A local North Colorado runner, and a new friend of mine, recently completed an astounding 200-mile race. Running is one of my passions and I want all my patients to stay as active as possible. While I don’t recommend an ultramarathon for most people; I do recommend creating and following through with achievable exercise goals.
After his outstanding run, he shared this photo of his foot with me (and has allowed me to share with all of you). As the lowest part of the body, the foot is prone to swelling. After running such an incredible distance, I am almost amazed his foot isn’t more swollen than it is. Our bodies have an amazing mechanism to keep the swelling at bay. Our main calf muscles are the gastrocnemius muscle and soleus muscle, both of which combine to make the Achilles tendon. There are a few other calf muscles that are deeper and closer to the bone. Each time we take a step, the muscles squeeze the veins which pushes our blood upwards and back towards the heart.
On average, a normal man running on flat, easy terrain would be taking 1,919 steps per mile1. Multiplying that by 200 miles, he would have taken 383,800 steps. However, this was no flat, easy race! His race included over 45,000 feet of elevation to climb. With steep inclines, he decreased his stride length and increased the number of gait cycles to keep momentum. In total, he took close to 460,000 steps! He worked his leg muscles to the limit.
Each time those muscles contract, they were not only propelling him towards his goal, but also fighting off swelling. That being said – a 200-mile run is a very, very long distance! Our bodies can only take so much! Unlike another (incredibly long) 100-mile run he recently finished in 23 hours, this 200 miler was also a mountain trek. He completed the extreme race in 85 hours, including breaks for filtering water, climbing over downed trees, eating, and of course- foot care. He knows the importance of foot care! It wasn’t until mile 180 that he developed his first blister on his foot. He was able to push through intense pain and endure more than I can imagine! That type of run is not only an immense physical battle, but also mental as well. I am left amazed at his fortitude!
Other factors affect swelling as well. Our blood is a well-regulated fluid with chemicals designed to keep our muscles, nerves, and other organs functioning. Most of us learned some time growing up that our bodies are about “70% water.” While that is definitely a generalization and can vary based on factors such as gender, age, body weight, and nutritional status, we do have a lot of fluid in us. When the normal balance of chemicals is disrupted, then the fluid can transition away from our blood vessels, and we end up with extra fluid in our tissues. The buildup of fluid can be seen in locations such as the ankle and foot.
While most of us are not out running ultramarathons, we may still be dealing with swelling. There can be multiple issues causing swelling in the feet and ankles, but swelling can be treated. If you are having issues with swelling, you may consider meeting with a doctor to discuss your options.
In the meantime, I recommend creating your own exercise goals. I doubt most of us would get as much enjoyment out of running for 200 miles as my new friend, but we can find other exercises that will keep us active and healthy. At Foot and Ankle Care of Colorado, we love helping athletes of all types and ages.
Amazingly, the story doesn’t end there. My new friend’s wife was not a runner. However, he shared his passion with her and incredibly was able to convince her to train for and run a 100-mile ultramarathon as well! With her husband’s support and coaching, she was able to build up her body to tolerate such an amazing distance. With a safe, well planned training regimen she was able to complete the race.
They train together and base their runs on how their body reacts to each run. This can be difficult at first, but they have improved as they have trained. They keep there base milage in the 40-60 mile range, but will increase that to the 60-70 mile range on peak milage weeks. They sometimes do multiple reps of 20-30 mile runs back-to-back. They also must train their minds by spending a few weekends without any sitting and practicing an overnight run. Working up the physical and mental stamina is a must for marathons and especially ultramarathons. Once again, each person’s body is unique, and I recommended creating a plan with a professional before attempting an intense feat as this training regimen isn’t for everyone.
When we run, our feet and ankles undergo immense forces. These forces are double to triple our body weight2. However, our bodies are amazing at adapting3. We have all seen how muscle size and endurance can increase with exercise. Another example is that our bones have the ability to change density depending on the strain they must undergo. Our bodies are capable of responding to incremental training. Even with intense training, any ultramarathon puts the body to the test. Unsurprisingly, my friend’s wife also had very swollen ankles after her race. However, I am certain she will remember much more than swollen ankles. What an incredible example of determination!
Unfortunately, any training method may come with setbacks. Falls, twists, sprains, fractures, and sores happen. However, they don’t have to be the end. Working with a doctor and other health professionals is an option to optimize your recovery and training. Sports medicine is a priority to our doctors at Foot and Ankle Care of Colorado. We enjoy seeing our runners, hikers, dancers, pickleballers, and all other athletes reach their full potential. Whether your goal is to run a marathon, one hundred miles, two hundred miles, or one mile, we want to see you achieve that goal!
By Dr. Logan Christiansen, DPM
References
All photos used with permission. Permission was received by both athletes before publication of this article.
- Hoeger, Werner W.K. Ed.D., FACSM; Bond, Laura M.S.; Ransdell, Lynda Ph.D., FACSM; Shimon, Jane M. Ed.D., A.T.C.; Merugu, Sunitha B.S., P.T.
- Haskell A, Coughlin MJ. Coughlin and Mann’s Surgery of the Foot and Ankle. Elsevier Health Sciences; 2023.
- Xiang L, Gao Z, Wang A, Shim V, Fekete G, Gu Y, Fernandez J. Rethinking running biomechanics: a critical review of ground reaction forces, tibial bone loading, and the role of wearable sensors. Front Bioeng Biotechnol. 2024 Apr 8;12:1377383. doi: 10.3389/fbioe.2024.1377383. PMID: 38650752; PMCID: PMC11033368.