BeActive – Health – Life – Well-Being

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Overuse Foot Injuries In Runners

It’s not difficult to imagine the feet as an area that may become overused and injured among runners. Consider, after all, the number of times and force with which they strike the ground. Studies show that running injuries tend to move along what is referred to as the “kinetic chain.” However, the specific location for an overuse injury is determined by a number of factors (e.g., genetics, previous injuries, training factors, etc.). This means that there is not an etched-in-stone overuse injury sequence through which all runners progress.

When searching for factors that may have contributed to any running injury, a good starting point is the foot. As a simplification, there are three types of ‘arches’ – neutral (normal), high and low (“flat feet”). In a normal running gait at footstrike, the foot is in a relatively supinated position and then progresses, or rolls, through pronation during the mid-stance phase. To visualize this, open a paperback book at the midpoint and place it face down on a table. It tends to tent-up with the spine elevated, supported on two “wings.” Each wing is in a supinated position relative to the spine. Now press down on the spine to flatten the book. Each wing has now moved towards a more pronated (less supinated) position. The action, from supinated to pronated, is called pronation — and going the opposite direction is called supination. Of course when we run, this happens to each foot alternatively, and obviously involves different mechanics and angles. The foot hits the ground in a relatively supinated position and then ‘rolls’ into a more pronated position by the mid-stance phase, which is the point when the foot is directly under the body and is bearing full weight.Runners with high arches are thus referred to as “supinators” or “under pronators.” In their running gait, they have decreased mobility – having a foot that doesn’t absorb shock well. This shock is transmitted to lateral (outside) structures in the foot, lower leg, and knee. An injury example is anterior (lateral) shin splints. “Overpronators” have the opposite problem where there is too much mobility and, thus, excess pronation during running.   Common Foot Injuries Among Runners

  • Plantar fasciitis: Heel pain caused by inflammation and tearing of the tough fascia on the bottom of the foot, usually right where the fascia attaches into the heel
  • Calcaneal Stress Fracture:  An overuse fracture of the “heel bone”
  • Achilles Tendon Bursitis: Inflammation of the bursa located at the attachment of the Achilles tendon to the heel
  • Extensor Tendonitis: Inflammation of the tendons on the top of the foot, usually midway along the foot
  • Sesamoiditis: Inflammation of those tiny little free-floating “sesame seed” bones, which are located in the ball of the foot near the base of the big toe
  • Metatarsal Stress Fracture:  An overuse fracture of one of the metatarsals. These are the long bones that start at the midway point of the foot and run right up to the base of the toes. There are 5 in each foot
  • Morton’s Neuroma: A condition caused by the chronic irritation of the local nerve, usually between the 3rd and 4th metatarsals, near the toes. Runners often experience a “pins-and-needles” or “electric shock” pain
  • Posterior Tibialis Tendonitis: This tendon passes underneath the medial malleolus (the inside “ankle bone”) and attaches into the medial aspect of the foot (navicular bone). Runners usually experience pain along the inner ankle or arch or slightly further along the inside of the foot
  • Peroneal Tendonitis: This tendon passes underneath the lateral malleolus (the outside “ankle bone”) and attaches on the lateral aspect of the foot (cuboid and base of 5th metatarsal). Runners usually experience pain on the outside part of the ankle or lateral edge of the foot up to the base of the 5th metatarsal
  • Shin Splint: This is pain that happens in the front or inside of the lower leg along the shin bone (tibia). Shin splints are common after changing your workout, such as running longer distances or increasing the number of days you run too quickly.  People with flat feet are more likely to develop shin splints
  • Ankle Sprain: Common among supinators, this is the accidental stretching or tearing of ligaments surrounding the ankle. It often happens when the foot twists or rolls inward.  Sprains typically get better with rest, ice, compression and elevating the foot