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Foot, Leg and Knee Injuries in Runners
Podiatrists with Special Expertise in Running Injuries and Runners
Biomechanics
Foot, leg and knee injuries are the most common injuries affecting
runners and joggers. For Seattle area runners with foot pain and
biomechanical problems Dr. Hale and Dr. Huppin provide the area’s
greatest expertise in treating running associated injuries, helping
runners prevent future problems and getting runners back to full
activity in as short a time as possible. If you are a runner and have an
injury – or want a biomechanical evaluation to help you prevent an
injury - call today for an appointment
in our Seattle clinic.
What to Expect in Our Office
On your first visit we will review your medical history, your running
history and perform a complete clinical examination. We will also
perform an initial analysis of your running, so be sure to bring your
running shoes and some shorts. We will then provide a detailed and easy
to understand explanation of our recommended plan for treatment or
further diagnosis.
Because running injuries can have many complicated biomechanical factors
involved, a more detailed running analysis may have to be performed.
This more detailed running analysis using our
4-camera gait analysis system
can give us much more information on foot and lower extremity function
during activity. Although we can sometimes perform this exam on the
first visit, depending on how long your initial exam takes this analysis
may have to be scheduled for another day.
Depending on the needs of each particular patient, after the first or
second visit we will go over our recommended treatment plan. This may
include strengthening, adjustments in training, orthotic devices, shoe
recommendations, or physical therapy. Your treatment plan is designed to
get you back to activity and prevent future problems.
To schedule your initial evaluation contact
us today.
Runners’ Feet, Knees, Hip and Back
It is easy to think of the feet as an area that may become overused and
injured in runners. They are, after all, the first part of the body that
hits the ground. In addition, injuries to the feet or improper foot
function can lead to problems elsewhere in the body.
When searching for factors that may have contributed to any running
injury a good starting point is the foot – even if it is not just the
foot that hurts. The biomechanics of your feet can play a huge role in
whether or not you develop leg, knee, hip and back injuries.
Running Biomechanics
Running biomechanics is very complicated, but a simplified way of
looking at running mechanics is to look at foot types. Runners with high
arches are referred to as “supinators” or “under pronators”. In their
running gait they have decreased mobility such that there is inadequate
pronation during running. These runners have a foot that doesn’t absorb
shock well. This shock is transmitted to lateral (outside) structures in
the foot, lower leg, and knee. An injury example is anterior (lateral)
shin splints.
“Over pronators” have the opposite problem. There is too much motion
and, thus, excess pronation during running. These runners end up
transmitting excess force to the medial (inside) structures of the leg.
An injury example here is posterior (medial) shin splints.
Orthotics for Runners
Some runners need the extra help provided by orthotics. These customized
shoe inserts may be prescribed to provide extra support and motion
control for over pronators, or extra cushioning for under pronators.
We
are known as experts in orthotics for runners. Orthotic
quality varies widely between practitioners and in runners in particular
it is critically important that orthoses be made in a very specific
manner. Read more on why our orthoses work better. If you think you
might be a candidate for custom orthotics, do not buy new shoes until
after your appointment with us – and bring your current running shoes
with you to your appointment.
Our Recommended
Prefabricated Orthotic for Running
Running Shoes
The right shoe for under pronators (supinators) are ones that provide
extra cushioning and shock absorbing capacity. Over pronators need shoes
that provide extra stability, or “motion control”.
Twice every year we evaluate running shoes and publish a list of our
favorites. You can use our recommended shoe
list to start you search for shoes. Be sure to purchase them at
a shoe store with educated employees. Good Seattle area shoe stores are
included on our shoe list.
A few other tips about running shoes. After about 250 miles shoes lose
about 30 – 50% of their shock absorbing capacity. The same is true for
wet shoes, which – depending upon how wet -- may take 48hrs to dry out.
If you run daily you may want to consider buying two pairs and using
them on alternate days. This will help prolong effective shoe life-span.
Aches and Pains of RunningEven with the best preparation, aches and pains are an inevitable result
of a jogging regimen. If the pain subsides with slow easy exercise, you
may continue, but if it gets worse, stop the activity and rest. If it
persists, call us for an appointment in our Seattle office.Other Common Foot Injuries in Runners
Runner’s Knee: The most common pain associated with jogging is
an injury known as runner's knee, a catch-all for jogging-related knee
pain. One of the most common causes of runner's knee is excessive
pronation of the foot. Several studies have shown that custom orthoses
(orthotics) are the best way to alleviate the problem.
Shin splints which are painful
and appear at the front and inside of the leg, are caused by running on
hard surfaces, over-striding, muscle imbalance, or overuse. Treatment
includes changing running technique or insertion of an orthotic device
in the shoe. Read more on shin splints.
Plantar fasciitis - heel pain caused by inflammation of the tough fascia
on the bottom of the foot, usually right where the fascia attaches into
the heel. A very common running injury.
Calcaneal stress fracture – an overuse fracture of the “heel bone”
Achilles tendon bursitis – inflammation of the bursa located at the
attachment of the Achilles tendon to the heel.
Achilles tendonitis – the most common injury of the Achilles tendon.
Extensor tendinitis – inflammation of the tendons on the top of the
foot, usually midway along the foot.
Sesamoiditis -- inflammation of those tiny little bones, which are
located in the ball of the foot near the base of the big toe.
Metatarsal stress fracture – an overuse fracture of one of the
metatarsals. These are the long bones that start at the midway point of
the foot and run right up to the base of the toes. There are 5 in each
foot.
Morton’s neuroma – a condition caused by the chronic irritation of the
interdigital nerve, usually between the 3rd and 4th metatarsals, near
the toes. Runners often experience a “pins-and-needles” or “electric
shock” pain.
Posterior tibialis tendonitis – this tendon passes underneath the medial malleolus (the inside “ankle bone”) and attaches into the medial aspect
of the foot (navicular bone). Runners usually experience pain below the
inside of ankle or slightly further along the inside of the foot.
Peroneal tendonitis – this tendon passes underneath the lateral malleolus (the outside “ankle bone”) and attaches on the lateral aspect
of the foot (cuboid and base of 5th metatarsal). Runners usually
experience pain on the outside part of the ankle or lateral edge of the
foot up to the base of the 5th metatarsal.
Subungual hematoma -- bleeding underneath the nail from the chronically
jamming the toe(s) into the shoe. Also may happen acutely if you drop
something heavy on your toe(s).
Medical References on Runners and Foot Orthotic
*The success rate in treating running injuries with orthotics alone has
been estimated by various researchers to be between 50 to 90% (D’Ambrosia,
1985; Dugan & D’Ambrosia, 1986; Eggold, 1981; Kilmartin & Wallace,
1994).
*Foot orthoses were shown to “definitely help” 70% of 180 patients with
athletic injuries
Blake RL, Denton JA: Functional foot orthoses for athletic injuries: A
retrospective study. JAPMA, 75:359-362, 1985.
*Orthotic treatment resulted in complete resolution or great improvement
in symptoms in 76% of 500 distance runners Gross ML, Davlin LB, Evanski
PM: Effectiveness of orthotic shoe inserts in the long distance runner.
Am. J. Sports Med., 19:409-412, 1991).
*Dugan RC, D’Ambrosia RD: The effect of orthotics on the treatment of
selected running injuries. Foot Ankle, 6:313, 1986.
*MacLean CL, Hamill J: Short and long-term influence of a custom foot
orthotic intervention on lower extremity dynamics in injured runners.
Annual ISB Meeting, Cleveland, September 2005.
*Baitch SP, Blake RL, Fineagan PL, Senatore J: Biomechanical analysis of
running with 25 degree inverted orthotic devices. JAPMA, 81:647-652,
1991.
*Mundermann A, Nigg BM, Humble RN, Stefanyshyn DJ: Orthotic comfort is
related to kinematics, kinetics, and EMG in recreational runners. Med
Sci Sports Exercise, 35:1710-1719, 2003b
*Smith LS, Clarke TE, Hamill CL, Santopietro F: The effects of soft and
semi-rigid orthoses upon rearfoot movement in running. JAPMA,
76:227-232, 1986
*Williams DS, McClay-Davis I, Baitch SP: Effect of inverted orthoses on
lower extremity mechanics in runners. Med. Sci. Sports Exerc.
35:2060-2068, 2003

All pages on this website © 2005-2010 Douglas Hale, DPM & Lawrence Huppin, DPM Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only. If you need specific medical advice, please contact the office for an appointment.

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