Runners Guide To Preventing Common Foot and Ankle Injuries

As a runner, you already know the many of the benefits you get from pounding the pavement--improved sleep, increased cardiovascular fitness, reduced stress, improved mood, and increased bone health.  Although great for your overall health, running can take a toll on your feet. While some foot problems in runners are fairly minor (blisters, corns, and calluses) many foot injuries will need more immediate attention so the problem doesn't worsen.

Many runners experience heel pain at least one time in their running career. One of the most common heel pain conditions brought on by running is plantar fasciitis. It occurs due to overstretching of the plantar fascia (the band of tissue that runs from your toes to your heel on the bottom of your foot). You'll feel pain on the bottom of your heel when you first get out of bed in the morning. If left untreated it will worsen and make it unlikely for you to continue to run.

The plantar fascia can get overstretched when:

• a runner overpronates
• has tight calf muscles
• has gained weight (more weight equals more force on the plantar fascia)
• a runner wears worn-out shoes

Another heel pain condition found often in runners is Achilles tendonitis. Achilles tendonitis is caused by the same factors as plantar fasciitis. But instead the pain is felt on the back of the heel instead of the bottom.

Other foot problems and injuries that occur frequently in runners are shin splints and ankle sprains.

Women runners often experience more painful foot problems than men. Neuromas, plantar fasciitis, and stress fractures are more common in women for reasons including improper footgear such as high heel wear and being more prone to bone loss. 

After pregnancy, women have looser foot ligaments due to the hormones produced to deliver their baby. This increases the chance of arch pain. In addition, rapid weight gain can increase shoe size. Wearing shoes that are too small can lead to ingrown toenails and neuromas.

Preventing Foot and Ankle Injuries in Runners

While the foot and ankle problems just described can land you in my office, here are ten things you can do to prevent them from occuring in the first place. 

Warm-Up and Stretching Is Essential for Runners

Effective warm-ups and stretching are extremely important tools in preventing foot and ankle injuries. Before you run try a 10-minute jog before you do your usual upper- and lower-body stretches. We also recommend Dynamic Warm-ups for Runners to enhance your performance and prevent injury before you run.

Increase Your Training Slowly

You're much more likely to sustain an injury if you do too much too soon or if you're a weekend warrior. Keep in mind your current fitness level and talk to your physician before beginning any new training program. Runner’s World suggests running three days per week to give your body time to recover in between runs. In addition, they recommend increasing your training time  by no more than 10-20% each week.

Change Up Your Exercise to Prevent Running Injuries

Your chance of getting an overuse injury goes up if you do the same exercises every day. We can all get into a rut. Changing up your exercise can help you avoid injuries that will sideline you from running.

Pick one or two other activities that use other muscles in your body and feet such as tennis, basketball, or weights at your local gym. In addition, you should also consider trying plank and yoga.

Plank

One study from Ohio State University Wexner Medical Center found evidence that weak deep core muscles can put runners at greater risk for back pain. They recommend runners do the plank to build up deep core muscles to prevent back pain.

Yoga

Yoga has many exercises specifically for the feet and ankles. In addition, it can help build strength and flexibility and increases awareness of how you're standing and walking. 

Foot and Ankle Strengthening Exercises

Add strength exercises for your feet and ankles. Check out our video, "3 Exercises to Improve Foot and Ankle Strength and Flexibility."

Try Surgical Tape on Blister Prone Foot Areas

A study of ultra runners found that those who used surgical tape on their blister prone areas had fewers blisters. By the end of the study, 63% had developed blisters on the untaped foot, while 77% avoided blisters on the taped foot.

Low-Impact Running Can Prevent Injuries

Research has shown that when runners increase the number of steps they take by just 5% and keep their speed the same they can reduce the impact on their body by 20% and reduce injuries. You can accomplish this by:

• Taking shorter, quicker strides
• Thinking about running more softly and quietly when you're running
• Landing on your mid or forefoot instead of the heel (Video on low impact running).
• Trying Chi Running which takes some of its principles from Tai Chi. You can also purchase the app of the same name.

 Although changing your running style can be difficult, fortunately, there are some apps that make it much easier.  Try RunCadence.

Purchase Proper Running Shoes

Buying proper running shoes and knowing when to re-purchase them are two of the most important decisions you'll make to prevent running injuries. We recommend that you go to a running store to get fitted properly. We recommend Super Jock 'N Jill, Fleet Feet or Road Runner Sports in Seattle.

Here are some important tips for buying a good pair of running shoes:

• Shop at the end of the day when your feet are slightly swollen to get a good fit.
• Try on shoes with the socks you will wear when running.
• If you use an orthotic, bring that to the store when you try on shoes as well.
• Have your feet measured standing up and fit your shoes to the larger of your two feet. Shoes that are too short can result in ingrown toenails and other foot problems.
• Be sure there is enough room in the toe box for your toes to wiggle and about a half inch between your toes and the end of the shoe.
• Run your hand all over and inside the shoes to feel for any seams or catches that might irritate your foot.
• Consider buying two pairs and rotating your wear to give each pair time to breath between runs and extend the life of each pair and prevent toenail fungus.
• Test your shoes for stability (video)
• Replace running shoes twice a year or about every 500 miles.
• Replace the insert that comes with your shoes with an over-the-counter insert like Powerstep or Superfeet for added support.
• For those who are over 65 with fat pad loss, consider running shoes with more cushioning such as Hoka One One.

Wear Your Orthotics When You Run

If you have orthotics to keep your feet aligned and balanced, be sure to wear them. You have them to prevent overpronation or rolling your feet outward. Without them, you're much more likely to sprain an ankle or develop an overuse injury like plantar fasciitis or Achilles tendonitis.

Buy Running Socks That Wick Away Moisture and Reduce Friction

Socks are one of the most important purchases you'll make second to running shoes. Avoid cotton-only socks to prevent sweat accumulation and blister formation. Socks that wick away moisture and reduce friction often combine Merlino wool and nylon and/or incorporate acrylic, polypropylene, or polyethylene fibers. Some favorites of Seattle runners that meet these requirements are Swiftwick, Feetures, and Wright Sock.   

Avoid High Heels When You Aren’t Running

Women who frequently wear high heels are more likely to experience plantar fasciitis. High heels cause the calf muscle to contract, the Achilles tendon to shorten, and place excessive body weight onto the ball of the foot.  Try to stick to a 1-inch heel or less, and save your stilettos for special occasions only.  

Eat Well and Keep Hydrated

Eat a diet containing fruits, vegetables, whole grains, and lean meats. Limit your sugar intake and keep yourself well hydrated. Post menopausal women should also eat calcium rich foods and take Vitamin D to prevent bone loss.

Listen to Your Body and Rest When Necessary

If you experience any signs of fatigue, pain, or discomfort these are warning signs that you need to give your body a break. Pushing through pain can cause overuse injuries. Take a rest day to allow your body to heal, repair, and rebuild to improve your performance and avoid injury.

Stay Safe When Running

Being careful where you run and how visible you are to drivers can help you avoid an accident.

• Run during the day and/or wear a running vest or strobe light at night.
• Avoid irregularities in the surface you run on to prevent ankle sprains and breaks.
• For tips on running in the rain, check out this blog, "The Art of Running Safely in the Rain".
• For tips on running in cold and snowy weather, go to "10 Tips for Running in Cold and Snowy Weather".

Treatment for Running Injuries at Our Seattle Office

While you may take all the necessary precautions to prevent yourself from getting injured while running, it's still going to happen on occasion. Our office will provide a thorough examination of your feet and your gait to determine the cause of your injury. 

Assessing Your Running Injury

• Gait Analysis - our office uses GO4D, a complete system for producing 3D-printed orthotics that analyzes your gait. It analyzes different aspects of your gait cycle including timing, weight distribution, and any discrepancies between your right and left foot.
• Foot Exam - Dr. Berg will examine your feet to determine if you've had previous injuries and to check things like your foot and ankle flexibility and calf tightness.
• Ultrasound - an ultrasound is often used to determine the level of inflammation in your feet to help determine a treatment plan.
• X-rays - X-rays may be taken if a stress fracture or other break is suspected.

Treating Your Running Injury

Many patients who come to our office are suffering from plantar fasciitis, Achilles tendonitis, or another type of heel pain. The focus of treatment for these conditions will include:

• Reducing your pain and inflammation - our goal is to give your immediate and long-term relief from the pain and inflammation you're experiencing from your condition.
• Relieving tight calf muscles - many of our patients who are runners have tight calf muscles. In addition to the regular stretching runners do before and after a run, we provide a much more aggressive stretching program to be done at home.
• Casting you for orthotics - as mentioned above we use our GO4D system to design the best orthotics for your feet to help alleviate pain and prevent problems.
• MLS laser therapy - this cold laser works well in treating heel pain problems and old injuries at the cellular level.
• Physical therapy
• Buying proper running shoes

A more thorough explanation of these treatments can be found on our page about Treating Plantar Fasciitis.