Keys To Treating Common Triathlon Injuries

Marybeth Crane, DPM, MS, FACFAS

   Making sure your cycling and running shoes are big enough is important for blister prevention. In a long course triathlon, I recommend athletes buy shoes at least a half size to a full size bigger than their street shoes. Feet swell during the race. Fluid balance is also important and runners rarely think of it in the quest to prevent blisters. If you over-hydrate and take in excessive sodium, your toes and feet swell and rub together, which is a recipe for painful blisters. Keeping your feet dry with moisture wicking socks or double layer socks can prevent blisters. Actually, wearing socks in cycling shoes (many triathletes go sock free on the bike) can also help. Liberally applying body glide or another lubricant on the toes, ball of foot and heels also helps.

   After the race, to pop or not to pop the blister is always a question athletes ask. The answer is to teach your patients to cleanse the area, drain the corner of the blister and leave the top as a biological dressing. Protect the area with a soft clean dressing. I always instruct my patients that if the blister is larger than a silver dollar or red and irritated, they should come into the office immediately. Debridement with application of a hydrocolloid dressing will quickly decrease their pain. Antibiotics may be necessary for large infected blisters.

Keys To Managing Subungual Hematomas

Black toenails are almost a badge of honor for the long distance runner. Triathletes are no different. Again, emphasize the need for slightly bigger shoes. An underlying biomechanical issue may be causing their toes to curl, forming a hammertoe and jamming their toenails. Educate your patients not to pick at their black toenails.

   I only recommend nail avulsion if the hematoma is almost 100 percent of the nail bed or if the edges are loose already. Using a fine gauge insulin needle to evacuate the hematoma is quick and virtually painless.8 The old school technique of trephining the nail is considered archaic. I also recommend discussing fungal infections that can occur in the damaged toenail so our athletes will be hyper-vigilant with their care of the damaged nail.

What You Should Know About Achilles Tendonitis In Triathletes

Irritation of the Achilles tendon is the most common myotendinous injury in triathlon events. Often, this is due to poor bike fit or old cycling shoes. If the foot is rocking on the pedals, pronation will occur through the bottom of the pedal stroke. The gastroc muscle will fatigue more quickly and the Achilles will be irritated. Changing shoes and/or type of cleats can help quickly.

   Achilles irritation can also occur due to the transition from cycling to running. If you have ever gotten off a bike and tried to run, you will understand the biomechanical imbalance that occurs in the first part of the running leg of a triathlon. A late stage pronatory foot type or wearing a racing shoe that is too flexible can also be the cause of irritation. A tight gastroc soleus complex is often the underlying culprit as well as a weak core and tight hamstrings.

   Early recognition of the problem and being a good detective is the key to successful treatment. Emphasize that rest is important. This is the time for athletes to work on swimming. Physical therapy with a lot of eccentric stretching and strengthening of the weaker muscle groups is extremely helpful. If the patient is experiencing a nodule within the Achilles paratenon or crepitus upon range of motion, a small period of immobilization in an Aircast AirHeel (DJO Global) or other device is often helpful. A below-knee walking cast with a heel lift or a non-weightbearing fiberglass cast for four to six weeks is useful in those tough cases or non-adherent patients. Functional foot orthotics in both cycling shoes and running shoes can be helpful in those patients with a pronatory foot type.


Allow sufficient "float of the shoe cleat" check on the pedaling down stroke, not too much "dropping the heel."

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