stretching, when you ankle is still warm.  Two good strength exercises are toe raises (stand on your toes on the edge of a stair or a book on the floor, and slowly stand up on your toes and back down) and heal-to-toe-walking (walk on your toes for one minute, and then your heels for one minute).  Perform each of the strength exercises until your ankle tires or starts to ache.

If your ankle heals sufficiently for you to compete in the upcoming marathon, there are some steps you can take to reduce the negative affects of your injury.  Before the race, take some non-steroidal anti-inflammatory medicines (NSAs) such as Ibuprofen and Naproxen.  These will help keep down the swelling and pain.  You should also be prepared to stop several times during the race and check your shoe (on the injured foot).  It is likely that you may need to loosen the laces a bit from time to time to compensate for swelling.  And of course if the pain gets bad, you will need to stop.  No marathon is worth causing permanent injury, so make a promise to yourself that you won't let your competitive drive overcome your long term heath!

---------- FOLLOW-UP ----------

QUESTION: Thank you for the information. I appreciate your time. I wanted to mention that my pain is specifically located in the arch of my foot. The pain spreads from the left to the right. It isn't my ankle and there hasn't been much swelling. Yet I feel the pain throughout the day.

Answer
The most common reason for pain in the arch of your foot would be Plantar Fasciitis.  This condition refers to inflammation of the thick tissue on the bottom of the foot, called the plantar fascia. It connects the heel bone to the toes and creates the arch of the foot.

According to the National Institutes of Health, the pain is usually worse:

-  In the morning when you take your first steps
-  After standing or sitting for a while
-  When climbing stairs
-  After intense activity

Pain may develop slowly over time, or suddenly after intense activity.

The initial treatment for Plantar Fasciitis is the same as for a sprained ankle: ice for the first 24 to 48 hours, followed by heat and NSAIDs.  Typically, people with this condition are advised to rest their foot for the first week.  In your course, this means no marathon training for a week!

Also, like the ankle, there are specific stretching and strengthening exercises you can perform.  See this link for info and videos:

http://www.heel-that-pain.com/plantar_fasciitis/exercise/plantar_fasciitis_exerc

Once you make some progress with these exercises, get yourself a lacrosse ball.  (This is a small, hard rubber ball approximately 3" in diameter.)  Keep it under your desk at work (or in front of the couch at home).  When you are sitting down relaxing, take off your shoe and roll your foot back and forth over the ball, just like you would use a foam roller in a gym.  This can help to stretch and loosen muscles and fascia.  (Note - this same technique can help with foot cramps.)

Plantar Fasciitis is common and often resolves on its own.  Depending on the severity of your specific case, you might be fine to run your marathon in a few weeks.  However, if your case is more severe, the above-mentioned treatments might not be enough.  If you find your condition is not improving, then you can try two more mechanical aids.  The first is heal cups (heel pads, shoe inserts, etc.)  These fit into your shoe and cushion the heel, which can help to reduce the irritation and inflammation.  You should put them in both shoes, even if you only have pain in one foot, because you don't want to be off balance while you walk around.  The second technique is to wear night splints.  These are worn while you sleep and help stretch the injured fascia and allow it to heal.

If your condition fails to respond to all of this, then you need to seek medical help.  A doctor can provide the next level of treatment, more aggressive still, which might involve one or more of the following:

-  A boot cast (looks like a ski boot); worn for 3-6 weeks
-  Custom-made shoe inserts (orthotics)
-  Steroid shots or injections into the heel

And if everything else fails, there are surgical methods to treat Plantar Fasciitis.

Hopefully you will not need anything more than rest, NSAIDs, and exercises, so try these first.  Good luck!