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A Well Balanced Runner

As a foot and ankle provider, I often get asked a TON of questions regarding running. The sport has blossomed and continues to gain popularity as it takes minimal equipment and you can run almost anywhere without an expensive gym membership. The questions I field range from: where can I get a good running shoe and what kind of running shoe do I need, to how can I prevent injury?

I think the most common question I get is, how can I prevent this (injury) from happening again? Lets start with the most common running injuries I see at the foot and ankle center:

  1. Plantar Fasciitis
  2. Achilles tendonitis
  3. Stress fractures 
  4. Shin splints

Plantar fasciitis is unfortunately the most common reason patients present to my office. Plantar fasciitis is an inflammatory condition of the ligament that covers the bottom of your foot. Pain is mostly over the bottom of the heel. The most common symptom patients complain of is, start up pain in the morning and pain throughout the day the more you are up on your feet. Rarely, do patients complain of night pain as a result. Plantar fasciitis can develop as a result of running due to the repetitive nature of the sport. It can be tough to shake and can take several weeks to months to eliminate the daily symptoms. Runners get particularly frustrated with this diagnosis as running can make this rip roaring painful and nobody wants to take time off from that awesome endorphin rush. Initial treatment involves: rest, ice, ant-inflammatories, and an aggressive stretching regimen. The biggest take home message I can provide regarding plantar fasciitis is, at some point it is going to get better, rest assured, there are really no complications related to the development of plantar fasciitis.

The second most common injury I see in my clinic as related to running are stress fractures. Unfortunately, they are all too common in the running world.
Pain across the foot, ankle or hindfoot often develops during a run and will persist. Often patients will describe a discrete sensation of a pop or crack across their foot during a run and they are unable to complete their run due to the nature of the pain. Swelling and occasionally bruising are found on exam. There are quite a few bones in the foot and ankle, 26 of them to be exact. The most common bones affected by stress fractures are the metatarsals. However, it is not uncommon to find stress fractures in the navicular, talus or calcaneus. Treatment typically involves rest, immobilization and rarely surgery. Bones in a mature adult take a full 3 months or more to heal, so patience is key!

Achilles tendonitis is another injury that plagues runners. The Achilles tendon is the largest tendon in your body. Achilles tendonitis is inflammation andpain along the tendon. As a result of overuse, and injury to the tendon, the tendon often swells, and patients will often notice a painful knot. Pain is mostly activity related. However, start up pain in the morning is a very common finding. Treatment involves dedicated rest, stretching, icing and often times a course of physical therapy. In severe cases immobilization in a fracture boot can be effective to help improve symptoms. Tendons do not heal quite as quickly or as effectively as bones, therefore this can take several weeks to get better.

Shin splints are very common in runners as well. Patients will often present to my office with chronic shin splints that have failed all conservative management and I am the last option. More often than not, the treatment involves a dedicated period of complete rest. Shin splints are an inflammation of the soft tissue that sits next to and coats the distal third of the tibia, aka the periosteum. Patients complain of pain that develops over their distal legs with increased running, often a mile or two after they start their run. Pain will typically stop when the runner stops running. However, in advanced cases the pain will persist to a lesser degree with day to day activities. Shin splints are NOT characterized by night pain. That could be an indication of a developing stress fracture. Treatment of shin splints involves rest, compression sleeves, anti-inflammatories and occasionally physical therapy to help stretch and strengthen.

Prevention of these afore mentioned common injuries can be tricky with runningbut hereare a few suggestions that can help:

  1. Take the time to Stretch before you run and work out the kinks (taking a foam roller to your calf muscles daily can help out a ton). Yoga isn’t a bad idea.

  2. A good fitting athletic sneaker - pay attention to the condition of your shoe! A shoe should be replaced every 400-600 miles – regardless. 
  3. Visit a local running shop to help you find the shoe that fits you best. A specialty store often has the expertise to advise you on your running shoe needs based upon your foot and gait. They typically have treadmills set up to watch how you run and will allow you to try out a few pairs to help you find the best possible fit. The most expensive shoe on the market isn’t always the best design for your foot.
  4. Log your mileage - be careful not to increase your mileage too quickly! A 10% increase of your weekly mileage is recommended.

  5. CROSS TRAIN, CROSS TRAIN, CROSS TRAIN. Swim, bike and lift weights.
  6. Pay attention to good biomechanics, as you fatigue your form suffers.
  7. Eat a well balanced diet. I find an alarmingly high number of patients with Vitamin D deficiency, which can lead to stress fractures.
  8. Change it up; try running on a variety of surfaces. Trail running can be fun. If you typically run one particular course make a concerted effort to switch directions, so that you aren’t running the exact same course everyday.
  9. Pushing through pain isn’t wise and will only lead to worsening of 
symptoms. The ‘no pain, no gain’ theory isn’t all too effective in running.
  10. Do no discount a rest day. Your body needs a day off.

In addition to being a medical provider, I’m also a mom. I know what it’s like to work all day, make time for your kids and family, and still try to find time for exercise and physical activity. Dealing with something as frustrating as these injuries can be a major pain – literally. If prevention or self-treatment doesn’t work, a visit with an orthopedic provider can help with a treatment path.

Kelly Stafford, PA-C is a Physician Assistant at OrthoCarolina’s Foot & Ankle Institute. She holds a Bachelor of Science from the University of Pittsburgh and a Master of Physician Assistant Studies from Drexel University. Find out more about Kelly here.

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