Common foot injuries in runners

Foot injuries and their treatment

Running takes its toll on the feet and no matter how good your running shoes might be, a foot injury is always a possibility. Here's the guide to common foot injuries and the potential solutions.

Foot injury1: Metatarsalgia

Metatarsalgia is simply a pain in the forefoot. It affects the metatarsal heads which can be considered to be the foot's equivalent of the knuckles in your hand.

The pain is often described as varying from sharp at times, to more of a dull ache, often localised to the ball of the foot. Metatarsalgia generally occurs over a prolonged period of time and worsens with activity. Symptoms can include pins and needles in some of the toes if there is irritation of the small nerves which sit between the metatarsal bones.

Metatarsalgia occurs when there is excessive load of weight on these bones, often due to factors such as joint stiffness in the foot or ankle, inflexibility in the lower limb, or poor running shoes not offering enough support.

Foot injury 2: Morton’s neuroma

Morton's neuroma is condition that also affects the forefoot. A neuroma is effectively a swelling of a nerve. Commonly it occurs between the third and fourth toes, where the nerve is pinched between the metatarsal bones in the foot.

The symptoms come on gradually and are described as a mild pins and needles or electric shock in the affected toes. The symptoms are brought on by weight bearing exercise and can be worsened if footwear is too tight.

When seeking physiotherapy treatment, it is important that you only visit a Chartered Physiotherapist who has the letters MCSP after their name. This is the seal of approval that the practitioner is someone who is qualified to an internationally recognised standard.

Treatment for both Morton's neuroma and metatarsalgia

Both Morton's neuroma and metatarsalgia can be treated in similar ways. After an assessment of the biomechanics of your lower limbs, including gait assessment, the physiotherapist may use manual techniques to improve the function of surrounding joints and soft tissue. Localised anti-inflammatory electrotherapy or acupuncture may help to reduce pain.

Exercises to improve function of the intrinsic and other foot muscles may be needed to regain support of the metatarsals when suffering with metatarsalgia (they may actually aggravate a neuroma by compressing it, so bear it in mind).

You can try this exercise by placing your foot flat to the floor and gently try to increase the arch of your foot by squeezing the muscles. Try not to curl your toes up, keep the pads of your toes in contact with the surface. This can be done, perhaps not so effectively, with your shoes on. This means whether you're standing or sitting at work, you can keep them active.

Working on the flexibility of your lower limb muscles may also help. Muscles to target include the gastrocnemius, soleus, hamstrings and quadriceps.

Orthotic support may also be suggested. A podiatrist or orthotist would take a detailed look at your gait cycle and the soft tissue and bone structures in the foot and limb, before constructing and supplying you with your orthotic insert.

Foot injury 3:  Plantar fasciitis

This is an inflammation of the attachment of the plantar fascia, a 'bowstring' arrangement of collagen fibres, running on the underside of the foot from the heel towards the toes. It is a common cause of heel pain.

It plays an important role in maintaining the shape of the medial arch in the foot. It is stretched when the medial arch is flattened and on the 'take-off' phase of the gait cycle, when the toes are in contact with the floor and extending. The inflammation occurs at attachment of the fascia to the bone.

Treatment for plantar fasciitis

Advice should be sought from a physiotherapist as plantar fasciitis is generally not a problem that will just go away, and will worsen if ignored and through continued exercise. The physiotherapists may use anti-inflammatory electrotherapy, manual techniques, as well as assessing the biomechanics of the limb. A regime of stretches and other remedial exercises will likely be prescribed, after which orthotics could be considered as an option.

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