Mile after mile they stand -- or, rather, move -- between us and the pavement, absorbing tremendous force and impact. Yet often it's not until runners suffer from blisters, pain, swelling or, worse yet, stress fractures that we start paying attention to our Herculean workhorses: our feet.
To keep our feet healthy, several foot and ankle specialists say, we need to give them a little attention before they become a problem.
"Foot and ankle injuries are often a result of training errors: too much, too soon," says Stephen Palmer, a podiatrist with Foot and Ankle Specialists of the Mid-Atlantic, with offices in Kensington, Md.
Too much, too soon can lead to conditions such as stress fractures, which can sideline you for up to two months; plantar fasciitis, the pain and inflammation of soft tissue that runs across the bottom of the foot; metatarsalgia, an inflammation in the ball of the foot; and Achilles' tendinitis, an overuse injury of the Achilles' tendon, Palmer says.
Lee Firestone, a podiatrist in Chevy Chase, Md., agrees that runners, in trying to "get the miles in," can overdo it.
"The ratio of the long run -- the weekend run -- should never be more than half of the total mileage for the week," Firestone says, referring to the danger faced by runners who overdo it on the weekend because they don't get as many miles in during the week as they would like.
This means if your mileage goal for the week is 20, you should do no more than 10 on the weekend.
And in terms of upping the weekly distance and workload, that should be done over time, Firestone says: no more than a 10 percent increase in total distance per week.
"The bones get stronger when we walk and run, as do muscles and tendons," Firestone says. "But we have to let them adapt gradually."
One way to learn how to pace yourself and figure out reasonable workloads is to join running clubs, where seasoned runners can help you, Palmer says.
"As you bounce ideas off of each other, you can figure out what works and what doesn't work," Palmer says.
Another important factor in keeping our running feet happy and healthy is to pick the right shoe, says Brian Neville, a physical therapist at Sports + Spinal Physical Therapy in Washington.
"I recommend that people go to specialty running shoe stores where the staff not only is knowledgeable about running shoes but many of them are runners themselves and can even field questions about injuries and injury prevention," Neville says. "They have a runner's mindset."
The minimalist running shoe has gotten very popular in recent years. And while foot and ankle specialists are not against them, they say that these shoes can take a while to get used to and that they are not for everyone.
"If you are going to switch from a shoe that allows for heel-striking to one that promotes running on the forefoot, you have to make an adjustment in your mileage," Neville says. "You have to dial back during that transition."
Neville says he saw many patients with foot and ankle injuries when the minimalist shoe trend started, but those visits have leveled off as
people either have gotten used to the shoe and adjusted their technique or have gone back to a more supportive running shoe.
The minimalist shoe, he adds, requires more foot and ankle strength, which is why the transition needs to include a decrease in mileage.
Firestone says that a minimalist shoe is probably not a good choice for someone with very flat feet, since their feet are more likely to pronate heavily without any arch support.
Finally, don't overuse your running shoes. They are done somewhere between 300 and 500 miles, Firestone says. That means roughly three months if you run 30 to 50 miles per week, assuming you are using the shoes only for running. Otherwise, their life span is shorter.
Cross-training -- any activity that complements your running -- is another way to help keep feet healthy, the experts agree. The better your posture and the more muscle groups recruited in your running, the safer for your feet, Neville says. One weak link can create instability, leading to compensations from the feet up, and possibly to injury.
Stretching should be part of that cross-training, he says. Typically, runners have tight calves, hip flexors and hamstrings. These muscle groups should be stretched thoroughly after running, Neville says.
For core strength, Firestone suggests activities such as Pilates to get your endurance needs met without relying solely on running. He also suggests swimming and cycling, which exercise different muscle groups and give certain muscles and bones of the feet a break.
Balancing exercises, such as heel raises, can be a good way to not only cultivate better balance but also strengthen the feet and ankles.
Breaks are also important in any running regimen, says Neville. Make sure to get enough rest and recovery to help prevent injury, he says.
"When you're overtired, your form tends to go, and that can lead to injuries," Neville says.
Nail and foot care is also important in keeping your feet healthy, says John Vonhof, author of "Fixing Your Feet: Prevention and Treatment for Athletes."
"Very often, people don't know how to manage their nails, which can lead to a lot of problems," Vonhof says.
Long nails can get caught in socks and rip, or if they are too long for the shoe, the pressure can create blood pooling under the nail.
Vonhof, who used to run marathons and ultramarathons, now works first-aid stations during ultramarathons and has seen some pretty gruesome feet. He recommends that runners -- and others -- cut the nails straight across and then use a file to thin and smooth out the top edge of the nail.
He also recommends a daily post-shower routine of filing down foot callouses.
When blisters form between the toes, he says, this usually has something to do with the socks. Avoid cotton, he says, and opt for the more high-tech synthetic socks that control moisture.
Blisters can be a first sign of bigger problems, Vonhof says.
"If your feet are starting to hurt and blister and they never have before, ask yourself: what's different? The shoes, the socks, the mileage, the heat, the rain?"
It's also important to recognize injuries early. Firestone suggests taking five to seven days off to see if symptoms such as redness, swelling and pain go away. If not, it's time to seek professional help.
He advises against anti-inflammatory medications during this period, since, he says, "that masks the symptoms."
If you don't take time off in the early stages of an injury, he says, you may not only worsen the primary injury but you also risk incurring additional injuries as the body rushes to compensate for any movement deficiencies.
A proper, early diagnosis will get you into a treatment plan that can help you recover quickly and well, Firestone says. He should know, but not just because he's a podiatrist. Firestone once suffered a partially ruptured Achilles' tendon. But with the right rest, rehab and training, he came back a better runner.
"You want to come back stronger than before."