Running and jogging place tremendous stress on the feet over time. Many of the causes of foot pain aren’t serious and get better with simple treatments, while others can be much more debilitating. This article lists some of the common problems that cause pain in the feet of avid runners.
The Achilles tendon can be affected in several locations in joggers. While many overuse issues with the Achilles tendon cause pain higher up the ankle, runners can experience pain where the tendon inserts onto the back of the calcaneus (insertional Achilles tendinitis). Inflammation of the tendon’s insertion can be very painful with jogging and even walking or other daily activities. Other problems in this area, such as a bony prominence at the Achilles insertion (Haglund’s deformity) or inflammation of the bursa under the tendon (retrocalcaneal bursitis) can similarly afflict running athletes. Stretching, ice, physical therapy, and other nonoperative treatments often relieve foot pain in these athletes.
Runners can develop plantar fasciitis, but it is a common cause of heel pain in athletes and non-athletes alike. The plantar fascia is the soft tissue that holds up the arch of the foot. A small area of degeneration can develop within this tissue. The patient usually complains of pain on the sole of the foot at the base of the arch just off the calcaneus. The pain is often worst with the first few steps in the morning. It can gradually improve throughout the day. Nonoperative treatments like stretching and a night splint often resolve the problem.
Metatarsal stress fracture
The metatarsals are the long bones in the foot. They are prone to overuse injuries with repetitive stress. All running athletes can suffer stress fractures of the metatarsals, although older runners with decreased bone density might be at higher risk. Running too many miles or increasing distance too quickly without enough time for the bones to rest can lead to the stress fractures. Pain in a specific location on one of the metatarsals that increases with distance or takes longer to go away could indicate a stress reaction or ultimately a stress fracture. Fortunately, metatarsal stress fractures rarely require surgery but often need weeks to heal.
Calcaneus stress fracture
Like metatarsal stress fractures, stress fractures of the calcaneus (heel bone) also result from overuse. They also commonly affect older patients with decreased bone density. The runner will usually have pain located within the substance of the calcaneus. The doctor can squeeze the calcaneus together from the sides to reproduce the pain, which suggests a fracture. Like most stress fractures, x-rays might not always reveal the fracture, so an MRI can help make the diagnosis. Treatment involves a period of rest from jogging, decreased weight bearing, and possibly use of a cast or boot.
Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint. This joint at the base of the great toe is what many people think of as the “ball” of the foot. The condition usually results from wear and tear over time in a running or jumping athlete, although acute trauma can initiate pain in this joint. Narrowing of this joint can cause pain and stiffness. Jogging and pushing off are often painful. Shoe inserts, anti-inflammatory medications, and cortisone shots can be used. Occasionally surgery to remove bone spurs can help. More invasive surgery can treat significant degeneration of the joint.
This problem can affect people other than runners. Women who wear narrow heels are thought to be potentially at risk. Runners and joggers can suffer this common cause of pain in the toes due to shoes that are too tight around the toes. Pain, numbness, and/or tingling from irritation of one of the sensory nerves to the toes are common symptoms of a neuroma. Anti-inflammatory medications, wider toe boxes in the shoes, and occasionally cortisone shots can help relieve pain. Surgical treatment is occasionally required.
This list provides an overview of some of the common orthopedic foot injuries that runners often suffer. Although I didn’t mention them here, calluses, nail disorders, or blisters can afflict runners too. An orthopedic surgeon specializing in foot and ankle surgery or sports medicine can evaluate the foot for a runner experiencing pain to try to find a diagnosis and start treatment. Hopefully the injury does not keep you from running for long.
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