The Injured Runner
It happens to all runners eventually, a foot or ankle injury that affects their ability to run the distances, pace or frequency they desire. What is appropriate treatment? Rest or run, ice or heat, seek professional help or self-treat?
Injuries can be acute or chronic. Acute injuries include ankle sprains or fractures specifically related to an injury incident. For acute injuries remember RICE. That stands for rest, ice, compression and elevation. Ice for the first 24-48 hours or until the swelling resolves. Heat is not used initially because it can increase swelling. Most soft tissue injuries—ligament or tendon sprains or strains—will take about three to four weeks to completely resolve. Pain and swelling should decrease and mobility should increase within seven to ten days after the injury. Pain and swelling that do not follow this course may indicate a more serious injury and require professional help. After any severe injury to the foot or ankle with pain, swelling and bruising, have the injury evaluated by a professional and have an x-ray taken. Severe foot and ankle injuries may take six to eight weeks or more to heal.
Common Overuse Injuries
Many runners experience chronic overuse injuries. These injuries may begin as mild discomfort after a run that progresses to pain during the run, sometimes severe enough that it becomes impossible to run. Some common overuse problems:
Plantar Fasciitis/Heel Spur Syndrome
The plantar fascia is a fibrous band of tissue that runs from the heel through the arch into the soft tissues in the front portion of the foot. Inflammation of this band occurs when the foot flattens excessively during running, stretching the plantar fascial band and causing inflammation at its attachment into the calcaneous (heel bone). A bone spur may be observed on x-ray. The goal of treatment is to reduce the pull on the plantar fascia. Supporting the foot with either an over-the-counter support or a custom foot orthotic usually accomplishes this. Adjunctive treatment can include physical therapy, stretching of the calf muscles, anti-inflammatories, strapping and cortisone injections. Typical symptoms include pain in the heel and/or arch that is generally worse first thing in the morning or when getting up after being at rest for a period of time. It can progress to pain during and throughout a run. It needs to be distinguished from a stress fracture of the heel or possible nerve inflammation of the heel. In some cases plantar fasciitis and nerve inflammation are both present.
Stress Fractures
Stress fractures represent micro fractures of bone secondary to repetitive or increased stress on the bone. Typically in the foot they occur in the metatarsal neck area, but can occur in any foot bone or in the tibia or fibula of a runner. Typically there is pain and swelling present as well as point tenderness at the stress fracture site. The difficulty in diagnosing stress fractures is that they do not always show on x-ray. They sometimes become visible after three to six weeks as the fracture begins to heal. Bone scans and/or MRI may be used for diagnosis in difficult cases. Running on a metatarsal stress fracture can lead to an actual complete fracture through the metatarsal neck area. Non-treatment of the stress fracture can prolong healing. Treatment is generally immobilization and can involve a fracture shoe or cast or cast boot depending the situation. There can be a pre-stress fracture condition when the periosteum (the covering of the bone) becomes inflamed prior to the actual fracture. At this point usually rest will allow the inflammation to subside, avoiding the stress fracture.
Posterior Tibial Tendonitis
The tibialis posterior tendon passes on the inside of the ankle and attaches to the medial aspect of the foot. This tendon holds up the arch during running. Significantly increasing running distance can lead to inflammation with pain and swelling on the inside of the foot and ankle. Typically it is present in a foot that is biomechanically faulty, i.e., flattens too much. The ultimate answer is usually the proper biomechanical support such as an over-the-counter arch support with a supportive running shoe or custom foot orthotics. Treatment of the acute presentation includes rest, ice and anti-inflammatories.
Listen To Your Body
The key to dealing with injuries is to listen to your body. Minor injuries usually cause pain after a run and are self-limiting. They respond to some rest and icing. Running less frequently, adding cross training, varying distance and speed may be necessary. More serious injuries will cause pain during running. Any pain that starts during a run and gets progressively worse rather than easing usually represents a serious problem that requires immediate attention. Remember injuries that become chronic will take the longest time to heal and may prevent running for the longest period of time.
A club member since 1991, Dr. James R. Christina is a podiatrist practicing in Rockville, at the White Flint Podiatry Center. He is a past president of the Maryland Podiatric Medical Association and is currently on the Maryland State Board of Podiatric Medical Examiners. He runs three to four times a week.
