Running injuries – common causes of foot pain in runners

Running has always been high on the charts of sports and physical activity. During the recently enforced lockdowns we saw a surge of runners on the streets – and in our foot & ankle clinics.

With sports facilities and gyms closed, many resorted to open air activities or at-home treadmills to stay fit and healthy. Exercise was allowed outdoors once a day, and running became one of the options to leave the home for a longing dose of daily exercise. With a ton of benefits reported from this type of exercise, it is also true that our legs are placed under stress that occasionally surpasses our  body’s natural resistance. 

The act of running regularly has been associated with a higher risk of overuse injuries than other forms of aerobic exercise such as walking, swimming, or cycling. The best advice I can give is that every runner should know about potential injuries from running, that they listen to their body, and that the right prevention and treatment are in place when injuries occur. 

The lower leg is under a disproportionate high risk of developing running injuries compared to other areas in the body. This is not only my personal experience from a foot and ankle specialised clinic but also what the evidence tells us. Studies have shown that 40% of all running injuries occur below the knee, affecting the lower leg, ankle and foot; with the remainder being shared amongst the rest of the body at much lower rates, including head concussions or even abdominal problems. A recent study showed that the foot was the number one area in trail running injuries followed by the knee. Causes for sore feet were many, ranging from skin blisters and abrasions to muscle strains and ligament sprains. When gender was taken into account, female runners suffered more running injuries overall but men suffered a higher proportion of ankle and foot injuries compared to women. 

If the foot hurts after running, narrowing down the exact location of the pain will be the first indicator for the diagnosis. Commonly, runners can experience heel pain, arch pain, or forefoot pain either in the ball of the foot or the big toe.

Metatarsalgia and sesamoiditis (click to know more) are frequent causes of forefoot pain. These conditions both share the pain location at the ball of the foot, with metatarsalgia being under the small toes and sesamoiditis under the big toe. As a root cause for this type of pain we often observe forefoot overloading which is the basis of a forefoot strike pattern, and something that can be modified.

Arch and heel pain are also encountered frequently as a consequence of the overload from running but in this case placed over the hindfoot. Tight calf muscles will further load some of the structures at the back of the ankle and heel contributing to these symptoms. Heel pain from running is generally down to plantar fasciitis or stress fracture of the heel bone (or calcaneus). Due to stress placed on bones when running, that repetitive minor trauma can cause the bone to fatigue and present with foot pain. The most common location for stress fractures however is not the heel bone but the metatarsals (top of the midfoot) and the tibia (shin bone). Those experienced in the metatarsals are also called “march fractures” given that marching soldiers are at high risk as are long distance runners. Increased stress in the tibia can lead to shin splints which can progress to a stress fracture. These type of stress fractures are very different from the standard fracture sustained as a consequence of trauma or a sudden twist of the ankle, although runners are not exempt from these either. Ankle fractures and ankle sprains are common when taking a misstep and can often be prevented with the right type of exercises.

Finally, tendons are some of the most frequent injuries afflicting the running athlete. The Achilles is the largest and most commonly affected tendon but peroneal tendonitis is another condition affecting smaller tendons at the side of the ankle.  

Each one of these conditions will benefit from specific treatments, in some cases requiring surgery but not in the majority. As a method of prevention and treatment across the board of all running injuries, I want to highlight two strategies: using the right running shoes for you, and a running style assessment. 

In terms of running shoes, they have to be fit for purpose and will be different for each person as the intention is that they fit your particular anatomy. Their characteristics are important and changes in one can affect the other, with endless tweaks targeted at aspects such as heel-toe drop, minimalist shoes or Masai Barefoot Technologies, bending stiffness and shock absorption. Running style assessments can be booked through our clinic and may address any subtle anatomical imbalances and assist in choosing the best type of running shoe. 

The burden of running injuries goes beyond that of foot pain. Being such a popular activity, any injuries sustained from running are bringing time loss from sports and work as well as from recreational activities. With the right precautions in place we will help you to remain a runner and not a foot patient.