At least 50 percent of runners are injured annually, according to a 听published in Current Sports Medicine Reports, and feet are one of the main culprits. But foot pain can be hard to manage. Is it a serious injury? Just an ache? Can you听push through, or will you make it worse?
We asked two podiatrists to give us a听rundown on the most common foot injuries for听runners.听, former president of the American Academy of Podiatric Sports Medicine, is a runner himself听and has treated听Olympic athletes.听 is a sports-medicine podiatrist and a certified athletic trainer who has been in practice for over 28 years.
Both听Pribut and Schoene听explained that most running-related foot injuries are a result of overuse, the wrong shoes, or an abrupt听transition between different types of shoes. Natural foot shape and biomechanics also听play a role. Here鈥檚 a helpful guide to figuring out why your feet hurt听and how to jump-start your recovery. But of course, this听doesn鈥檛 replace a visit to your doctor. If you鈥檙e dealing with serious or persistent pain, make an appointment with a physician.
Plantar Fasciitis听
What it is:
The most common foot injury among runners is plantar fasciitis, an听inflammation of a web of thick ligaments (the plantar fascia) that runs along the bottom of the foot and connects the heel bone to the bones of the forefoot. The plantar fascia support听the arch of the foot听and act听as a spring for forward propulsion. The usual signs and symptoms include听pain on the bottom of the heel, which could present as dull, sharp, or a burning ache, either directly below the calcaneus (heel bone) or toward the front of it. The pain typically comes on slowly and builds over multiple days or weeks. It can be strongest when you wake up in the morning听or during a run.
Why you get it:
- Overuse from an increase in training volume or intensity
- Switching to a zero-drop shoe or a pair of shoes with less arch support
- Tight Achilles tendons or calf muscles
- Weight gain, which adds unaccustomed stress to the plantar fascia
How to fix it:
Reduce your training volume and intensity听or, better yet, lay off running altogether for a few weeks. 鈥淚f you keep running through your plantar fasciitis, it will inevitably get worse,鈥 Schoene听says, 鈥渂ut you can definitely cross-train.鈥 In your day-to-day life, wear shoes with ample cushioning, arch support, and elevated heels. Seriously鈥攚hether they鈥檙e 12-millimeter drop running shoes, clogs, or kitten听heels, they鈥檒l alleviate the pressure on your plantar fascia. Avoid going barefoot.听
When you return to running, ease back into it. If you had switched to different running shoes in the weeks before your pain started, it might be wise to switch back听to something like what you had before. You鈥檒l want a shoe with ample cushioning, a high drop, and good arch support. If the heel pain returns, go see a professional, because听you might benefit from orthotics.
As for physical therapy, do 20 reps of towel crunches听once or twice per day: place a towel on the floor, put your foot on top, and curl your toes to squeeze a fold of fabric. Stretch your calves from a step. Roll out your arches with a soft massage ball or a tennis ball (as opposed to a firmer lacrosse ball), and be extremely gentle around your heel. Roll out your lower legs with a foam roller or a massage stick to release tension in your calves and Achilles.
Achilles Tendonitis
What it is:
The Achilles tendon connects the calf muscle to the heel bone and is subject to听repetitive stress. When the calf contracts, it pulls the heel up, and this movement allows us to push off our toes when we run, walk, or jump. Over time听this can lead to inflammation, micro tears, and tendonitis. The tendonitis can be located at the insertion point where the Achilles connects to the heel bone, in the middle of the tendon, or higher up where the tendon attaches to the calf muscle. Achilles tendonitis typically involves pain or a dull ache behind the ankle, anywhere between the heel bone and the start of the calf muscle. This area can also swell and become red.
Why you get it:
- Overuse from an increase in training volume or intensity
- Hill workouts (running uphill puts more strain on the Achilles)
- Change in running stride (heel strike to midfoot strike,听or vice versa)
- Worn-out shoes听or switching to a flatter or less supportive shoe
- Tight calf muscles
- Hip听and听core weakness
How to fix it:
Shin Splints
What it is:
Shin splints听is a catchall term听for pain in the front of the shins, also known as medial tibial stress syndrome. The tibia, your shin bone, is the larger of the two bones in your lower leg, and this听stress occurs in the midline of the bone and the surrounding tissue. This overuse injury is characterized by inflammation and possible micro tears in the posterior tibialis muscle听(the key stabilizing muscle of the lower leg), as well as听inflammation in the surrounding tissue and shinbone. Shin splints usually present as a throbbing, aching pain or soreness in the front or inside of the lower leg听between the ankle and听knee. Pain can last all day听but is usually sharpest during each foot strike听and right after exercise.
Why you get it:
- Overuse from an increase in training volume or intensity
- Poor foot mechanics, including overpronation (foot rolls inward), which puts repetitive tension and stress on the tibialis posterior muscle and tendon, which hold up the arch
- Worn-out or unsupportive shoes that allow overpronation
- Frequent running on hard surfaces, such as pavement or a track
How to fix it:
If your pain isn鈥檛 increasing, you can keep running, but you鈥檒l recover much faster if you switch to low-impact cross-training until the pain and inflammation have subsided. If you continue to push through, it鈥檚 best to cut back on mileage and intensity, avoid hills, and stick to softer surfaces like trails. After runs, ice for 20 minutes on, 45 minutes off, repeating this sequence three times.
Have a coach or trained medical professional assess your foot mechanics. If you are mildly overpronating, you鈥檒l likely benefit from shoes with motion control and better arch support. Severe overpronators should talk to a podiatrist about custom orthotics. Fixing overpronation removes the source of stress from the tibialis posterior muscle and tendon, which helps you recover faster and prevents the injury from reoccurring. Stretch your calves, and roll out your lower legs (be cautious around your shins, though, and avoid rolling over the shin bone altogether). Once the initial pain has subsided, begin a strength-training routine to target the calves, the core, and the hips.
Posterior Tibial Tendonitis
What it is:
Posterior tibial tendonitis and shin splints are both inflammation injuries in the same muscle-tendon structure. While shin splints occur in the posterior tibialis听muscle (the shin), posterior tibial tendonitis can occur听in the tendon that wraps around the inside of the ankle and connects the muscle to the navicular bone at the midfoot. They can usually be traced to similar causes. If you鈥檙e dealing with tendonitis, you鈥檒l feel pain, tenderness, and swelling around the inside of the ankle听and sometimes down to the navicular bone.
Why you get it:
- Overuse from an increase in training volume or intensity
- Overpronation (foot rolls inward), which puts repetitive tension and stress on the posterior tibialis muscle and tendon
- Worn-out or unsupportive shoes that allow overpronation
How to fix it:
See the above steps for shin splints. Wearing an ankle-compression sleeve can also help alleviate pain and prevent further injury when you return to running.
Peroneal Tendonitis
What it is:
Peroneal tendonitis is posterior tibial tendonitis鈥檚 evil twin鈥攊t鈥檚 an inflammatory injury of the peroneal tendons (there are two) on the outside of the ankle. The main function of these tendons is to stabilize the foot and the ankle听and prevent them听from rolling outward. Unlike the majority of the other injuries listed here, peroneal tendonitis can be acute (from a single injury, like rolling your ankle) or result from overuse. The usual signs and symptoms are pain, tenderness, and swelling around the outside of the ankle听and possibly down to the outside of the midfoot. Pain can sometimes occur on the bottom of the foot, where it听is often听.
Why you get it:
- Overuse from an increase in training volume or intensity
- Supination
- Unsupportive or too soft shoes that allow supination
- Chronic ankle instability
- Inversion ankle sprain (foot inverts and ankle rolls to the outside)
- Running on uneven terrain with roots, rocks, and other obstacles that stress the ankles
- Lateral sports that involve quick changes of direction
- Always running around a track in the same direction
How to fix it:
Reduce your training volume and intensity, and wear an ankle-compression sleeve for support when you run. Switch to shoes听with firmer听stability to prevent supination. Orthotics might help severe supination, and heel lifts can help relieve tension on the tendon. After runs, ice for 20 minutes on, 45 minutes off, and repeat this sequence three times. While you recover, avoid knobby trails and technical terrain where you risk rolling or straining the ankle.
Spend some time on a to improve your balance and ankle strength. Start with one to two minutes, going side to side, front to back, and in circles, to improve your balance and ankle strength. Build up to longer sessions of up to ten听minutes. Stretch your calves and roll out your lower legs (avoid rolling over the ankle bone). Once the pain is gone, begin a strength-training routine to target the calves, the core, and the hips.
Metatarsal Capsulitis and Morton鈥檚 Neuroma
What they are:
Metatarsalgia is a general term to describe pain, tenderness, and inflammation in the ball of the foot. Usually, that pain comes from metatarsal capsulitis: swelling in听the capsule surrounding the joint where your toe meets your foot, typically听at the second toe. Morton鈥檚 neuroma, the enlargement of the nerves between your foot bones,听feels similar, though the pain is closer to the outside of the foot, at the third and fourth toes.
Sharp, aching, or radiating pain in the ball of the foot is a common symptom of both metatarsalgia and Morton鈥檚 neuroma. The pain typically worsens during exercise听or when you wear a firm or tight shoe. Pain or a sensation of numbness can also extend into the toes. You might also get the feeling that there鈥檚 a bunch in your sock or a pebble in your shoe under the ball of your foot.
Why you get them:
- Overuse from an increase in training volume or intensity
- Shoes that are too narrow or tight (including听climbing or cycling shoes)
- Low-cushion or minimalist shoes
- Bunions (the curvature of the big toe can put more pressure on the second toe, creating a greater risk of capsulitis)
How to fix them:
If you鈥檙e dealing with听capsulitis, lay off running altogether for a few weeks and visit your doctor. 鈥淵ou want to jump on capsulitis as quickly as you can, because the capsule around the joint can tear, and if that happens, the second toe can pop up into what we call hammer toe, which is very unstable and painful,鈥 says Shoene. In daily life, wear a wider, high-cushion shoe with a rockered sole听to remove some of the impact and stress to the metatarsal bones and joints.
For Morton鈥檚 neuroma, switching to a wider, high-cushioned shoe often brings immediate pain relief, since that decreases pressure on the nerve. If the pain is manageable and begins to fade, you can usually continue running and training with a wider shoe.
Stress Fracture
What it is:听
A stress fracture is a hairline crack or group of cracks in a bone. These can happen in any bone, but for runners, they most commonly occur in the tibia (and are often associated with shin splints), metatarsals, and the calcaneus (heel bone). This is primarily an overuse injury听but can also result听from a single event, for example, if you鈥檙e used to running on softer trails and then complete a long road race in low-cushioned shoes. Typically, stress fractures听present as an aching or burning pain, usually localized, anywhere along a bone.
Why you get it: 听
- Overuse from an increase in training volume or intensity
- Running frequently on hard surfaces听or a track in a single direction
- Running in low-cushioned shoes, such as track spikes or minimalist shoes
- Eating disorders or energy imbalances (burning more calories than you鈥檙e consuming)
- The female-athlete triad: an eating disorder, amenorrhea听(the absence of a period), and osteoporosis
鈥淚t often starts as a physiological change at the cellular level, where you鈥檒l have decreased production of new bone, increased absorption of bone, and an inflammatory component that can cause pain,鈥 says Pribut. 鈥淎s bone density decreases听and the stress of running continues, it can become a physical crack.鈥
How to fix it:
Reduce training volume and intensity, and visit your doctor. Switch to a high-cushioned, rockered shoe, such as those made by听, to reduce听impact forces. Eat a well-balanced diet with adequate calcium and vitamin D. Build consolidation weeks鈥攄uring which you back off your mileage鈥攊nto your training plan to give your body a chance to recover and put the calcium where it needs to be.
鈥淩unners have good pain tolerance听and often ignore the issue,鈥 says Pribut. 鈥淟isten to your body for warning signs. If your bones are achy, back off the training immediately, assess, and get to work on recovery.鈥
Mild stress fractures can heal in approximately three to six weeks if you鈥檙e diligent about recovery, but serious stress fractures can take six weeks to three months to heal听and might require a walking cast. If you鈥檙e prone to stress fractures, consult a medical professional and ask for a bone-density scan.
Blisters and Black Toenails
What they are:
You probably don鈥檛 need help identifying blisters and blackened toenails (which form when blood vessels rupture beneath the nail). They can sneak up on you anytime, and, if you鈥檙e lucky, you鈥檒l only notice once you take off your shoes. That said, they can certainly derail a run or two, with burning pain or听dull achiness.
Why you get them:
- Blisters result听from prolonged friction, pressure, and moisture, all of which can be exacerbated by your shoe and sock choice.
- Black toenails come from repetitive trauma to the nail bed, usually from the toe hitting the front or top of the inside of a shoe, which can be exacerbated by ill-fitting shoes and long downhills.
How to fix them:
Both blisters and black toenails generally resolve on their own. In the case that a blister ruptures or a toenail falls off, do your best to keep it clean and otherwise leave it alone.
To avoid blisters, keep your feet dry with moisture-wicking socks and breathable shoes. During long training runs or races, periodically change into fresh socks, and even shoes, if you can. If you鈥檙e getting a hot spot, dry your feet and try to put padding around the area.
Buy shoes that fit well. Shoes that are too tight cause excessive pressure, which leads to blisters and jams your toes against the top or front of the shoe. Shoes that are too loose allow for too much movement within the shoe, which causes blisters and black toenails, especially on the downhill. If you just bought new shoes, break them in around the house, office, or on shorter runs before using them for a long run or race.