Continuing on from last week’s blog and down the kinetic chain, let us talk about foot and ankle running injuries. Like the hip and the knee, the foot and ankle take 3-4 times bodyweight when running and are therefore prone to injury. There are many different injuries around the foot and ankle but today I will focus on three of the most common ones.

Achilles Tendonitis

This is a very common injury amongst runners. It is usually caused by overuse/training error but can be traumatic in origin is a runner is running up/down hills or on trails. The tendonitis can be at the Achilles insertion into the heel, mid tendon or at the musculotendinous junction. Classically, patients will complain of pain on getting out of bed or getting up after prolonged sitting and it usually forces a runner to stop training.

Treatment consists of soft tissue release, rolling, stretching, strengthening (both concentric and eccentric) joint mobilizations, and modalities. Research has shown Shockwave to be beneficial to Achilles tendonitis. There may be a contributing factor from higher up the chain so nerve flossing, core and hip strengthening may be appropriate in some cases.

Plantar Fasciitis/Heel Spur

If I had a dollar for every time a runner came to me with this injury over the course of my career, I would be a rich lady. This a very annoying and can be a very persistent injury. A heel spur, to me, is just a more extreme case of plantar fasciitis. Let me explain. The plantar fascia is a band of connective tissue underneath the foot that runs from the heel to all 5 toes. The main purpose of the fascia is for arch support and weightbearing. It is usually strained secondary to an underlying biomechanical issue and/or overuse. When it is strained, it usually starts to tear away from the bone under the medial heel. In some cases the stress on the bone then leads to a heel spur.

Classically, patients will complain of pain under the heel when getting out of bed and with prolonged sitting. Treatment includes rolling, calf and foot stretches, joint mobilzations and modalities. Shockwave also gets good results for patients with plantar fasciitis. As with Achilles tendonitis, there could be factors higher up the kinetic chain contributing to the complaint so nerve flossing and core/hip strengthening may be prescribed as well. If faulty biomechanics are contributing to the complaint, orthotics would also be prescribed.

Metatarsalgia

This is burning in the ball of the foot. It could be under the entire ball of the foot or very localized to one metatarsal head. It is usually caused by loss of a transverse arch and usually easily treated with an over the counter metatarsal pad or custom orthotics with metatarsal pads built in. If the metatarsal heads are very inflamed, US or laser may be beneficial.

So that is it for my running series. Stay tuned next week for a series on fitness for various ages.