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Overuse Foot, Leg and Knee Injuries in Runners

Foot, leg and knee injuries are the most common injuries affecting runners and joggers.

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 injuries.

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.

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”. A quick and dirty method for determining individual needs is the wet footprint test. Start by placing a wet towel on concrete. Simply step onto the towel with each foot (one-two) then step forward (one-two) onto dry concrete and then step forward again. Now look at your footprints. If the only wet spots are the ball, the heel, and a sliver of the outside edge of the foot you are likely an under pronator. Conversely, if the entire footprint is filled in then you fall into the over pronator camp.

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.

Some runners need the extra help provided by orthotics. These customized shoe inserts may be designed to provide extra support and motion control for over pronators, or extra cushioning for under pronators. Detailed information available in our orthotic section.

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 Running

Even 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.

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.

Other Common Foot Injuries in Runners

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).

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 scheduled for a later date. 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. This more detailed analysis cannot be scheduled until after your initial examination by Dr. Hale or Dr. Huppin. 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.
 


All pages on this website © 2008
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.