Doc, I just finished the New York City Marathon, my first marathon, in 5:40:59! What a great time! I followed all your advice but last night -- starting at about 3 a.m. -- both my feet started killing me. I could not walk! It hurt even to have my comforter rest on them! Is this normal? What is it? How can I prevent it? - Jillian G., Westbury, NY

Congrats, Jillian. How cool to have finished and achieved that goal! And what you write about is not at all uncommon and is actually the greatest complaint call I receive in the middle of the night post first-time marathon finish. As with most injuries and conditions, it is most easily prevented if understood.

What you are describing, if there is no bony tenderness or swelling, is what I call "marathon feet." In basic terms, it is inflamed soft tissues of the feet from the street pounding of the 26.2 (although also seen at the 13.1 distance as well) roads. We most commonly see this in people who have trained on softer surfaces (like the reservoir track in NYC) or who race in thin racing flats when they did not train in them. These inflamed soft tissues get more and more painful until it truly is hard to walk or even put a comforter over them.  

Here are some things you can do to prevent and/or treat "marathon feet":

* Train on the same surface you plan to run on. If you are training for a marathon on roads, the treadmill or a soft track will not prepare your body for the pounding.

* Run in a well-cushioned shoe. Unless you plan on winning the race, racing flats or old, worn-out shoes that have lost their cushion will cause this problem. Remember my “change shoes every 500 miles” rule so that your shoes are not too old or worn.

* After the race, and you are urinating normally (not experiencing “marathon kidney” as I discussed in a previous post on hyponatremia) you may take a non-steroidal anti-inflammatory (e.g., aspirin or ibuprofen) unless your doctor has told you that you cannot due to a contraindication.

* Most important: Immediately upon returning home or to your hotel post-race, soak your feet for 15 minutes in an ice bath. This is the best way to avoid this middle-of-the-night pain.

Now, if you have pain the Monday after the event, 15-minute ice baths three times a day and a non-steroidal anti-inflammatory may be necessary for two days to ease the inflammation. If you feel bony tenderness, see a doctor sooner than later -- what you have may not be "marathon feet" but rather a stress or full fracture of a bone in your foot.

I hope this helps. If anyone out there in reader-land has any other ideas how to prevent "marathon feet," please join the discussion. And Jillian, congrats again. Great job.

Enjoy the ride.

Have a question for the Running Doc? E-mail him. NOTE: Due to the volume of mail, we regret that the Doc cannot answer every e-mail.

I am about to run my first New York City Marathon. Although I have done three other marathons, I am nervous about NYC because the start is later and I hear Staten Island is freezing in the morning. Any special hints for race day at this event? - Wendy G., Miami

Thanks for the question, Wendy. It's true that the weather is very different in NYC than Miami, and the later start time is unique. I've been involved with this event since 1988, and can tell you that we have had all types of weather and conditions.

Here are some general guidelines you can follow in order to have a successful day:

When going to the start, wear extra layers of clothing you don’t care about. As the day becomes warmer you can shed layers as you run, to stay comfortable.

Have a game plan for your wait. There will be a lot of “down time” when you get to Fort Wadsworth. Be prepared with a game plan to occupy your time. For instance...

• Bring with you your pre-race meal (Elvis bagel?) so that you eat it approximately the time you eat before your long runs.
• Plan to visit the porta potty at least twice. Clear everything out so you aren’t looking for one in Brooklyn!
• Stay hydrated even if it’s cool and windy: not too much/not too little. Drink sports drink. Check your urine: It should be lemonade yellow. If it's clear, you have drunk too much; if dark, like iced tea, you have drunk too little.
• Limit caffeine to no more than 200 mg (2 small cups of coffee).
• Take your baby aspirin while waiting at the Fort.
• Have with you your two fast food packets of salt: consume one while in the corral before the start and save the second to consume at about mile 16 or 17 while you are on 1st Avenue after you’ve experienced the exhilaration of coming off the 59th Street bridge into Manhattan!
• Seek out and say thank you to Joanne Navarro. Joanne and her late husband, Vic, have been responsible for the great organization of 40,000 participants at the start of this event forever. She does an amazing job. Tell her “Running Doc” and all the participants appreciate her hard work! She deserves to be recognized!

Know how you'll warm up. You don't want to stretch right before you run, but you do want to warm up. Do some light jogging or calisthenics.

Optimize your post-race recovery. Remember, this means no massage within the first 2 hours after finishing, no deep tissue work or stretching out by some practitioner until 72 hours have passed. Remember your recovery drink with protein in it (chocolate milk works well) and remember to put warm clothes in your gear check so when you finish and it is cool in Central Park, you can put something warm on.

Note: If you are in New York City on Thursday, October 29, NYU Hospital for Joint Diseases Department of Orthopedics Sports Medicine Division and I are hosting a free Marathon Prep Course called “Ready, Set, Go!”  We'll review everything you need to know for race weekend, including how to optimize performance, prevent and deal with injuries on race day, and tips for recovering quickly. Here's when and where:

NYU School of Medicine
401 East 30th Street: Schwartz Lecture Hall E
(Entrance on 30th Street between 1st Ave and FDR Drive)
Thursday, October 29
6 to 9:30 p.m.

Registration on site starts at 5:30 p.m. Pre-registration is suggested to be eligible for raffle prizes. To pre-register or for more information, e-mail ana.dejesus@nyumc.org.

We hope to see you and all my RunnersWorld.com friends there Thursday evening. Steve Jones, former marathon world record holder, will be our special guest talking about the worst (and best) advice he received about running 26.2!

Until then…

Enjoy the ride.

Have a question for the Running Doc? E-mail him. NOTE: Due to the volume of mail, we regret that the Doc cannot answer every e-mail.

Dear Readers,

Last fall, I published a post titled When Should I Get a Flu Shot? With flu season upon us again, my office phone is ringing off the hook with similar questions. So I thought revisiting this topic would be useful for  everyone.

In addition to the advice I gave last fall, I would just add these notes:

• Swine flu vaccine is becoming available and I recommend that you get that shot as well. You do need to take a two-week break between each vaccine, so they become most effective for you.

• These vaccines  are safe! And if getting a shot helps you prevent the flu, that's better than just eating right and exercising -- though you should certainly keep that up as well.

• Get your flu shot when your body, and your immune system, is strong. This means NOT getting one within three days post-marathon, when your body is still recovering.

• On the other hand: Don’t get a flu shot right before a marathon, either. A bad reaction is unlikely, but if you do have one it could affect your race.

Click here to read my original flu-shot post.

Enjoy  the ride.
 

Have a question for the Running Doc? E-mail him. NOTE: Due to the volume of mail, we regret that the Doc cannot answer every e-mail.