July 27 2018
Lifelong running and exercising requires constant body maintenance to make sure you’re taking proper care of yourself.
In just one foot, you have 26 bones, 33 joints and more than 100 muscles, tendons and ligaments. When you run, every one of these structures plays a role. Most foot injuries are not solely (pun intended) a result of dysfunction at the foot but are related to imbalance and weakness up the kinetic chain. “Injuries occur when the foot has to work too hard to compensate,” says Rebecca Johnson, a physical therapist in Wheaton, Ill., who frequently treats runners. Following is advice for common foot injuries.
Pain on the outside of the foot often occurs when this area is overloaded. “Ideally you should roll off of your foot between the first and second metatarsal. If you’re relying more on the outside edge of your foot, there’s often an imbalance higher up the chain,” Johnson says. For instance, if the hip-pelvis muscles aren’t doing their job as functional stabilizers, the fallout can include compensation at the lower leg and foot.
There are multiple conditions that can cause this: Peroneal tendonitis, or inflammation of the peroneal tendons that run from the back of the calf to the lateral foot, typically feels like a sharp or aching sensation along the side of the foot. Stress fractures of the fifth metatarsal, the long bone that connects to the pinky toe, can also occur with abnormal foot placement. With a stress fracture, swelling and pain intensify as soon as you start to run and never completely go away. Other common lateral foot injuries include stretched, torn or pinched nerves and pain related to unhealed ligaments from a previously sprained ankle.
Treatment varies for each of these conditions, but one thing Johnson recommends is looking for clues as to why you might be overloading your lateral foot. Strengthening the muscles at the hips and releasing tension up the leg may help disperse forces more evenly when you run.
Several factors can contribute to this pain, including wearing shoes that are too narrow; having tight calves, which increases the time you spend on the ball of your foot; and lacking hip extension, which can cause you to compensate by pushing off with the ball of your foot.
“A lot of people think they need to push off the ball of their foot when they run, but the structures in the foot are not meant to do a heavy push-off,” Johnson says.
Excessive stress to the ball of the foot can lead to metatarsalgia, a general term for pain and inflammation under the metatarsal heads of the foot where the toes attach. It can start as an annoying discomfort, but if left untreated, it can become so painful that it hurts to bear any weight on your foot.
Another injury is Morton’s neuroma, a thickening of the tissue around one of the nerves that go to your toes. Morton’s neuroma can cause a sharp, burning pain and can feel like you have a pebble stuck inside your shoe.
For treating both metatarsalgia and Morton’s neuroma, Johnson recommends a multifaceted approach that includes modifying how much weight you’re putting on your foot, stretching and bodywork for the calves, releasing the sciatic nerve and strengthening both the feet and up into the kinetic chain.
In most cases, tight shoelaces are the simple cause of pain on the top of the foot, formally known as extensor tendonitis. “It’s all about finding the right marriage of your shoes, shoelaces, socks and orthotics if you wear them,” Johnson says. “If you alter any one of these, be aware of whether you need to make any adjustments.”
Having strong and mobile feet can limit your risk for foot injuries, but it’s also important to strengthen the muscles higher up the chain that affect how your foot hits the ground and your weight-bearing pattern. Johnson recommends the following exercises and stretches.