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Top Five Running Injuries
Running is a great way to both get and stay healthy. However, without proper precautions, foot and ankle injuries can occur. We are here to help treat running-related foot and ankle injuries to keep you running. Don’t let an injury stop your running routine in its tracks! Look below for the five of the most common foot and ankle-related running injuries, as well as prevention and treatment tips for each.
#1 Plantar Fasciitis
What it is: Plantar fasciitis is an inflammation of a fibrous band of tissue in the bottom of the foot that extends from the heel bone to the toes. This tissue can become inflamed for many reasons, most commonly from irritation by placing too much stress (excess running and jumping) on the bottom of the foot.
Prevent by: Stretching both before and after every run. Proper stretching is gentle and should not be painful. Wearing supportive running shoes that are appropriate for your foot type will also be effective. Make sure to not over-train, gradually increasing how long or far you run.
Tips for treatment: Immediate treatments should include icing the area to help with inflammation (several times per day if possible), stretching, and taking OTC anti-inflammatory medication and resting (refraining from running). For further protection, taping, custom foot orthotics, and the use of a night splint may be recommended by your podiatrist.
#2 Achilles Tendonitis
What it is: An ailment that accounts for a large number of running injuries, Achilles tendonitis is an irritation or inflammation of the large tendon in the back of the lower calf that attaches to the back of the heel. The condition is often caused by lack of flexibility and overpronation.
Prevent by: Stretching regularly. Shoe inserts such as heel cups and arch supports may also help to correct faulty foot mechanics that can lead to this injury.
Tips for treatment: Ice and OTC anti-inflammatory medications can be taken in the short term. Resting the affected limb is vital for quick recovery. A podiatrist may recommend immobilization in more severe cases (such as a walking boot) to allow the area to heal faster. In some cases, custom orthotics can also help resolve pain and prevent recurrence.
#3 Morton’s Neuroma
What it is: Morton’s neuroma is often described by runners as a burning, stinging pain in the forefoot (commonly in the third and fourth toes). Other symptoms include pain in the ball of the foot and a feeling of “pins and needles” and numbness in the toes. Runners who wear tight-fitting footwear often experience this condition. A true neuroma is a benign tumor of the nerve, although entrapment of the nerve will give the same symptoms.
Prevent by: Wearing proper running shoes that fit well and have a roomy toe box, and do not lace shoes too tightly in the forefoot. Runners should wear shoes that feature adequate forefoot cushioning, and fit shoes with running-appropriate socks (those with a poly-cotton blend).
Tips for treatment: A podiatrist may administer a cortisone injection to provide relief for a Morton’s neuroma, and recommend a wider pair of running footwear. A professional gait analysis, paired with customized foot orthotics, can often prevent the condition from reoccurring. Occasionally, alcohol sclerosing injection therapy or surgical removal of the neuroma is necessary.
#4 Stress Fracture
What it is: Stress fractures in the lower limbs are common among athletes in general, and are commonly caused by repetitive forces on these areas. Symptoms include localized pain and swelling that grows worse over time. Stress fractures can occur over a period of days, weeks, or even months.
Prevent by: Modifying running equipment or training regimens. Replace running shoes on a regular basis (about every 400-500 miles), and see a podiatrist when pain is first noticed.
Tips for treatment: Stress fractures are like any other fracture in the body and require at minimum 6 weeks to heal completely. Treatments may include complete rest and icing, immobilization using casting or bracing of the affected area. Aggressive early treatment can get you back to running sooner.
#5 Shin Splints
What it is: Also referred to as “tibial stress syndrome,” shin splints affect runners of all ages and are commonly experienced as a shooting pain felt near the front or sides of one or both tibia bones (the shins).
Prevent by: Performing stretches such as toe raises and shin stretches, and replacing running footwear often.
Tips for treatment: Shin splints can be treated immediately with ice and anti-inflammatory medications. A podiatrist may also recommend a physical therapy program, as well as testing to determine if prescription orthotic inserts could prevent further injury.
Differences in Orthotics for
By Dr. Noushin Shoaee
What are Orthotics?
Orthotics are shoe inserts
that are intended to correct an abnormal, or irregular, walking pattern.
Orthotics are not truly or solely “arch supports,” although some people use those
words to describe them. They perform functions that make standing, walking, and
running more comfortable and efficient by altering slightly the angles at which
the foot strikes a walking or running surface. Orthotics take various forms and
are constructed of various materials. All are concerned with improving foot
function and minimizing stress forces that could ultimately cause foot
deformity and pain.
Rigid Orthotics- are chiefly designed to control motion in two major
foot joints. These devices are long lasting, do not change shape, and are
usually difficult to break. Strains, aches, and pains in the legs, thighs, and
lower back may be due to abnormal function of the foot, or a slight difference
in the length of the legs. In such cases, orthotics may improve or eliminate
these symptoms, which may seem only remotely connected to foot function. This material is best for motion control
however it gives the least amount of shock absorption.
Soft Orthotics- the second, or soft, orthotic device helps to absorb
shock, increase balance, and take pressure off uncomfortable or sore spots. It
is usually constructed of soft, compressible materials. The advantage of any
soft orthotic device is that it may be easily adjusted to changing weight-bearing
forces. The disadvantage is that it must be periodically replaced or
refurbished. It is particularly effective for arthritic and grossly deformed
feet. This material gives the greatest
shock absorption however it has the least control of muscles and tendons.
Semirigid Orthotics- the third main type of orthotic device (semirigid)
provides for dynamic balance of the foot while walking or participating in
sports. This is the ideal material for
runners. This orthotic is not a crutch, but an aid to the athlete. Each
sport has its own demands and each sport orthotic needs to be constructed
appropriately with the sport and the athlete taken into consideration. This
functional dynamic orthotic helps guide the foot through proper functions,
allowing the muscles and tendons to perform more efficiently. This material gives dynamic control with
efficient and moderate control of muscles and tendons. It has greater shock
absorption as compared with rigid materials.
Research has shown that back
problems frequently can be traced to a foot imbalance. It’s important for your
podiatric physician and physical therapist to evaluate you as a whole to
provide for appropriate orthotic control for your individual needs.
Importance of how orthotics are made: It doesn’t end at just getting the right material,
how an orthotic is made is just as, if not more, important than the material.
Casting your feet (with
plaster) in a non-weight bearing position captures your joints in a 3 dimensional
model/mold which is much more accurate than any other technique. The second
technique, the use of computer gait scanners only gets a 2 dimensional image of
the feet and does not capture the subtalar joint which shows how much your foot
is pronating or supinating (3 dimensional gait scanners exist however they are
too expensive and most places do not have them yet). The third technique is the
use of a foam box which captures the subtalar joint in a semi-weightbearing
position. The problem with this technique is that it captures the “abnormal”
image of your foot, the position which has caused pain in the first place. With
casting, the foot and its joints are placed into an “ideal” neutral position
and this is the gold standard technique that we use.
Next the 3 dimensional ideal
molds are sent to a laboratory to produce your custom orthotics. Not all labs
are created equal. It is very important for your mold to be sent to a lab with
experience in biomechanics and has podiatrists on staff. The lab we use is run
by podiatrists and continues to do research to come up with innovative
techniques to solve patient concerns and eliminate pain and help prevent injury.
Importance of shoes: There are three common foot types: Flat feet, medium arches, and high
- For individuals with flat
feet (low arches, over pronators), we recommend motion control shoes with
- For individuals with medium
to low arches, we recommend stability shoes with a slight curve last.
- For individuals with high
arches (over supinators), we recommend a neutral shoe with a curved last.
If for example you have high
arches and you place orthotics into a motion control shoe, you may end up with
more pain. It is therefore very
important that the right type of shoe is combined with the right type of
orthotic for YOUR individual needs. That is why it is important as a runner
to have a consultation with your podiatrist to evaluate and recommend the best types
and materials for you. Then follow up with your physical therapist to reduce symptoms
associated with previous injuries. Together this can solve current symptoms and
prevent future injury.
Also consider the soles of
your shoes for traction needs of different running surfaces. The heel height is
also important. Too much heel height on a running shoe may be good for people
with a tight calf or people who have Achilles tendinitis, however if too high,
it can cause back, knee or hip pain.
For all foot types, the soles
of the shoes should not be too flexible or the orthotics will not function at
their maximum capacity. For example, if you place rigid graphite orthotics into
ballet flats (which have VERY flexible soles), you may only get 50% function
out of your orthotics. However if you place them in a more rigid sole dress or
athletic shoe, it will function at its optimum and give you ideal support to help
What about the whole “barefoot running” phenomena?
Barefoot running is an
ancient practice widely popularized by one man’s experience with a tribe in Mexico.
Products marketed to devotees now reportedly sell more than five times what
they did two years ago. “Barefoot running and the use of minimalist footwear
are very controversial topics. They are movements within the running community
that many are incredibly passionate about,” said Paul Langer, DPM, APMA member,
book author, and avid marathoner. While anecdotal evidence and testimonials
proliferate on the Internet and in the media about the possible health benefits
of barefoot running, research has not yet adequately shed light on the
immediate and long term effects of this practice. Dr. Jenkins, a professor at
Midwestern University’s Arizona Podiatric Medicine Program, recently compiled
extensive research from more than 120 external sources—including Christopher
McDougall’s “barefoot bible,” Born to Run. “There has been a lot of focus
on the biomechanics of barefoot running, and not as much on the perceived
hazards that can cause injury,” he said. Barefoot running may be a
possible alternative or training adjunct to running with shoes. Barefoot running
has been touted as improving strength and balance, while promoting a more
natural running style. However, risks of barefoot running include a lack of
protection--which may lead to injuries such as puncture wounds--and increased
stress on the lower extremities including causing stress fractures and tendon
injury (tendinitis or tendon tears).
Not all foot types are
compatible with barefoot running so it is important to consult a podiatrist to
better determine if this type of running is ideal for you.
Running and Your Feet
Running Advice From The APMA
Nowhere is the miracle of the foot more clear than watching the human body in motion. The combination of 26 bones, 33 joints, 112 ligaments, and a network of tendons, nerves, and blood vessels all work together to establish the graceful synergy involved in running. The balance, support, and propulsion of a jogger's body all depend on the foot. But before entering a fitness regimen that includes jogging, don't forget to make certain your body's connection with the ground is in proper working order.
See Your Podiatrist
It is a good idea for a beginning jogger to visit a podiatric physician before starting an exercise program. Your podiatrist will examine your feet and identify potential problems, discuss conditioning, prescribe an orthotic device that fits into a running shoe (if needed), and recommend the best style of footwear for your feet.
Frequent joggers ought to see a podiatrist regularly to check for any potential stress on the lower extremities. During a 10-mile run, the feet make 15,000 strikes, at a force of three to four times the body's weight.
If you are more than 40 years old, see a family doctor before starting any exercise regimen. The doctor will perform an electrocardiogram, check for any breathing problems, high cholesterol levels, and high blood pressure before giving the go-ahead for a vigorous exercise program.
Anyone, regardless of age, should check with a doctor if a cardiac condition, weight problem, or other medical complication already exists.
The Importance of Stretching
Before beginning an exercise regimen, proper stretching is essential. If muscles are properly warmed up, the strain on muscles, tendons, and joints is reduced.
Stretching exercises should take 5-10 minutes, and ought to be conducted in a stretch/hold/relax pattern without any bouncing or pulling. It is important to stretch the propulsion muscles in the back of the leg and thigh (posterior) and not forget the anterior muscles.
Some effective stretching exercises include:
The wall push-up. Face a wall from three feet away, with feet flat on the floor, and knees locked. Lean into the wall, keeping feet on the floor and hold for 10 seconds as the calf muscle stretches, then relax. Do not bounce. Repeat five times.
The hamstring stretch. Put your foot, with knee straight, locked, on a chair or table. Keep the other leg straight with knee locked. Lower your head toward the knee until the muscles are tight. Hold to a count of 10 then relax. Repeat five times, then switch to the other leg.
Lower back stretch. In a standing position, keep both legs straight, feet spread slightly. Bend over at the waist and attempt to touch the palms of your hands to the floor. Hold the stretch for 10 seconds and repeat 10 times.
Shoe choice should be determined by weight, foot structure, and running regimen. Keep in mind that all shoes have a different shape, and sizes and widths are not uniform from shoe to shoe.
Consider whether an orthotic device will be placed in your shoe and whether your running style is flat-footed or on the balls of the feet. Shoes should provide cushioning for shock absorption and ought to be able to fully bend at the ball of the foot area. Visit the shoe store in the afternoon, when the feet are slightly swollen, and wear thick running socks when trying shoes on.
Systematic exercises must progress slowly from easy to rigorous to prevent debilitating muscle strain or more serious injury. The best and safest way to start a running program is with a four-day-per-week conditioning program for 12-16 weeks.
Begin with two sets of two-minute jogs interspersed with five minutes of fast walking. If muscles are stiff, walk only; have an "easy day" if you're in pain. As the weeks progress, gradually increase the number of minutes jogged per set to 20 minutes. Spend at least five workouts at each new level attained.
By the 16th week, you should be able to run two sets of 20 minutes each, with a five-minute walk before, between, and after. Make adjustments for heat and altitude, and don't be frustrated if you think your pace is too slow. Remember, a disciplined regimen will decrease your chances of injury.
Proper foot hygiene can also prevent injuries. Keeping feet powdered and dry is important, especially to the jogger suffering from blisters. Blisters can be prevented by application of petroleum jelly or creams to the places where they tend to occur.
Aches and Pains of Running
Even with the best preparation, aches and pains are an inevitable result of a new jogging regimen. If the pain subsides with slow easy exercise, you may continue, but if it gets worse, stop the activity and rest. If it persists, see your podiatrist.
The most common pain associated with jogging is known as runner's knee, a catch-all for jogging-related knee pain. One of the most common causes of runner's knee is excessive pronation, or rolling in and down, of the foot. Orthoses (arch supports -- shoe inserts) prescribed by your podiatrist are the best way to alleviate the problem. Occasionally, rubber pads in the arch of the shoe will help.
Shin splints, which are painful and appear at the front and inside of the leg, are caused by running on hard surfaces, overstriding, muscle imbalance, or overuse. Treatment includes changing running technique or insertion of an orthotic device in the shoe.
Start easy and build up your distances slowly
Don't forget to stretch regularly
Use sport specific shoes
Fit your shoes with the socks that you plan to wear during your running.
The American Podiatric Medical Association
TOP 10 TRAVEL TIPS FOR YOUR FEET
- Before traveling, visit a podiatric physician if you are experiencing any pain, problems, or discomfort with your feet or ankles. Foot pain is NOT normal.
- To condition your feet and legs, begin a regular walking program wearing the shoes you plan to travel with - include inclines if your destination has hilly terrain - at least four weeks before your trip.
- Review your travel itinerary and the activities planned to determine the kinds of shoes you will need (should pack).
- Take a few pairs of supportive, comfortable shoes, and plenty of appropriate socks so they can be changed frequently. Try not to take new shoes that have never been worn.
- When traveling, periodically flex feet at the ankles, wiggle toes, unlace shoes if feet swell, keep legs uncrossed, and move around if possible (especially during airplane travel - get up and move around once for every hour on the plane).
- Be prepared: in case of a minor foot problem, pack adhesive bandages, talcum powder, antibiotic or first aid cream, tweezers, and nail clippers in your toiletry bag.
- If you injure your foot or ankle while away, seek professional attention from a podiatric physician. We often assume that if a toe is broken, that it doesn't require treatment. That is not true. When traveling within the United States or Puerto Rico, contact the state podiatric medical association to obtain a referral to a local podiatrist, or access www.apma.orgvia the Internet to locate a podiatrist.
- Limit walking barefoot to safe, sandy beaches or close to the pool. Walking barefoot exposes feet to sunburn, as well as the plantar wart virus, athlete's foot, and other infections.
- Regularly apply sunscreen to the tops of your feet.
- Treat your feet well after a long day of sightseeing, shopping, or hiking: massage them and keep them elevated.