Running and walking are by far the most popular physical activities, especially for adults, because there is very little equipment required. When someone, who has perhaps had little or no physical activity for several months, laces up the running shoes and takes off down the road, injuries – both major and minor –are likely to occur. An orthopedic surgeon specializing in foot and ankle injuries and a participating member of the Texas Health Spine and Orthopedic Center referral line, Dr. Keith Heier, was asked for his opinion on avoiding and treating running related injuries.
An Ounce of Prevention
Many injuries to the feet and ankles can be avoided by simple, preventative actions. Dr. Heier explained.
“For the casual runner, there are several stretching exercises that can help prevent minor injuries,” he said. “The classic calf stretch involves the runner leaning against the wall and stretching the back of his Achilles tendon. A hamstring stretch – where the runner is bending over and touching her toes – is an easy and effective exercise to do before running. It is also advisable to do a planter-fasciitis stretch, which involves pulling one’s ankle back as far as possible and then grabbing the toes back toward the tibia (lower leg). With this stretch, the runner will feel the tightening in the planter-fasciitis part of the foot.
“Finally, simple balance exercises, which help to strengthen the core of the body, are advisable before the run begins. This could be in the form of planks, back extensions or jumping rope.”
Medical Analysis of Foot and Ankle Injuries
Most adults have experienced the pain of a sprained ankle. While this is a very common injury, the medical explanation of this condition is somewhat more complicated.
“There are acute injuries such as sprained ankles and metatarsal fractures, which typically occur when a runner accidentally steps in a hole or off a curb and lands awkwardly, Dr. Heier said. These happen randomly and aside from careful observation, there are very few preventative measures which can be employed.
“There are also injuries which can be prevented among runners who are just getting started with their program called “overuse” injuries. Muscles can be strained, especially if there is little warm-up, and if the runner doesn’t give this strain the time necessary to heal, the pain and injury will get worse. Overuse injuries can also result from a runner increasing the length of his run before his body is acclimated to the distance,” he noted.
“Genetics can also play a part in running injuries,” he said. “Some have flat feet, high arches, bunions or hammertoes, and these conditions can lead to stress fractures of the metatarsals, tendonitis in the Achilles or planter-fasciitis.
Shin Splints: A Common but Painful Condition
Many runners complain of a condition popularly known as “shin splints.” Dr. Heier clarified the definition and causes for this painful condition.
“To runners, ‘shin splints’ is a catch-all term for several medical conditions,” he said. “However, to an orthopedic surgeon, this condition is very specific. Runners can experience shin pain, which can be the result of shin splints, a stress fracture in the fibula or tibia, or a rare condition called chronic exertional compartment syndrome.
“A classic shin splint condition involves the experience of pain just off the edge of the muscle, typically on the medial side of the muscle,” he said. “With this condition, the muscle is being pulled tightly from the bone, which causes inflammation in the muscle. This is a very common problem for runners and it can be caused by overuse due to increase in mileage and intensity, running on hard surfaces, or poorly fitted shoes where the runner is overpronating.
It's gotta be the shoes. Right?
Choosing the right shoe can make a huge difference in the health and fitness success of a runner. There are several nuances that runners should be aware of when choosing shoes.
“Running shoes may look great on the outside, but when they have been used for more than 250 miles they present an injury danger to the wearer,” he said. “Wear and tear can cause running shoes to be too tight or too loose. The padding can be worn away and this causes problems.
“My approach to choosing the right shoes involves first examining the type of foot of the runner. Someone with flat feet should choose a ‘motion control’ shoe with a high arch which helps prevent the flat foot. There is also the classic ‘neutral’ shoe which enhances stability or cushioning. If, for example, someone has a high arch and they choose a shoe designed for a flat foot, this will tilt the runner to the outside of the foot. This could lead to a stress fracture on the outside of the foot.
“The best advice I can offer for getting the correct running shoe is to go to a retail store where there are seasoned, knowledgeable runners involved in the sales process.
Treatment for Foot and Ankle Injuries
As a foot and ankle physician, Dr. Heier treats many serious and casual athletes in his practice. The treatment can range from the very simple, such as advising rest, or complex, such as surgery.
“In most cases, stopping the running, icing, light stretching and prescribing a nonsteroidal are the first lines of treatment,” he said. “Sometimes our treatment includes changing running shoes or placing an orthotic in the shoe. In rare cases, the injury might require surgery.
“Conditions such as plater-fasciitis, tendonitis of the Achilles and even stress fractures will heal if we give them a chance. Surgery is always the last resort ” he concluded.
If you’ve started a spring running program and are experiencing pain in your feet or ankles, contact the Texas Health Orthopedic & Spine Center for an appointment.
*Physicians who are members of the referral program practice independently and are not employees or agents of THSOC.