The multiple bones, joints, ligaments and tendons in the foot are all at risk for athletic injuries. Many of these injuries occur with regular running and begin with mild pain that gets worse over time. To stop any pain from worsening, an athlete must first understand their condition and recognize its symptoms.
The following are common foot injuries in people who run. I have included their descriptions and classic symptoms. As with most injuries, these conditions are easier to treat in the early stages. It’s a good idea to get medical attention if the pain does not resolve after 2 – 3 weeks of rest or if the pain becomes severe.
Plantar Fasciitis
This condition can affect runners and non-runners alike. It can also be called plantar fasciopathy. The plantar fascia is a thick band of fibrous tissue that runs between the toes and heel. It stretches and contracts thousands of times a day, with each step. If the area where the plantar fascia attaches to the heel bone becomes damaged, it is called plantar fasciitis. Plantar fasciitis causes a stabbing heel pain that tend to be worse in the morning, especially during the first few steps out of bed, and at the end of the day. Pressing on the inside (medial side) of the heel may feel like a bruise. There is more information about this condition in my blog post here.
Nonsurgical treatments, such as stretching the plantar fascia and calf muscles, help in the majority of cases.
Achilles Tendinopathy
Achilles tendinopathy is most common in runners and other athletes who ramp up their training too quickly. The Achilles tendon connects the gastrocnemius and soleus muscles in the calf to the back of the heel. If the tendon tissue breaks down or fails to heal from a tear, it is called tendinopathy. While the term Achilles tendonitis is popular, doctors prefer to use the term Achilles tendinopathy. Pain is typically felt above the back of the heel and affects a person’s ability to run as fast and comfortably as normal. Stiffness, swelling, and tenderness may also be noticeable. Symptoms may be worse first thing in the morning or after a workout
Stress Fracture
Almost all stress fractures in the foot occur in runners, dancers and other athletes. The bones most likely to be broken are the Metatarsals, Navicular and Calcaneus (Heel).
A stress fracture is a broken bone. A crack in the bone develops gradually through repetitive pressure. Stress fractures in the foot are often associated with intense running schedules and not enough recovery time. People diagnosed with osteoporosis or osteopenia have less dense bones and are more likely to get this condition. The pain of a stress fracture in the foot increases over time. Pain is worse when running, walking, or standing and less noticeable when sitting or lying down. Pressure on the skin over the affected bone may cause a lot of pain. As the pain gets worse, the foot may appear swollen and bruised.
Stress fractures can be difficult to see on a standard X-ray. A definitive diagnosis may require an MRI or bone scan, though this step is not always necessary before nonsurgical treatment. Recovery takes several weeks. For more information, please read my blog post here.
Metatarsalgia
Too much pressure on the long metatarsal bones in the foot can lead to a painful condition called metatarsalgia. Intense running training, poorly fitting footwear, and high arches are often linked to this condition. Most cases of this condition are related to problems with biomechanics – your foot anatomy and how it moves during walking and running. Pain is felt right behind the base of the toes, often in the ball of the foot. Exactly where the pain appears and how it feels will depend on the cause. Metatarsalgia is most notable when running, walking, or standing. Some people with metatarsalgia are later diagnosed with osteoarthritis.
Morton’s Neuroma
The repeated pressure and hyperextension of the joints in the ball of the foot during running, can cause unwanted tissue to grow in and around the plantar nerves on the base of the foot. When this extra tissue compresses a nerve, it’s called Morton’s neuroma. Some doctors also refer to this condition as Interdigital neuroma or Morton metatarsalgia.
Morton’s neuroma causes foot pain that feels like cramping, burning, tingling, or numbness. Runners sometimes often say they feel like a lump or pebble is stuck in a shoe. Symptoms are most likely to occur between the base of the third and fourth toes or the second and third toes. This condition is often treated with surgery to remove the excess tissue.
Posterior Tibial Tendon Dysfunction
Usually linked to flat feet, posterior tibial tendon dysfunction typically develops over time in runners and other athletes. This condition may also be called posterior tibial tendinitis. The tibialis posterior muscle is deep in the calves. This muscle, like all others, is connected to one of the foot bones by a tendon. If that tendon becomes inflamed or torn from overuse, it causes this condition.
Runners, and other athletes with posterior tibial tendon dysfunction, may notice the affected foot’s arch getting flatter over time. As the foot flattens, the ankle may begin to collapse inward. This condition tends to cause pain in the ankle or the area where the ankle meets the foot. This pain gets worse with running or other activities. Swelling, warmth, and redness are often seen if inflammation is present.
Runner’s Toe (Black Toenails)
The medical name for blackened toenails is subungual hematoma. Runners tend to develop this condition if their toes repeatedly bang into the front of their shoes. This can occur while running downhill or in shoes that are too small or too big. The repeated mini-traumas to the toes can cause blood to collect and become trapped under the nail. The most obvious symptom of this condition is not how it feels but how it looks. The toenail bed will appear black, brown, purple, or dark red. Pain is also possible, especially if the toe area is squeezed. The nail may get thick, crack, split, or come off. This condition can be avoided by ensuring that your shoes fit correctly and are tightly laced up.
Blisters
While rarely serious, blisters are painful. Distance runners often get blisters on the bottom of their feet or on their heel. A blister is a bubble of fluid trapped under a layer of skin. Blisters usually develop in areas where a foot rubs uncomfortably against a shoe. This friction causes layers of the skin to split and separate, and fluid collects in the space. Even a small blister causes pain with every step. Many distance runners have had to drop out of races due to severe blister pain.
Heel (Retrocalcaneal) Bursitis
The retrocalcaneal bursa is a small, fluid-filled sac located between the heel bone and the Achilles tendon. Normally, this bursa works as a cushion and lubricant between the two structures. Running, particularly uphill, causes the foot to flex considerably. This flexion can be especially irritating to the bursa. When a bursa becomes inflames it is known as bursitis. Retrocalcaneal bursitis causes pain, tenderness, and swelling at the back of the heel.
Because the symptoms are similar, heel bursitis and Achilles tendonitis are often mistaken for one another. Moreover, a person can have both conditions at the same time. For example, if Achilles tendonitis is left untreated, it might lead to retrocalcaneal bursitis.
If you want any discuss how massage and gentle exercise can help you to recover from any injury, please get in touch.