Running Injuries – Prevention & Rehab
Part 2: Foot injuries – plantar fasciitis
The subject of running Injuries is a lengthy and specialised topic requiring knowledge and skills on many levels. However, common running injuries do occur and we’ll highlight these, breaking them down with some useful info and guidance to help the interested runner gain more personal knowledge of their injury and rehabilitation needs.
The subjects of foot and ankle injuries are both vast on their own and we cannot hope to cover them comprehensively in one article, however we will try and cover an overview of one of the most common injuries of foot – plantar fasciitis.
Please note: At Pete Fraser Fitness we refer any client with chronic, highly painful or complicated symptoms to seek the advice, guidance and treatment of a medical professional in the first instance. Nothing replaces the correct diagnosis from a chartered physio or sports physician.
In part 1 we introduced some basic info on biomechanics and running gait – you need to walk before you run, right? Let’s take a closer look at foot and ankle injuries…
The running kinetic chain
Proper running mechanics involve synchronous movements in all of the kinetic chain – in other words the arms, spine, hips and legs all need to `talk to each other and get on happily`. If any of these components are not synchronised, or `talking to each other`, injury is a likely outcome.
Approx. half of all running injuries occur below the knee. Between 10% and 20% of all running injuries are foot injuries. Research has found that foot problems are the most common reported injury in long distance and marathon runners.
Research has found that foot problems are the most common reported injury in long distance and marathon runners.
Why so common?
- Roughly 80% of the general population report foot problems – therefore it follows that runners are likely to have similarly high incidents of foot related issues
- The foot is under great biomechanical stress during running and the impact forces plus the repetitive nature of the movement are potentials for injury
Factors for runners to consider when thinking about foot/ankle health
- The foot is the only contact point with the ground in running
- It consists of mostly bone, ligaments and tendons with very little muscle mass
- It must withstand forces up to 3 to 4 times body weight and more in downhill running
- There is high demand for neuromuscular coordination, especially on technical cross country, trail or fell terrain
- In running gait, the foot must quickly change from a load-transferring, rigid structure at heel strike, to a flexible load-absorbing one, then widening to accommodate the `feel` of the ground and stability and finally back to a rigid one to transfer forces for push off – without you even thinking about it!!
Common injuries of the foot
- stress fractures
- soft tissue injuries
- Plantar fasciitis – the most common cause of rear foot pain in runners
This image shows the location of the plantar fascia
So you have rear foot pain, what has potentially caused it?
Take note of and assess these factors:
- Recently increased training volume or intensity
- Using new shoes
- Running on a different surface
- Been injured recently
Also, take note of these changes and decide if they may be a contributing factor:
- Did the pain become noticeable gradually
- Is the pain on the heel
- Is the pain worse when taking the first few steps in the morning or after resting
- Is it worse after a run or when you’re tired
- Note: for a correct diagnosis you should seek advice from a physician or a chartered physio. However if you’ve answered yes to these symptoms it’s likely you have plantar fasciitis
So what do you do about your plantar fasciitis?
As we’ve already said, ideally go and see a sports physiotherapist. Alternatively try these treatment techniques over a 2 – 3 month period and note any improvement. The condition is likely to take much longer to remedy fully.
Stage 1: Assessment
Apply pressure with your thumb on the rear, middle heel, 2/3 cm above the sole – you may feel pain/tenderness here. Also, pain is sometimes felt along the middle/central line of the sole of the foot when pressuring the thumb along this line.
OK, so now you’ve assessed it, how do you start correcting it?
Stage 2: Treatment
Rest it, stretch it, ice it, massage it
- Initially reduce loading on the plantar fascia by stopping running. Replace CV with bike and/or swimming until progress is noted
- Passive calf and soleus stretch for 60 sec in each stretch 2/3 times each day
How to perform a static calf stretch
Keep the foot flat and knee straight. Exert pressure onto the rear lower leg and maintain for 60 – 90 secs.
How to perform a static soleus stretch
Notice the small variation in the knee position. Flexing the knee slightly and maintaining pressure on the foot draws the soleus into stretch. Maintain for 60 – 90 secs.
- Active calf and soleus eccentric stretch, 12 x stretches 2/3 times each day
How to do an eccentric calf stretch – start and finish
Instructions on how to perform an eccentric calf stretch
- Balance the toes of both feet on the edge of a step
- Use both feet to push down onto the step and raise the ankles as high as possible
- Lift off one foot and slowly lower down the other until the heel has dropped as far as possible
- Repeat for 3 x 10 reps
- To eccentrically stretch the soleus repeat as above with the knee slightly flexed for 1 x 10 reps
- Ice & massage: follow this simple but effective method to lengthen the plantar fascia and reduce inflammation:
- Fill a 500 ml plastic drink bottle water and freeze it. Take off socks and shoes, in a seated position place the frozen bottle under the affected foot. Apply pressure and roll the foot over the bottle from the heel to the toes for up to 10 minutes. Repeat 3/4 times each day.
- Or massage with a `pediroller`. A specifically designed foot massage device available from most good chemists or sports shops.
This is a `pediroller`
Using a `pediroller` for plantar fascia massage
So you’re working on recovery, what about the cause of the injury?
Stage 3: Assess and correct training errors
In part 1 we showed you how to perform a single leg squat as an assessment tool to highlight instability and weakness of the lower limb. Perform this exercise and assess if you can see any deficiencies. If any are noted perform it as a rehabilitation exercise daily to strengthen the lower kinetic chain. Start with 3 x 5 – 10 reps on each leg focusing on slow knee flexion, especially on the downward movement.
Other things to look at:
- Iliotibial band tightness – see our foam rollers article for a comprehensive explanation
- Core weakness – see our spinal health article or plank article
- Do you need new running shoes – have a professional running specialist shop look at your mechanics with different shoes
- Running intensity, duration or surface – assess changes to your routine and have a specialist trainer or coach advise on progression
If you’d like us to cover any specific rehab or performance topic, email us!