Running is one of the most accessible sports and forms of exercise that you can do. You just need to lace up your shoes, step out your front door and go. Despite your best intentions, however, injuries do happen. With some of the injuries, it's okay to run through them. With others you need to take time off. My name is Dr. Andrew Schneider, and I'm a podiatrist in Houston, Texas. In my practice, I work with runners of all abilities, from people running their first 5K to Ironman triathletes.
No one plans to be injured. In fact, most people actively do their best to avoid injury. The first video in this series focuses on just that. Steps you can take to prevent injuries when you're running. If you're just starting a running program, take a look at that video and see what you can do to avoid injuries in the first place.
If you run long enough, you're going to experience an injury. It may be because of a mileage increase, a change in running surface, or running in shoes that have worn out. Don't let an injury discourage you. You should come in and get checked at the earliest sign of injury, though, that will ensure that you're able to keep on running.
One of the most common running injuries is heel pain. The most common cause of heel pain is plantar fasciitis. The plantar fascia is a broad ligament that attaches to the heel and extends through the entire bottom of the foot. The plantar fascia is important for the stability and support of your feet. It also acts as a shock absorber when you walk or when you run. As you run, the plantar fascia pulls on the heel and that can cause two things to happen. First, the ligament becomes inflamed. This usually happens where it attaches to the heel, but it can be inflamed in the arch as well. It's the inflammation that's responsible for the pain of plantar fasciitis. Also a heel spur can form. A heel spur is a growth of bone on the bottom of the heel. It forms in response to the pulling of the ligament on the heel bone. It's usually not the cause of the pain associated with plantar fasciitis. I see it more as a symptom that can predispose you to develop plantar fasciitis. Because plantar fasciitis occurs along with a heel spur, it's sometimes referred to as "Heel Spur Syndrome".But it's important to note, just because you have a heel spur, it does not mean that it has to be removed. So don't let the fear of surgery stop you from coming in to get your foot pain checked.
Common symptoms of plantar fasciitis include pain with the first step in the morning and after periods of inactivity. Often that pain will lessen or even go away after you start walking and your foot warms up. Sometimes the pain progressively gets worse as the day progresses. 95% of the time plantar fasciitis is managed with conservative treatment. So, again, don't let that fear of surgery stop you from coming in. Since the pain of plantar fasciitis is due to inflammation of the plantar fascia ligament. We need to address the inflammation. We do that through either a cortisone injection or using oral anti-inflammatory medication, or sometimes topical anti-inflammatory medication. We also use ice on the bottom of your foot because ice is a natural, anti-inflammatory. The pain of plantar fasciitis persists because of unstable mechanics. For that, we use medical grade insoles. I may apply a strapping of tape to the bottom of your foot. I'll have you stretch with a foam roller. I recorded a video series focusing exclusively on plantar fasciitis.
Another common running injury occurs with pain in the ball of your foot. This is often due to a Morton's neuroma. A neuroma is an inflammation of a nerve. As it travels between your metatarsal bones. It gets irritated by the bones and the ligament that occurs between them and that causes the nerve to enlarge. A Morton's neuroma is particularly painful when wearing narrow shoes. I see it more in someone who runs with a mid-foot strike, since that's right where the nerve is located. Women's dress shoes and high heels make the pain worse because they generally run more narrow. That said, it can affect anyone because of their foot structure.
The first thing I do with a runner with Morton's neuroma is to ensure that she's wearing the right running shoe and that it's properly fitting. Sometimes simply wearing a shoe that's a little wider helps alleviate the pain. Like plantar fasciitis, treatment starts with anti-inflammatory medication, sometimes taken orally, but more often given with an injection. Treatment with medical grade insoles and custom orthotics are often helpful to keep the pressure off the nerve. In severe cases, the neuroma is removed surgically.
The next running injury I'd like to discuss is a toughie. It's a stress fracture. For runners, it's common to have a stress fracture in the metatarsal bones because of the excessive load during running. In fact, this is one of the greatest dangers of running on a hard surface. A stress fracture is a break in the bone that is not displaced. Sometimes it's referred to as a hairline fracture, but don't let that make you take it any less seriously than any other type of broken bone.
A stress fracture needs to be immobilized and you need to stop running. Plain and simple. If you continue to run or don't properly treat a stress fracture, it can become displaced and at best will require a longer recovery. At worst, it will require surgery to repair the broken bone. You can expect to be immobilized for six to eight weeks with a stress fracture. That's just how long it takes for bone to heal. Even so, you won't go back to running until at least 12 weeks after the injury. I need to know the bone is strong enough to support you when you run. It doesn't make sense to go back to running sooner only to be injured again right away.
The final common running injury that I'm going to discuss today is shin splints. Shin splints are an inflammation of the muscles that attach to the front of your leg. Those muscles become tendons that traveled to the front of your ankle and the top of your foot. Shin splints are common in runners with flat feet and also those with high arch feet. They're an overuse injury. The muscles are contracting too much, which is what causes the inflammation. That's why we see it in foot types that are less stable. If you've had shin splints, then you know how painful it can be. And it seems like it will never go away. Initially, you can treat shin splints with oral anti-inflammatory medication and ice. That will help to control the inflammation. But the true culprit that makes shin splints so insidious is your mechanics. Even though you're controlling the inflammation, the muscles are still working too hard. The way to get the muscles to work less hard is with the use of a custom orthotic. By providing mechanical support to your foot, your base of support, it will allow your mechanics to work in a much more efficient way. This will reduce the pull of the muscles to the point where you no longer need to take an anti-inflammatory medication.