It’s easy to run into trouble in a marathon — you could hit the wall, suffer heat exhaustion, chafe your nipples and even poop yourself over the course of 26.2 miles.
The road to recovery begins as soon as you hit that finish chute, collect your medal and take your selfies. Some problems are easy to identify — blisters, black toenails, bumps and scrapes.
Others are more subtle, living deep within tissue and manifesting as a vague ache or dull pain.
Your feet do much of the heavy lifting during a marathon, so they’re particularly vulnerable to injuries you don’t see coming.
Ahead of Sunday’s TCS New York City Marathon, two podiatrists talked to The Post about the unexpected foot issues that can trip up even seasoned marathon runners — and the best ways to get back on track.
Sesamoid injuries
You’ve probably never heard of the sesamoid bone, which is so small that it gets its name from the Greek word for “sesame seed.”
There are two pea-shaped sesamoid bones under each big toe. They help the boss toe push off the ground while walking and running.
“Sesamoid injuries are uncommon in the general population but seen on a fairly regular basis with runners,” Dr. Jeffrey Baker, a Balance Health podiatrist at Weil Foot & Ankle Institute in Chicago, told The Post.
Runners with high arches face a higher risk of sesamoid injuries because their rigid feet do not flatten enough to absorb the impact of running.
Instead of spreading pressure across the entire foot, high arches concentrate weight on the heel and the ball of the foot.
“Those that are forefoot strikers during running or have tight calf muscles are at increased risk as well,” Baker said.
A stress fracture of the sesamoid typically means four to six weeks in a walking boot.
If it’s just inflammation without a fracture, a condition known as sesamoiditis, the treatment is ice, oral anti-inflammatory medication, no bare feet and a temporary switch to low-impact cross-training.
Cuboid syndrome a k a cuboid subluxation
“The cuboid is a square-shaped bone that can get slightly dislodged out of place to the outside of the foot, creating an annoying pain during running,” Baker said.
The pain can be felt on the outer, bottom edge of the foot halfway between the heel and the pinky toe.
While that sounds excruciating, at least the fix has a fun name. The cuboid whip moves the bone back into its proper position.
Here’s how it works: The runner lies on their stomach with the knee of the affected foot flexed to 90 degrees, so the foot is in the air.
“The physician stands over the foot and places thumbs on the bottom of the cuboid,” Baker explained. “A forceful downward motion is performed by the physician to manipulate the cuboid back into its alignment.”
Runners may feel immediate relief, allowing them to quickly hit the ground running.
Navicular stress fracture
“The navicular is a kidney-shaped bone, toward the back of the foot, that has a limited blood supply,” Baker said.
Since circulation is poor, the navicular struggles to repair micro-damage fast enough to keep pace with high-impact training.
Pain can be felt across the top and middle of the foot and along the inner arch.
“This is a doozy,” Baker lamented. “If a navicular stress fracture occurs, there is an extended healing time, and in many cases, the runner would require surgery.”
How to tell when there’s trouble afoot
When you cross the finish line, it can be difficult to distinguish between post-race soreness and pain that requires immediate attention.
Baker recommends visiting a podiatrist if you have a red, warm, swollen foot that can’t bear weight.
“Some soreness and [an] achy feeling to the foot, where it may be annoying to walk, without a red, warm, swollen foot, is most likely overuse tendinitis,” Baker said.
“The runner can give it a few days to see if the discomfort goes away. If it does not after two to three days, [I] would recommend seeing a podiatrist for evaluation.”
X-rays can help reveal the extent of the injury.
How to put your best foot forward on race day
It’s easy to get swept up in the excitement of marathon training, but running coaches warn against training too hard, too fast and too often.
And race day is not the time to try something new — apparel, gear, nutrition and hydration should have been tested in the weeks leading up to the marathon.
Wearing new shoes on the big day, for example, can cause torturous blisters.
“Not breaking in the shoes properly before a race is a nightmare,” Dr. Mario Porciello-Donnarumma, a Balance Health podiatric physician at University Foot & Ankle Institute in Southern California, told The Post.
“We recommend, at minimum, four to six weeks in new running shoes before race day.”
Porciello-Donnarumma also recommends stopping running immediately and seeking medical attention if you suffer a traumatic injury on race day.
You may be tempted to crawl to the finish line, but that move could cause lasting damage.
“Putting weight on your foot can instantly worsen the injury and can make something that might not have been surgical, now a surgical emergency,” Porciello-Donnarumma said.
Oh, de agony of de feet!
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