Boston, June 26-27, 2010
New York, June 4-5, 2011
Note: The Out of the Darkness Overnight provides healthcare and training information for educational purposes only. This information should not be used as a substitute for the advice of your physician or other qualified healthcare provider.
I have pain in my knees when I walk.
A common cause of knee pain is a condition called Iliotibial Band (ITB) Syndrome. This band is the tendon attachment of hip muscles into the upper leg just below the knee to the outer side of the front of the leg. Where the tendon passes the knee, there is a sac (bursa) between the bone and the tendon that cushions and reduces friction and wear of the tendon against the bone. In this condition, overuse causes excessive friction to the tendon as it passes the bone, resulting in inflammation and pain to the bursa (bursitis), tendon (tendonitis), or both.
Common signs and symptoms include pain, tenderness, swelling, warmth, or redness over the ITB at the outer knee. The pain may travel up or down the thigh or leg. Pain may occur at the beginning of exercise but lessen once you are warmed up. Pain also may be felt most when the foot of the affected leg hits the ground.
Preventive measures include appropriate warm up and stretch before activity, allowing time for adequate rest and recovery after activity, maintaining appropriate conditioning for knee and thigh flexibility, muscle strength and endurance, cardiovascular fitness and use of proper training techniques.
General treatment includes the use of an anti-inflammatory medication such as Ibuprofen or Aspirin and application of ice to relieve the pain, stretching and strengthening exercises and modification of the activity that initially caused the problem. A knee sleeve or bandage may help keep the tendon and bursa warm during activity and reduce some symptoms. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after any activity that aggravates symptoms. Heat may be used before performing stretching and strengthening activities.
Training techniques can be altered by lessening the amount of the training activity, changing the stride length, or even changing the side of the road you train on if you walk next to the curb in the same direction all the time.
If your symptoms worsen or do not improve despite this treatment, see your primary care physician for evaluation. Wearing an elastic knee brace for further support might help decrease your pain level. These types of braces can be purchased at most major pharmacies or drug stores or you might want to consult with your physician for a recommendation.
I have pain in my lower legs when I walk:
Shin splint is a term broadly used to describe pain in the lower extremity. Pain is typically in the inner part of the lower half of the shin and, at first, may begin at the start of exercise and then decrease after a warm up period. However, with continued exercise, the pain can become constant.
Shin splints are caused by overuse from repetitive activity. Continuous walking pulls on the soft tissues in this area and can lead to breakdown and inflammation. As your calf muscles grow and build during training this can create an imbalance of muscles from the front to the back of the leg. Uneven surfaces and hard surfaces like concrete can also increase the stress on the front of the leg. Flat feet, abnormal gait and a sudden change or increase in activity can also increase your risk for shin splints.
Take a look at your shoe for wear and consider using a cushioned arch support. Also check your shoe for adequate cushioning for shock absorption. Try to increase your walking gradually and alter your walking surfaces to include grass, dirt and track surfaces as much as possible.
To prevent shin splints, adequately warm up and then stretch before exercise. Adequate rest of the inflamed tissue and then proper stretches are a key to quick return to activity. Stretching tips are available on this website in the training section. Start with the runner's lunge stretch for the calf or put a towel around your foot and pull your toes up towards the direction of your head. You also can use your hand to stretch your toes and ankle down so that you feel a gentle stretch in your shins. Also, try sitting on your knees and feet to really stretch the front part of your leg.
Once you have stretched and your pain is decreased, begin strengthening exercises. Start with toe taps, first straight up and down and then right to left. Add heel and toe raises and finally, put a towel on the floor and use your toes to grab an edge of the towel, pulling it towards you while keeping your heel on the floor. Repeat this 10 times, 3 times a day.
If you develop shin splints, freeze water in paper cups and use them to ice up and down the area of pain for 10 minutes, 3 times a day. An anti-inflammatory medication such as Ibuprofen may help. Take as directed for 7 days.
Adequate rest, ice, anti-inflammatory medication, stretching and strengthening should improve your shin splints within 2-3 weeks. If your symptoms worsen or do not improve despite this treatment, see your primary care physician for evaluation. Shin splints left untreated can develop into a stress fracture.
I am a smoker and get shortness of breath when I walk:
An initial evaluation by your primary care physician is indicated in order to evaluate the extent of your shortness of breath with exertion. While oxygen consumption capacity (VO2 max) is decreased due to smoking and decreased fitness, shortness of breath with exertion can also be related to your heart. An exercise treadmill would be able to differentiate between the two. If the treadmill is negative, based on your physician's recommendations, you can continue your walking.
To increase your exercise capacity, you should increase the time that you exercise and not the intensity. Slowly increase by 10% each week the number of minutes, not necessarily the miles that you are exercising.
The bottom of my feet burn when I walk:
Athlete's foot (Tinea Pedis), with or without scaling of the skin is a condition that can cause burning of the feet. This is a fungal infection that is easily curable with appropriate treatment and there are over-the-counter antifungal creams, ointments and powders that can be used. It also is important to wear clean, dry socks so that the feet do not stay moist.
Overheating of the feet may also cause burning of the feet. With this it also is important to wear clean, dry socks to keep the feet dry.
Plantar Fasciitis (Heel Spur Syndrome) could also be the cause. This is a condition in which the fibrous connective tissue on the bottom of the foot becomes stiff and inflamed. It is occasionally associated with a bone spur on the heel. Common symptoms include pain and tenderness in the sole of the foot, mostly under the heel bone, with standing or walking. Preventive measures include appropriate warm up and stretching before activity and maintaining appropriate conditioning of calf, ankle and foot flexibility, strength and endurance, cardiovascular fitness and ideal body weight.
General treatment considerations for Plantar Fasciitis include the use of an anti-inflammatory medication such as Ibuprofen or Aspirin and application of ice to relieve pain, stretching exercises of the heel cord and the Achilles tendon (that thick cord at the back of your ankle, below your calf), and modification of activities. If the burning continues, see your primary care physician for evaluation.
Can I participate if I am pregnant?
All participants (walkers and crew members) who are pregnant are asked to get a written authorization from their obstetrician in order to be able to participate. This authorization from your obstetrician is turned in with your medical form.
How do I prevent or take care of blisters on my feet?
Blisters are the most common problem seen on the event and the best way to protect your feet is to prevent blisters from forming. Blisters can be a direct result of a friction rub between the skin and another object (skin, sock, shoe, etc.) or due to pressure in the shoe or moisture from perspiration. Staying well hydrated during the event is important for blister prevention as dehydration allows the skin to fold on itself and create a friction rub.
Proper shoe and sock selection also is key to blister prevention. Purchase a shoe that is ½ to 1 full size larger than your normal walking shoe. There should be ample room to wiggle your toes in the toe box. Break in your shoes slowly by alternating at least two pairs of shoes during your training. Do not wear brand new shoes on the event.
Choose a sock that pulls moisture away from your feet. This will keep your feet cool and dry. Synthetic socks such as "Coolmax" or "Dryfit", or wool socks are better than pure cotton socks for keeping your feet dry. Try wearing two socks, or double-layered socks and plan on changing to clean and dry socks halfway through your training walk. If your socks are still wet, try foot powder or spraying your feet with spray antiperspirant. Make sure that your socks fit you well and do not bunch up in any areas.
Hot spots are places on your feet or toes where you feel tenderness, pressure, heat, burning or pain. If you feel a hot spot during training, stop and change your socks. Increased protection can be obtained by applying moleskin, second skin or a bandage. Moleskin acts as a second layer of skin and should not be removed until the end of the walk to prevent peeling of the skin. Any bandage that is applied should be smooth and wrinkle free. Benzoin liquid, or Nuskin or Toughskin spray found at medical supply stores are sometimes used to "toughen" the skin at problem areas. Do not get a pedicure or try to remove calluses before the event or long training walks.
If you get a blister, try not to pop it. They are nature's way of creating a protective cushion and intact skin protects you from infection. Small blisters should be covered with antibiotic ointment and a bandaid; this is then covered with a square of second skin or a corn pad for further protection. Do not leave the second skin on overnight as it will dehydrate and can irritate the skin.
For large blisters that are painful, clean the blister with an alcohol pad and have a medical professional drain it with a sterile needle. Be sure to keep the open blister covered with antibiotic ointment to prevent infection.
Take time during your training to experiment with techniques and products that work for you. Blister care products that you should carry with you in a waist pack during the event include bandaids, moleskin, benzoin, synthetic "wicking" socks, alcohol swabs, blister care bandages, small scissors and Body Glide or Vaseline.
I get a rash while walking:
Rashes are conditions difficult to interpret without actually seeing them. If you have a persistent rash or any other symptoms associated with a rash you should see your primary care provider for evaluation. A discussion of all possible rashes is beyond the scope of these guidelines however, a rash seen amongst walkers is a condition called "Capillaritis". Many walkers on these events present to the medical area with complaint of a cayenne pepper rash to their legs without any complaint of injury or trauma. This rash may be slightly itchy but NOT associated with any lower leg swelling, shortness of breath, fever, chills or red streaks.
Capillaritis is the name given to a harmless skin condition in which there are small reddish-brown patches caused by leaky capillaries (very tiny blood vessels) primarily on the legs. These capillaries become inflamed resulting in tiny red dots that look like cayenne pepper to appear on the skin. The cause is unknown but this condition may develop with prolonged impact activities such as walking. Blood thinning medication such as aspirin, non-steroidal anti-inflammatories, such as Ibuprofen, and birth control pills may increase its occurrence.
There is no known cure for most causes of Capillaritis. It usually disappears within a few weeks, but may recur. Treatment is based on the presenting symptoms and can include:
- Considering if a medication could be the cause.
- Avoiding food preservatives and artificial coloring agents.
- Application of a topical steroid cream (1% Hydrocortisone) to help relieve any associated itching.
Another rash common amongst walkers is a contact irritant rash. Sweating can cause clothing that was previously fine to become an irritant. Friction from repetitive rubbing of the clothing against your skin can cause a contact rash. This rash is usually blotchy and red. Can be itchy and burn. Again there are usually no other associated symptoms such as fever, pus filled lesions or lower extremity swelling. Remove your sweaty clothing as soon as possible after exercise; use absorbent socks and clothing that will remove moisture from your skin. Check your walking outfits for seams that might cause a friction rub. Use petroleum jelly, body glide like products or zinc oxide (Desitin) to prevent chafing in friction areas. Avoid perfumed lotions, deodorants or soaps that may increase your skin's sensitivity. Test your sunscreen on a training walk to see if it is irritating to your skin or your eyes.
Since many skin conditions can be misinterpreted or be presentations of other systemic illnesses it is advisable to seek the care of your personal physician if your symptoms worsen or do not improve despite the above prevention and treatment advice. Your primary care physician can help to clarify the problem, rule out viral or bacterial infections and provide the proper treatment. Some skin conditions are chronic and may need long-term medication, while other skin conditions may point toward specific systemic illnesses.
I have pain in my ankles when I walk.
Wearing an elastic ankle brace for further support might help decrease your pain level. These types of braces can be purchased at most major pharmacies or drug stores or you might want to consult with your physician for a recommendation.
Can I keep my toe rings on when I walk?
It is recommended that you remove all toe rings during your training walks and also the event. If your feet swell the rings can cause damage to your toes. In these situations, the toe rings will need to be cut off by someone on the medical team.