Identifying and Treating Foot Problems

Get a proper diagnosis and get back to happy healthy feet

Let’s start with some simple mathematical estimates. There are 26 bones and 33 joints in the human foot. Running a marathon at an average pace requires more than 40,000 steps. That number doesn’t include the thousands more steps that add up in the accumulated miles in training. Ponder the anatomical impact of those numbers and it’s not surprising that sooner or later most runners will be affected by an injury, ranging from something as simple as a blister to a months-long bout of plantar fasciitis.

Injured runners share the same goal. How fast can I get back on the road? The search for solutions often starts with advice from well-meaning training partners and internet searches that return thousands of links to potential treatment options. However, self-diagnosing injuries may not be the smartest approach to returning to running, says Paul Langer, DPM, Twin Cities Orthopedics and past president of the American Academy of Podiatric Sports Medicine. Visiting a podiatrist or physical therapist who is familiar with the kinesiology of running and running injuries is a much better way to expedite the appropriate treatment.

“A treatment approach that helped a running friend isn’t going to be the same treatment that helps you,” says Langer, who estimates that about 80 percent of the runners he sees have self-diagnosed their injury and started some kind of treatment. “Not every injury has the same cause and treatment.”

“The good news is that I rarely see them making things worse with that approach,” he says. “ I like working with runners who are engaged and try to figure out what’s wrong and help themselves. On the other hand, sometimes that will lead you down the wrong path, waste your time and delay treatment.”

Dr. Langer starts his evaluation with a series of questions to get specific information about how and when symptoms first appeared.

“I want to know what happened before they get hurt. That can give me a lot of clues,” he says. “Did you get new shoes? Did you change your training? Did your work responsibilities unrelated to running change? Runners haven’t thought about what’s changed in their training regimes.”

The next set of questions deals with actions taken after the injury.

“What did you do after you felt you were starting to have a problem? Did you change your training? Shut your running down? Change shoes? Those are the questions I want them to think about before they come in,” Langer says.

Also be sure to bring your running shoes with you when you visit your podiatrist or physical therapist. This allows the practitioner to check wear patterns and understand the type of footwear you use for running. For example, if you have excessive wear showing on a certain part of one or both of your shoes, it will indicate a lot about your gait pattern and possibly suggest imbalances in your mechanics that can be tweaked or addressed through strength and form drills.

Overuse Stages

Significant changes in training are one of the high-risk factors in causing injuries. Increasing mileage too quickly, adding too much speed work or not letting your body recover between hard workouts can contribute to overuse injuries.

READ MORE: How to Smartly Increase Your Weekly Mileage

“In the early stages of an overuse injury, the area will be stiff and sore after your workout. That’s the first sign of an injury, and you can’t ignore that,” Langer says. “That’s the time to schedule an appointment since it can take 2-3 weeks to see an experienced specialist. If you wait too long, there’s a risk of doing more damage.”

Understanding the four stages of overuse injuries helps you know if your injury is getting better or worse. If you are going in the wrong direction you may need to take a break from running. It also means it’s time to schedule an appointment with an experienced podiatrist, so they can expedite treatment options and get you back on the road as quickly as possible.

Overuse injuries can be classified into the following four stages.

Stage 1: Pain/irriation in the affected area after physical activity

Stage 2: Pain/irritation during the activity, without restricting performance

Stage 3: Pain/irritation during the activity restricting performance

Stage 4: Chronic unremitting pain even during a rest

Injury Glossary

The first conversation with a podiatrist or physical therapist will be more effective if you have a basic understanding of what’s causing your symptoms—which could be inflammation, minor irritation, soreness or acute pain. Below is a glossary of the most frequently treated running injuries.

Bone Spurs

Bone spurs often arise where a tendon or ligament attaches to bone. The spur itself is not always the source of pain and does not need to be surgically removed to resolve pain. For example, plantar fasciitis is often called heel spur syndrome because approximately 50 percent of people with heel pain have a spur at the site where the plantar fascia attaches to the heel bone. However, pain resolves for the vast majority of people with physical therapy without ever removing the spur.

Shin Splints

Shin splints refer to sharp pains that occur down the front of the lower leg. They are a common complaint, particularly among runners. Shin splints are most commonly the result of “too much, too soon.” Also called Medial Tibial Stress Syndrome (MTSS). The connective tissue (fascia) that wraps and attaches the muscles to the membrane on the bone (periosteum) can become chronically inflamed and irritated.

READ MORE: Overuse Injuries: Shin Splints

Stress Fractures

Stress fractures are often called the “sneakiest” running injury because they kind of sneak up on runners, who don’t realize the injury is something serious until it’s too late. A stress fracture develops because of repetition. There are 1,000-1500 steps per mile when running so a bone that is overloaded will first start to get sore. As it gets sore it gets weaker, and if running persists then the bone will crack and fracture.

Achilles Tendinitis

This condition is characterized by pain and swelling along the Achilles tendon, tenderness and reduced ankle mobility. The term “tendinitis” is falling out of favor because the suffix “-itis” means “inflammation of.” More accepted terms are tendinopathy or tendinosis, which refer to degeneration and not just inflammation. The Achilles tendon is the largest tendon in the body and transfers all of the power from our largest muscle groups—quads, glutes, hamstrings—to our foot. Older runners and high-mileage runners are more vulnerable to Achilles tendon strains and injuries.

READ MORE: Overuse Injuries: Achilles Tendinitis

IT Band Syndrome

A syndrome of knee pain that may result from inflammation due to mechanical friction of the iliotibial band and the lateral femoral epicondyle. It’s an overuse injury which may be exacerbated by muscle imbalances or running too many hills without allowing your body to adapt.

READ MORE: Overuse Injuries: IT Band Syndrome

Hammer Toes

Hammer toes develop over years and decades due to muscle imbalances of the small muscles in the feet. The muscle imbalance causes the toes to flex and eventually the bones and joints become more rigid. It most often affects the second toe.

Plantar Fasciitis

As with tendinitis, this not so much an inflammatory as it is a degenerative condition. The plantar fascia is an important ligamentous structure that stabilizes the arch in static stance and when walking and running. It is under the highest load as the heel lifts, weight begins to transfer to the forefoot and the propulsive phase of gait begins. According to Langer, 80 percent of people can reduce their pain by supporting the foot better and stretching.

READ MORE: What ‘Foot Core’ Is and Why It’s Important

Morton’s Neuroma

This condition features painful enlargement of interdigital nerves between the third and fourth metatarsal heads. Symptoms are usually burning, tingling or numbness that radiates into the toes. Some people feel like there is something lumpy in their shoe or their sock feels “rolled” under the area. Wider shoes and metatarsal pads can help with this condition for most people.

READ MORE: 8 Ways to Take Better Care of Your Body

READ MORE: The Benefits of Running Barefoot Occasionally

Lou Dzierzak

A full-time freelance writer based in Minneapolis, Lou Dzierzak has written about outdoor recreation since 1997. Although slow and steady, he’s completed multiple marathons, triathlons and finished Ironman Wisconsin before the midnight deadline.