With mud season just around the corner, the minds of outdoor athletes begin to shift to warmer weather activities and the joy of getting out on hiking or running trails.

But the rapid transition from ski boots to athletic shoes – and the various strains and stresses that running-related activities can put on feet and ankles – often brings up orthopaedic issues that can be exacerbated by summertime running.

Dr. John Paul Elton is a foot and ankle surgeon with Vail-Summit Orthopaedics & Neurosurgery and expert on diagnosing and treating ankle and foot injuries. As runners make their first outings, Elton begins seeing patients with a wide range of ankle and foot problems. He says many of those can be prevented with some warm-ups as well as more attention to proper footwear.

“As people ramp up their activity with more running, they’re often causing stresses on their feet that are completely different than what they’ve done over the winter,” he says. “I end up with a lot of patients with stress fractures and stress injuries in their feet and ankles, as well as tendonitis from over-use. We get a range of fractures and damage to tendons and ligaments.”

One of the major issues is the variety of surfaces runners encounter while out on the trail, with uneven surfaces making it easier to roll an ankle. Other ailments Elton sees commonly include heel pain from plantar fasciitis, an inflammation of the tissue that connects the heel to the toes.

“Generally, people in mountain towns are pretty tough folks, and a lot of people think they can just ‘push through’ the initial pain, that it’s related to breaking in shoes or getting used to a new adventure,” he says. “Unfortunately, that pain could be a pinched nerve or even a neuroma growth. And as the pain starts, people can end up with stress fractures if they push themselves too hard. If it’s something that comes on during a run and resolves itself, that may be fine, but if you have lingering symptoms, even when you stop running, or you’re on day two of limping around, you should give us a call.”

Elton says the safest preventative strategy is to start off slow and to get back into running or hiking gradually, not 10 miles on the very first outing. “Ideally, you’ve been doing some cross-training during the winter, either running on a treadmill, Nordic skiing or something with the right kind of impact. But a lot of people haven’t, and they can get into trouble. I suggest starting gradually, and increasing the miles as you go. Then you can ramp it up and have fun.”

Doing a range of warm-up stretches before you head out is also important, Elton explains, as that’s good for your tendons, especially, as well as reducing the risk of injury to muscles. He also recommends a vitamin D supplement as a way of helping your body to build and maintain bones and reduce inflammation.  “In mountain towns, everyone has been bundled up all winter without much sunlight, and that can cause a vitamin D deficiency, which can lead to stress fractures. I’d suggest talking to your primary care doctor about which supplements can help.”

And while you may still be in love with last season’s running shoes, Elton suggests that runners consider investing in updated footwear, as well as taking the time to properly break in a new pair of trail or athletic shoes. He’s become a fan of performance brands including Topo and Hoka. “I encourage patients to try a couple of different pairs of shoes, in person, and see what feels best, as they all fit differently. Look for shoes that offer more support, as that can help prevent injuries.”

When injuries do strike, Elton says it’s critical for patients to recognize their symptoms early and get into see him or another member of the VSON team, as they can diagnose and provide systemic treatment that specialists like podiatrists may not be able to offer. “Overt signs like swelling indicate that something might be going on. My benefit as an orthopaedic specialist is that I’ve been trained on the whole musculoskeletal system, from head to toe, especially joints and bones. I focus on feet and the care of ankles, and we’re well-equipped to treat what’s indicated. Sometimes foot problems are connected to knee, hip and back issues – we can look at that and address the whole system.”

Elton’s treatments range from discussions of footwear modifications and custom footbeds to physical therapy to address instability and tightness in feet and ankles. He can also order x-ray or MRI imaging to evaluate stress fractures, or provide injections when needed.