Nov 19, 2019
Forgetting the feet: How foot care is overlooked
By Kevin Hoffman, Editorial Director

Athletes often neglect their feet, requiring more education from athletic trainers.

running shoesAthletes need their feet. Regardless of sport, the inability to run, jump, accelerate and change direction minimizes any player’s effectiveness during competition.

But the foot is complex and often overlooked. Dr. Doug Tumen, a board-certified podiatrist and marathon runner, suspects that’s because the foot is not as simple as something like the knee.

“It’s a lot of structure,” Tumen said. The foot has 33 joints, 26 bones, 19 muscles and 107 ligaments. “If it’s not swollen and not black and blue, it gets overlooked. But so much can go wrong with the foot.”

The fall sports season typically sees an uptick in foot injuries. During the summer, young athletes tend to be more inactive than they are during the school year. Without proper exercise to prepare their feet for competition, it’s not uncommon for injuries, aches and pains to set in. That’s especially true in sports like track and field or cross country, where athletes might go from spending their days on the couch to running countless miles on harsh concrete.

So, what can athletes do, and how can athletic trainers help them? That’s a difficult question to answer, but Tumen said it starts by teaching athletes to understand their feet. Each athlete has their own personal running style and strike pattern, which means everyone requires a unique approach.

“Every foot is different in general,” said Tumen, author of ‘Ask the Foot Doctor: Real-Life Answers to Enjoy Happy, Healthy, Pain-Free Feet.’ “The shoe-wear patterns we look at in all of our athletes. If you wear a shoe out on the inside, that’s really bad; that means you’re pronating excessively. Medial shoe wear is going to cause a lot of potential foot injuries, knee injuries and hip injuries, so that’s something we want to be aware of as well.

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“These are things where, if we can control with better shoes and proper orthotic inserts, we’re going to prevent a lot of injuries for sure.”

KeithJJ / Pixabay

Appropriate footwear is among the primary ways to avoid injuries, and Coconino High School (Arizona) athletic trainer Eric Freas understands that concept all too well. Freas, who also is the school’s athletic director, doesn’t deal with a considerable number of foot injuries, but he can understand how problems easily arise. He constantly sees kids walking the halls in flip flops or Chuck Taylors, which offer little support.

“I do a lot of educating,” he said. “I always recommend to kids, ‘You need to wear a pair of shoes. Shoes with a solid sole that you lace up.’ I kid with them all the time about that, because they just don’t do so. Not only does the activity increase from summer to fall, but when they’re not wearing the correct shoe wear, even throughout the school day, it can create problems.”

Both Tumen and Freas recognize that education is a critical component of their jobs, and most athletes don’t understand how to take proper care of their feet. It’s up to them to discover whether their athletes pronate or supinate, and how they can adjust.

In addition to helping athletes understand their feet, athletic trainers also pay considerable attention to running form and correcting faulty mechanics. Tumen said he coaches both athletes and adults on how to improve their form, but it can be a difficult task.

“If you’re running, your arm movement is something you can change or modify,” he said. “Let’s say you’re running and your arms are crossing the midline of your body. That’s going to stress the lower portion of your body. You’re going to have more chances of pronating excessively or rotating your body and wasting motion if your arms are inefficient. So, we work on things like that.

“It’s the same thing with the head. We want it so the head isn’t bobbing up and down, and that’s putting a lot more impact on the lower extremities. Those are some things you can work on, but things like a heel strike is difficult.”

Some of the more common injuries Tumen sees are plantar fasciitis and stress fractures. Blisters also can be an issue, and most times that’s traced back to the athlete not having the correct footwear.

One solution that could help athletes avoid foot injuries: playing multiple sports.

“If you’re just a runner and that’s what you’re going to do, and then you go play basketball, you’re at a greater risk of injury because you don’t have that lateral stability and training,” Tumen said. “In general, I’m always going to recommend that athletes do multiple sports. I think there’s a lot of advantages to it.”


There are three types of running shoes: neutral, stability and motion control. They vary in levels of support to accommodate the different types of feet. The goal of any shoe is to help bring the runner to a neutral stance.

1. Neutral shoes offer no support. White foam, which is used for cushioning, is wrapped around the entire bottom (if you see any other block of color, it’s not a neutral shoe). This type is best for under-pronators and neutral foot types, because it allows their naturally aligned foot to move freely.

2. Stability shoes offer support. The support comes from a piece of gray foam found the inside heel and arch area. The gray piece is dense foam that prevents the foot from fully rotating inward. It’s strong enough to keep the foot at a neutral stance through the gait cycle. This shoe is best for moderate over-pronators. Most people fall into this category.

3. Motion control shoes offer high support. These shoes have a thick piece of the gray, dense foam in the arch and heel area. The amount of dense foam (sometimes coupled with a piece of plastic) causes the shoe to weigh more than neutral and stability shoes. People with flat feet who severely over-pronate need this type of shoe to hold up their flexible ankles and flat arches.

The saying “more is better” is definitely not true when it comes to running shoes. If you have a neutral foot, it’s harmful to use a stability or motion control shoe. Neutral feet do not require the support those shoes offer.

Likewise, if an athlete moderately over-pronates, don’t have that person jump in a motion control shoe. This also offers far too much support. Both shoes, in this case, are over-correcting the problem. This leads to a whole set of unwanted issues. It’s important to embrace your foot type.

Test the shoes

The next step is to give the shoe a test. After putting on the shoes, have a teammate or coach follow the athlete. If they see the Achilles standing tall with no inner rotation of the ankle, the athlete found the proper shoe. If the ankles still are rotating inward, repeat the process using a more supportive shoe.

Don’t forget about comfort. A shoe that corrects foot rotation but is uncomfortable doesn’t do athletes any good. Try out a few different brands within the support category. Shoes vary in weight, shape and amount of cushion, all of which are important specs to consider.

Make sure the right size is chosen. When exercising, blood is pumped to the feet, causing them to swell. If shoes are too small or tied too tightly, the runner may experience black toenails, tingly toes or a burning sensation in the bottom of the feet. The shoe must give the toes wiggle room. There needs to be about a nail’s width of space between the longest toe and the end of the shoe. This extra room accommodates for natural swelling.

Kevin Hoffman is the editorial director of Training & Conditioning. He can be reached at [email protected].

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