The foot is an incredibly complex extremity, made up of a network of bones, tendons, ligaments, and muscles that all work together in harmony. One disgruntled cog, and the whole machine can stop functioning.
Foot pain is a common problem among runners, that plagues both beginners and professional athletes alike. And with all the stress and impact runners put their feet through, it’s practically expected that they’ll experience an injury at some time in their career.
Some advice from an ultramarathon runner
We recently caught up with Gold Coast resident and ultra-marathon runner, Trent Harding, and chatted about some of the common foot injuries he’s experienced from running, and the steps he’s taken to look after his feet.
It’s no surprise Trent has experienced foot pain while running. In the first half of 2019 alone he clocked up 1,137kms, which includes five half marathons, two full marathons, a 96km trail race, and a 100km road race. And this is all on top of regularly running four times a week.
Among blisters, swollen feet, and losing nails, Trent was also suffering from ITB syndrome, and regular foot and arch pain while running. The constant stress on his joints was causing problems all up and down his legs.
It took him three long years to see a podiatrist, and the change he saw was almost immediate.
When asked, Trent was blunt. “If you’re serious about running, you need to go to a podiatrist to get the right advice.”
It turned out that for years he’d been running in the wrong shoes, which caused major issues. But since seeing a podiatrist who advised him to switch his shoes to a better fit, he’s experienced much less pain, and fewer foot injuries from running.
“It’s definitely the shoes, and the weekly physiotherapy, that keeps me injury-free and running well,” he told us.
So to all runners out there currently living with foot injuries from running, the good news is that all of the issues you’re facing are treatable. And, like Trent, with the correct treatment plan most people will make a full recovery, and get back on track to running their best.
Let’s take a look at some of the more common running and foot injuries, and what we can do to help you avoid them.
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Heel pain (plantar fasciitis/plantar fasciosis)
The plantar facsia is a thick band of fibrous connective tissue that attaches from the ball of the foot through to the heel bone (the calcaneus), so it takes a lot of pounding on a regular basis. As a runner, it’s practically a given that at some point in your career you’ll experience heel pain while running, which can indicate a plantar fascia injury.
People tend to use plantar fasciitis and plantar fasciosis interchangeably, despite each one referring to a different issue.
Plantar fasciosis (osis meaning degeneration) occurs when the plantar fascia develops microtears. Plantar fasciitis occurs when the plantar fascia becomes inflamed in the acute stages.
Both lead to chronic heel pain, but the significant difference is that some interventions work specifically to target inflammation, and some work to heal degeneration.
Heel pain can be caused by a variety of factors, and is a common heel injury caused by running. It can be due to poor running technique, a flow-on effect from tight calves, microtears after an increase in training, wearing the wrong shoes, and even just from prolonged standing on hard surfaces.
Do I have it?
You might begin to notice arch or heel pain after running, which becomes particularly bad in the morning, or when you’re barefoot. A good way to test at home is by pressing firmly on the plantar fascia, or giving your heel a squeeze. If the pain intensifies then it’s likely you’re experiencing plantar fasciitis/fasciosis.
If this is the case, we recommend booking in to see a podiatrist. They will check your symptoms, and perform a clinical examination of your foot to determine what’s wrong.
The most effective treatments will address all the contributing factors to your injury, with a holistic management plan that addresses each of these factors.
Treatments can include:
- a stretching and strengthening program, to reduce the strain on your plantar fascia
- footwear advice (they should be strong through the midfoot, with limited flexibility)
- orthotics, to improve the alignment of your foot
- addressing your running technique
- dry needling
In between sessions, you can get some relief by foam rolling your calves, or getting a golf ball and rolling it under the arch of your foot to reduce tightness through the fascia.
The extensor tendons attach your leg muscles to your toes, running across the top of your foot from your toes up to the front of your leg. Extensor tendonitis is irritation or inflammation of these tendons.
Extensor tendonitis is caused by fatigue in your muscles, generally due to extended time on your feet, or wearing shoes that are too tight.
Do I have it?
If you feel foot pain after running, localised to the top of your foot, and pain or weakness when moving your toes, then it’s possible you’re suffering from extensor tendonitis. It will generally get worse after running, and even more painful when running uphill.
If you’re experiencing extensor tendonitis after running, lie your leg flat on the floor and try pulling your toes back. If it hurts even more, it’s likely that your extensor tendons are inflamed.
Your podiatrist will perform a physical examination of your foot to assess your foot biomechanics and determine the root cause of your injury. They’ll then provide you with a management plan so you can reduce the likelihood of it recurring. This may include orthotics, to ensure your foot sits correctly in your shoe, and a stretching routine to reduce the tightness in your tendons and muscles.
There are a number of things you can do to help avoid this even becoming an issue.
- Icing the top of your foot after running (if it feels tight)
- Check your footwear to make sure it’s the correct fit
- Re-lace your shoes to make sure they aren’t too tight across the top
- Perform stretches for the front of your foot
- Avoiding slip-on shoes
When we think of fractures, we normally imagine breaking a bone in an unfortunate accident.
Unfortunately for runners, fractures can also develop over time, caused by fatigue and repeated stress on the bone. These are known as stress fractures.
Do I have it?
Stress fractures manifest in fairly obvious ways. You might be suffering from a stress fracture if you feel:
- foot pain that progressively gets worse when you put weight on it
- a deep, aching pain in your foot
- tenderness or swelling on a specific spot
- aching when at rest.
Booking in for an MRI, a CT, or a bone scan is the best way to determine whether you’ve received a stress fracture or not.
Treatment for this injury varies depending on the location of the fracture, and its severity. Bone takes 6-8 weeks to heal, so the quickest way to fix a stress fracture is taking 6-8 weeks off your foot. Both your doctor or your podiatrist can advise on the best course of treatment for this.
A podiatrist can’t help you heal your bone, but we can help you to offload this injury by implementing a treatment plan which will get you back into activity quicker.
This includes measures like:
- increasing the shock absorption for your feet through innersoles, changing your shoes, or even recommending running on softer ground
- progressive loading in training, to ensure you build up to a safe level of biomechanical stress
- calf stretches to reduce the pressure on your forefoot.
Bunions aren’t just a complaint of the elderly, and can be a painful imposition on your day-to-day activities. But they’re not just unsightly lumps that appear on your feet.
There are a few causes, bunions can be hereditary, caused by wearing incorrectly fitting footwear or caused by poor foot biomechanics. The adductor hallucis, abductor hallucis, flexor hallucis and extensor hallucis muscles run along the top, bottom and either side of your big toe. Together, these muscles work to keep your big toe in place, so it doesn’t bend too far towards your other toes, or too far away.
When these muscles are stressed, fatigued, or just generally out of balance, they’ll stop working as efficiently, which will cause your big toe to begin leaning inward towards your second toe. This progresses over time, causing a painful, bony lump to appear at the inside base of your big toe, right where it bends.
Do I have it?
If you’re experiencing a hard, aching, painful lump on the outer side of your big toe, and it’s noticeably leaning towards your other toes, then you’re experiencing a bunion.
While some people opt for surgery to fix a bunion, the good news is if it hasn’t progressed too far that you can tackle this issue with the help of a podiatrist—and you can start the process at home.
Your podiatrist can implement a treatment plan to treat your bunions conservatively, and help you avoid or prolong the need for surgery.
By regular icing at the pain point, good footwear choices, correcting foot biomechanics and undertaking a series of simple toe stretches that your podiatrist can provide, you’ll effectively reduce the tension on these overworked muscles, and reduce the severity of your bunion.
Neuroma may sound like it occurs in your brain, it’s actually a common issue that causes the ball of the foot to experience sharp pain while walking or running.
A neuroma is a thickened bundle of nerve fibres, and is a result of regular pressure or irritation on the balls of your feet.
Do I have it?
Neuroma takes the form of very localised sharp pain, or pins and needles, generally under the ball of your foot and more commonly between the third and fourth toe. So if the ball of your foot is sore after running, and it gets worse barefoot or in narrow footwear, then it’s likely you’re experiencing neuroma.
Your podiatrist can diagnose neuroma through a physical examination, with an ultrasound or MRI to confirm if need be.
Before considering surgery, a neuroma can be treated conservatively by reducing the nerve irritation. This can be done through dry needling or injection therapy, adding extra padding to your shoes, or orthotics to redistribute the pressure. Foot mobilisation exercises can help to decrease the recurrence of this injury in the future.
At home, we recommend giving yourself a regular massage on the ball of your foot, using either your hands or a massage ball. It’s also a good idea to wear wider-toe shoes, or re-lacing your shoes to allow for more space at the toes.
ITB syndrome (iliotibial band syndrome)
The iliotibial band is a thick band of connective tissue that attaches at the top of the hip, spans down the side of the leg, and attaches just below the knee. ITB syndrome is one of the most common causes of ‘runner’s knee’, a catch-all term for knee pain in runners.
ITB syndrome is caused by stress on your ITB, which itself is caused by a wide range of issues. The most common causes are:
- poor running technique, which can cause tightening of ligaments and fascia
- muscular imbalances (weak hips, weak glutes, tight calves, weak core)
- poor choice of running shoe
- sharp increase in mileage.
Do I have it?
If you begin to feel a sharp burning pain on the outside of the knee joint (with or without swelling), pain that gets worse when you’re running, moving side-to-side, or when you bend your knee, then it’s possible you’ve got ITB Syndrome.
However, it’s difficult to diagnose at home. We recommend booking in a physical and functional examination with your podiatrist to determine if you’re experiencing ITB syndrome.
Fixing ITB syndrome can mean re-training yourself how to run properly. To do this, your podiatrist will assess your running style and provide you with tips on how to run effectively and in a way that reduces the strain on your ITB. They’ll recommend the right shoes for your foot and running style, so you can train yourself to run in a way that’s best for your body.
It can also be cured by:
- focusing on reducing pain and inflammation, and increasing the mobilisation of the ITB
- providing a remedial massage and stretching of the adjacent muscles (this can be done at home with a foam roller)
- helping you strengthen your glutes and associated muscles through a series of strengthening exercises.
Shin splints (medial tibial stress syndrome)
Shin splints is the inflammation of the tissue on the inside of your shin, and almost every runner will experience it at one time or another.
Shin splints are caused by over-training or over-stressing your shins. This can be through increasing your mileage too quickly, poor running technique, or insufficient rest.
If unchecked, shin splints can cause thickening of the bone and a longer period of rest to resolve.
Do I have it?
Shin splints take the form of dull pain or tenderness down the inside of your shin, and soreness after exercise. It’s particularly noticeable after exercising on hard surfaces, or after high impact activities. You might experience swelling, and increased pain when you apply pressure to your shin.
Your podiatrist will perform a physical examination and undertake some functional testing to determine the severity of the injury.
Curing shin splints can sometimes just be a case of icing the shins, rest, and taking time away from high-impact activities. You can also perform exercises to strengthen your calves. In some cases you may need orthotics to reduce the twisting on your shin, and even a program of running retraining, to help you run in a way that’s better for your muscles.
Your podiatrist will advise on the best course of action for your condition.