The Unexpected Foot Injuries That Can End a Marathon Runner's Season

As marathon runners prepare for the TCS New York City Marathon, experts are highlighting three less common but potentially season-ending foot injuries that can affect even experienced athletes. These issues, often subtle, can manifest as persistent aches and pains long after the finish line is crossed.

Sesamoid Injuries

Sesamoid bones, two small, pea-shaped bones located beneath the big toe, play a crucial role in push-off during running. Dr. Jeffrey Baker, a podiatrist at Weil Foot & Ankle Institute, notes that while uncommon in the general population, sesamoid injuries are frequently seen in runners. Individuals with high arches are at greater risk, as their feet are less flexible and absorb impact less effectively, concentrating pressure on the ball of the foot. Forefoot strikers and those with tight calf muscles also face an increased risk. A stress fracture of the sesamoid bone typically requires four to six weeks in a walking boot for recovery. Inflammation, known as sesamoiditis, can be managed with ice, anti-inflammatory medication, and avoiding barefoot walking, often supplemented by low-impact cross-training.

##Cuboid Syndrome

Cuboid syndrome, also known as cuboid subluxation, occurs when the cuboid bone, located on the outside of the foot, becomes slightly dislodged. This can cause discomfort along the outer edge of the foot, between the heel and the little toe. A corrective technique called the "cuboid whip" can often resolve the issue, involving a physician manipulating the bone back into its correct alignment while the runner lies prone with their knee flexed. Relief can be immediate, allowing runners to resume their activities quickly.

##Navicular Stress Fracture

The navicular bone, situated toward the back of the foot, has a limited blood supply, making it susceptible to injury. The constant high impact of marathon running can exceed its ability to repair micro-damage, leading to pain across the top of the foot, midfoot, and along the inner arch. Dr. Baker describes this as a serious "doozy" injury, often requiring extensive healing time and potentially surgery.

##Identifying and Managing Foot Pain

Distinguishing between normal post-race soreness and a serious injury can be challenging. Podiatrists recommend seeking immediate medical attention if a foot is red, warm, swollen, and cannot bear weight. If pain is merely annoying and fades within a few days, it may be overuse tendinitis. However, persistent discomfort warrants a podiatrist's evaluation, which may include X-rays to assess the extent of any damage.

##Race Day Preparedness

Experts caution against overtraining and emphasize the importance of testing all gear, apparel, nutrition, and hydration strategies well before race day. Wearing new, unbroken-in shoes on marathon day can lead to severe blisters. Dr. Mario Porciello-Donnarumma, a podiatric physician, advises that new running shoes should be worn for at least four to six weeks prior to a race. In the event of a traumatic injury during the race, stopping immediately and seeking medical help is crucial, as putting weight on an injured foot can significantly worsen the damage and potentially turn a non-surgical issue into an emergency.