Whether you are running recreationally or professionally, running puts you at a relatively high risk of developing overuse-related injuries. In fact, research suggests about 30 to 80 percent of runners develop some type of injury each year. And around a quarter of those annual running injuries are foot and ankle injuries.
As a physical therapist, I love to help folks understand the underlying causes of these running foot injuries, and figure out how to handle ’em. Let’s take a look at the five most common foot injuries in runners and tips on preventing and treating them.
Disclaimer: This post was written by JayDee Vykoukal, Doctor of Physical Therapy. It has been reviewed by Chrissy Carroll, MPH, USAT Level I Triathlon Coach, RRCA Running Coach. This post is for informational purposes only and does not constitute medical advice or individual training advice. Consult a doctor for any running injury.
5 Common Running Foot Injuries
The foot is a complex part of the human body composed of 33 joints, 26 bones, and over a hundred muscles, tendons, and ligaments. They all work together to allow weight bearing for standing, walking, jumping, running, and beyond.
Injuries can occur due to various factors, such as overuse, improper footwear, lack of strength and flexibility, poor running form, or even anatomical predispositions.
Here are the top 5 most common foot injuries in runners:
1. Plantar Fasciitis
Plantar fasciitis is the most prevalent cause of heel pain, which can occur after running, first thing in the morning, or throughout the day. According to one study, it affects over 40% of middle-distance runners and 25% of long-distance runners.
Plantar fasciitis is an overuse injury that occurs when the plantar fascia, a thick band of tissue connecting your heel bone to your toes, becomes strained and inflamed.
Common Causes of Plantar Fasciitis
Several factors can cause Plantar Fasciitis. The most common ones include:
- Overpronation (flat feet)
- Longer periods of time on the feet
- Larger body size
- Running on hard surfaces
- Poor foot mechanics
- Tight calf muscles
- Improper footwear, particularly poor arch support
- Sudden increases in mileage or intensity
- Switching from traditional running shoes to “barefoot” style shoes with a minimal heel drop (especially without a sufficient period of time to gradually adjust to them)
- Biomechanical issues stemming from the core, hips, knees, and ankles can also contribute to this classic foot injury.
Tips for Dealing with Plantar Fasciitis
Here are some essential tips on how to deal with this common foot injury:
- Rest: Avoid activities that aggravate the pain.
- Stretching exercises: Perform calf stretches and plantar fascia stretches regularly.
- Strengthening exercises: Focus on strengthening your foot muscles, particularly the arch muscles. One easy exercise to try at home is the “towel scrunch”, where you place a hand towel on the floor and squeeze your toes and foot to scrunch up the towel.
- Orthotic inserts or Proper Footwear: Consider using orthotics or provide additional support and cushioning.
- Massage: Use a foam roller or massage ball to relieve tension in your feet and calf muscles. Add ice with a frozen water bottle for extra benefits.
- Talk to a physical therapist: They can help you identify and address underlying biomechanical issues that may be causing the injury. Plus, give personalized exercise and home treatment recommendations.
2. Metatarsalgia
The term metatarsalgia describes pain in the ball of the foot, specifically in the area between your arch and toes (metatarsal heads). This pain point is common with consistent high-impact movement, such as running.
Common Causes of Metatarsalgia
Metatarsalgia can range from mild to severe. Is often caused by:
- Overuse or overtraining
- Wearing ill-fitting or unsupportive shoes
- Running on hard surfaces
- High arches or flat feet
- Abnormal foot alignment
An underlying stress fracture can also cause Metatarsaliga. While the metatarsal bones are the most common site for stress fractures in the foot, they can also occur in the other bones of the foot, such as the calcaneus (heel bone) and navicular.
Tips for Dealing with Metatarsalgia
Basic tips for getting started with metatarsalgia treatment include:
- Rest: Take a break from high-impact activities that cause pain.
- Wear proper footwear: Invest in shoes with adequate cushioning and arch support. If you have high arches, consider using orthotic inserts.
- Icing: Ice your foot for 10 to 15 minutes two to three times daily or after activities that cause pain.
- Run on softer surfaces: Switch to running on softer surfaces, such as grass or a rubber track.
- See a doctor: If the pain persists, consult an orthopedic or physical therapist for an accurate diagnosis and treatment plan.
3. Skin and Toenail Damage
With running, there are lots of opportunities for friction and pressure – particularly in the toe-box area of your shoes. When combined with sweat, dirt, inadequate toenail trimming, foot abnormalities (such as bunions), or poorly-fitted shoes – it can result in toe or heel blistering, black toenails, ingrown toenails, or calluses.
Tips for Preventing Skin and Toenail Damage
Here are some essential tips to help prevent skin and toenail damage while running:
- Keep your feet clean: Wash your feet regularly with soap and water. Dry them thoroughly afterward.
- Proper toenail trimming: Trim your toenails straight across and file any sharp edges. Avoid cutting them too short, as it can increase the risk of ingrown toenails.
- Wear well-fitting socks and shoes: Choose socks made from moisture-wicking fabrics to keep your feet dry and minimize friction. Make sure your sneakers have enough room in the toe-box area.
- Use anti-chafing products: Apply petroleum jelly or other anti-chafing agents in areas prone to friction before a run.
- Listen to your feet: If you feel any discomfort, take a break and examine your feet. Address any potential issues before they become more severe.
4. Peroneal Tendonitis
Peroneal tendonitis is a common cause of lateral ankle and foot pain, particularly in runners. It refers to the inflammation of the peroneal tendons that run along the outside of your ankle and lower leg/foot. These tendons are responsible for everting the foot (moving the toes away from the body), pointing the toes, and stabilizing the ankle and foot during movement.
Common Causes of Peroneal Tendonitis
The leading cause of peroneal tendonitis is overuse, which can occur due to:
- Excessive running or other high-intensity activities
- Poor foot mechanics or running form
- Wearing unsupportive shoes, especially on uneven terrain
- Ankle sprains or other ankle injuries that have not fully healed
- Switching running shoes to a lower heel drop without adequate training
Tips for Dealing with Peroneal Tendonitis
If you experience symptoms of peroneal tendonitis, here are some tips to help alleviate the pain and promote healing:
- Rest: Take a break from activities that cause pain and irritation.
- Ice: Apply ice to the affected area for 10 to 15 minutes several times daily.
- Stretching exercises: Focus on stretching your calf muscles. Consult with a physical therapist for personalized recommendations.
- Supportive footwear: Wear shoes with adequate cushioning and arch support. Orthotic inserts can also provide additional support.
- Use a brace or tape: Consider using a peroneal tendon strap or taping to help stabilize the ankle and reduce stress on the tendons.
- Make biomechanical adjustments: Work with a physical therapist to improve your foot mechanics and running form, which can help prevent future injuries.
5. Heel Spurs
Heel spurs are bony growths that develop on the back or underside of the heel bone. They are often associated with Achilles tendonitis or plantar fasciitis due to extra strain on the area. They can cause significant discomfort, especially during weight-bearing activities like running.
Common Causes of Heel Spurs
Heel spurs are caused by repetitive strain and stress on the muscles and ligaments that attach to the heel bone, resulting in inflammation and spur formation.
Risk factors for developing heel spurs include:
- Age: Heel spurs are more common in older adults due to the natural wear and tear of the plantar fascia over time.
- Biomechanics: Abnormal gait or foot mechanics, such as overpronation, can place additional stress on the heel bone and attached tissues.
- Larger body size: A higher amount of body weight can put additional stress on the heels, which can increase the risk of developing heel spurs.
- Wearing unsupportive footwear: Shoes without proper arch support or cushioning can contribute to the development of heel spurs.
- Occupational factors: Jobs that require prolonged standing or walking can put excessive pressure on the heel, leading to spurs.
- High-impact activities: Activities such as running or jumping, particularly on hard surfaces, can contribute to the formation of heel spurs due to the constant pressure on the foot.
- Conditions: Conditions like plantar fasciitis and Achilles tendonitis can increase the risk due to the continuous pulling on the heel bone.
Tips for Managing Heel Spurs
If you suspect you have a heel spur, consult with a doctor for an accurate diagnosis and treatment plan. Some tips to manage symptoms include:
- Rest: Avoid high-impact activities that cause pain.
- Preventing further aggravation: While bone spurs won’t go away on their own, you can prevent them from worsening by switching to supportive shoes and modifying activities that put excessive pressure on the heels.
- Surgery: If a heel spur is causing severe pain and other ineffective treatment methods, surgery may be necessary to remove the spur.
- Physical therapy: A physical therapist can help address any underlying biomechanical issues and provide exercises to strengthen and stretch muscles and tendons in the foot. They can also utilize modalities like ultrasound or electrical stimulation to promote healing.
- Orthotic inserts: Custom orthotics can provide support and cushioning to help reduce pressure on the heel bone and attached tissues.
Less Common Causes of Foot Pain
Outside of the most common running foot injuries, other potential causes exist. They are less likely but still essential to be aware of. These include:
- Fat Pad Syndrome: This condition occurs when the fat pad on the bottom of the foot (heel or ball of the foot) thins out or shifts, leading to pain and discomfort. It can occur due to aging, weight loss, or activities that put excess pressure on the feet.
- Tarsal Tunnel Syndrome: Similar to carpal tunnel syndrome in the hand, tarsal tunnel syndrome involves compression of the tibial nerve that runs along the inside of the ankle. It can cause numbness, tingling, or burning pain in the foot and is often seen in runners.
- Sesamoiditis: The sesamoid bones are two small bones located on the underside of the big toe joint. They can become inflamed and painful due to repetitive pressure or injury, particularly in activities like running, dancing, or jumping.
- Turf Toe: A sprain of the big toe joint, usually caused by hyperextension or jamming of the toe. It is often seen in sports involving quick direction changes and can be painful and limiting. While less common with running, it can occur when training with explosive movements.
- Hallux rigidus: This condition is a degenerative arthritis of the big toe joint, resulting in limited movement and pain. It can be caused by overuse or an injury to the joint.
- Morton’s Neuroma: This condition involves the thickening of tissue around a nerve in the foot, leading to pain and numbness in the toes. It is often caused by ill-fitting shoes or repetitive pressure on the ball of the foot.
- Posterior Compartment Syndrome: A rare condition that involves compression of the nerves and blood vessels in the back of the lower leg, leading to pain, numbness, and weakness. It can be caused by overuse or trauma.
- Secondary health problems contribute to foot injury: Health conditions like Gout, Diabetes, Bunions, and Rheumatoid Arthritis can also cause foot pain in runners. It is essential to manage these conditions with proper care to prevent the development of more severe injuries.
Nearby Injuries That Affect Foot Health
In addition to foot injuries, runners may experience pain or discomfort in other lower body areas. Pain in other areas of the body can exacerbate or contribute to foot pain, making it crucial to address these issues as well. The most common examples include:
- Runner’s Knee: Pain in the front of the knee, often caused by overuse or biomechanical issues.
- IT Band Syndrome: Inflammation and tightness of the iliotibial band (connective tissue that runs along the outside of the thigh) can cause pain outside the knee or hip.
- Ankle sprains: A common injury in runners, ankle sprains occur when the ligaments supporting the ankle are stretched or torn.
- Achilles Tendonitis: Inflammation of the Achilles tendon, often caused by overuse or increased training intensity.
- Shin splints: Pain along the front or inside of the lower leg, often due to overuse or biomechanical issues.
Additionally, weakness in key areas like the core, hips, and glutes can lead to compensations and imbalances in the body, leading to injuries in the feet, knees, hips, or back.
General Prevention Tips
As you read through the tips for treating common foot injuries, you may have noticed a lot of overlap in recommendations. In general, here are some essential tips to help prevent foot injuries from occurring:
- Wear proper footwear that provides support and cushioning for your feet. This will vary with each person depending on foot flexibility, arch height, preferences, running style, and previous injuries.
- Gradually increase training intensity and distance to allow your body to adapt and avoid overuse injuries.
- Strengthen the muscles in your feet with barefoot exercises, such as single-leg balance, toe curls, or picking up objects with your toes.
- Stay aware of any pain or discomfort in your feet and address it before it becomes a more severe injury.
- Mechanics matter – maintain good form (for your body) and avoid overstriding to prevent excessive shock and stress on your feet.
- Be mindful of your running surfaces. If you notice foot injuries frequently happen with road running, try switching to a trail or track and see if they improve.
- Cross-train with low-impact activities like cycling, swimming, and well-rounded strength training to give your feet a break from high-impact running.
- Get help from a physical therapist sooner rather than later. See a professional for a gait/running analysis, recommendations on proper footwear or orthotics, home exercises, and pain management tips.
- Listen to your body – take rest days when needed, pay attention to any warning signs of injury, and make modifications as necessary.
Take Care of Your Feet
To continue running and staying active, it’s essential to take care of your feet properly. By knowing what to look out for and implementing prevention tips, you can avoid common foot injuries that may sideline you. Don’t ignore any pain or discomfort in your feet – see a doctor and address it early to prevent more severe issues from developing. With proper care and attention, you can keep your feet healthy and happy while pursuing your running goals!
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