June 3rd is National Running Day and many running organizations from across join forces in an effort to promote running as an easy, healthy, affordable form of exercise. Unfortunately, runners are susceptible to foot problems, including heel pain, tendinitis, ankle sprains, stress fractures and blisters. Proper shoe fit and training are two of the easiest ways to prevent foot and ankle injuries while running. This article review the top 5 foot problems in runners and simple tips for treatment and prevention.
1. Heel Pain and Plantar Fasciitis: Plantar fasciitis is caused by excess stress on the ligament-type structure within the arch of the foot. The tearing causes inflammation and the inflammation causes pain, most commonly at the inside of the heel. Over million runners develop plantar fasciitis each year. Although classic plantar fasciitis pain occurs at the heel upon stepping down first thing in the morning, this is not always true for runners. Many runners experience pain on the bottom of the heel and through the arch during the first 10-15 minutes of a run. In most cases, it works itself out as the run progresses, but returns at the end of the run, or later in the day.
To prevent the development of plantar fasciitis when running or to help avoid re-injury, pay special attention to your shoes. Check your shoes for support and make sure they do not fold in the middle. Take the heel of the shoes and press the toe of the shoe into the floor. If the foot collapses under this pressure, it is much too flexible. A short run in an old pair of shoes can cause plantar fasciitis to development. Throw out old shoes when they are worn out and test all new shoes with this simple test. make sure your shoe is supportive. Just one run in that old, worn out pair of shoes can cause enough stress on the plantar fascia to start the process.
If you are prone to developing arch pain or plantar fasciitis, stretch the arch before you run for at least one minute. Place one foot on the opposite knee while seated and grab the toes. Pull both the ankle and toes back. This will stretch the arch and you should be able to palpate the plantar fascia. Perform this stretch after the run as well. Calf stretching will also be beneficial, but if not done appropriately, can lead to Achilles problems. Warm up first, then perform calf stretches. Repeat the stretches when you are finished.
Slowly progress with training by adding in distance and hills gradually and increasing pace and stride gradually.
2. Achilles Tendinitis: Achilles tendinitis and calf related injuries are the most common injuries experienced by runners. Pain may gradually develop at the back of the heel or calf, or come on suddenly as a sharp pain. Pain at the beginning of a run is common as well as pain and stiffness when first stepping down in the morning. Improper training, over training and poor footwear are the three most common reasons for development. A sudden increase in distance or pace or additional of steep hill climbs can strain the muscles and tendons in the foot and ankle causing microtears within these structures, resulting in pain and inflammation. Prevention for Achilles tendinitis and calf problems is similar to that of plantar fasciitis. Appropriate shoes and training are the most important. Calf stretching should be done after a 5-10 minutes warm up and it’s important to note that improper stretching or over-stretching can cause injury.
3. Stress fractures: A stress fracture is an incomplete break in the bone. In the foot, the long bones (metatarsals) are the most commonly affected. A sudden onset of pain and swelling on the top of the foot is an indication of a stress fracture. Stress fractures are generally not associated with blunt trauma or a specific injury, but are more often linked to unsupportive shoes in combination with overuse. Individuals with flatfeet, overpronation, hypermobility and tight calves are at the greatest risk. Those with very flexible feet tend to overstress the ball of their foot because the great toe joint tends to rise (hypermobility) during the push off phase of walking. The great toe joint does not take it’s fair share of weight and a greater force is placed on the smaller metatarsal bones. Individuals with tight calf muscles have a heel that lifts earlier than normal when walking. This also places excess stress on the ball of the foot and lesser metatarsals. Hypermobility and tight calves are linked to overpronation and this triad of abnormal foot mechanics, in combination with poor quality shoes and overuse can lead to stress fractures. Supportive shoes, heel lifts, orthotics (if necessary), proper training and stretching are the keys to avoiding stress fractures.
4. ankle sprains: ankle sprains are a common injury experienced by runners. The most common injury is called an inversion ankle sprain and involves the ankle rolling out while the foot turns in. This causes a partial tearing of one or more of the ligaments on the outside of the ankle. Most ankle sprains are mild to moderate in severity, but some may be severe and involve complete tearing of the ligaments. Rest, ice, compression, elevation and early range of motion are the keys to treating most ankle sprains. Mild ankle sprains will need 2-6 weeks of rest and support, while moderate ankle sprains may take 6-12 weeks to heal. Severe ankle sprains will take 12 weeks to a year to heal and some involve surgery. An evaluation by a physician may be important to rule out a fracture or complete ligament tear.
5. Blisters: Almost all runners have experienced blisters and although they may not be as limiting as other running injuries, they are annoying at best. Blisters develop as a result of friction and shearing forces on the skin. Abnormal motion in the foot, such as pronation, excess moisture on the feet or within the socks, ill fitting shoes and foot deformities all increase the chance of blisters forming. The body’s natural defense mechanism to excess rub, irritation and shearing forces on the skin is to develop fluid between the outer layers of the skin. This provides a cushion and protects the under layers, allowing for a new layer of skin to grow.
Blisters can be prevented with proper fitting shoes and appropriate socks. Finding the right combination of shoes and socks can be a challenge. Socks should be made of a wicking material which facilitate the transfer of moisture from your feet to the outer layer of the sock, so it can evaporate. Cotton socks absorb moisture like a sponge and should be avoided. The American Academy of Podiatric Sports Medicine recommends socks made with CoolMax. Shoes with mesh fabric allow for breathability and help with moisture evaporation. Supportive shoes with proper fit are important to avoid excess movement in the shoe. If you have orthotics, make sure you run with them, as excess pronation and abnormal foot motion are also factors causes friction, shearing on the skin and contribute to blister formation.
-By: Christine Dobrowolski, DPM
Christine Dobrowolski, DPM is a podiatrist and owner of Northcoast footcare, Inc an online resource for foot health information and foot care products. More information and images on foot injuries in runners.