Common Running Injuries

Shoes:

There is no single correct shoe for anyone and everyone. When utilizing an orthoses, certain characteristics of a sport shoe are very important.

The shoe must have a firm midsole. You cannot place an orthoses on a pillow and expect the orthoses to improve the gait. Soft shock absorbing soles are a definite     no-no.

When one simultaneously pushes the heel and toe towards the center of the shoe, the sole should bend across the ball of the foot and not across the midsole.

When the shoe is placed on a table top the heel counter should be perpendicular to the table top. About ten percent of the common running shoes have everted heel counters guaranteeing that the wearer will pronate his or her foot, even with the orthoses. If the heel counter is inverted by three or four degrees the shoe should be satisfactory because of the very high incidence of rearfoot varus.

Torsionally rigid shoes (resist twisting on the long axis of the shoe) are better for cross training and for walking. These shoes offer more support and enhance the function of the orthoses.

Do not recommend shoes with a flared heel because these shoes have a larger lever arm and increase the pronatory forces across the rear foot at heel contact. In actual fact, a small heel is almost universally preferable.

Injuries:

Patello-femoral stress syndrome: This is also known as “Runners Knee”. Normally the patella tracks centrally in the femoral grooves during flexion and extension of the knee. The tracking is maintained by the depth of the femoral condyles, muscle pull from the quads (vastus medialis and vastus lateralis), and by ligamentous support. In this condition, the patella tracks laterally. Pronation is a significant factor in this displacement (why doesn’t the patella track medially?) because the internal rotation of the limb supposedly predisposes to lateral tracking of the patella (the patella stays with the femur rather than being pulled with the tibia). Orthoses have a definite place in the treatment of this condition but not an absolute place. This condition has been successfully treated with orthoses. It has also been successfully treated with orthoses only.

Ileo-tibial Band syndrome: A very common overuse syndrome due to rubbing of the ileo-tibial band (thick fibrous band that runs down the lateral aspect of the thigh that gradually forms a narrow band that attaches on the lateral aspect of the tibia) (the band crosses the knee joint)on the lateral femoral condyle. It is a friction rub. This responds very well to stretches and increase flexion and extension during running. Orthoses are not specifically indicated.

Popliteal Tendonitis: Positively identified with excessive pronation running downhill. Excessive internal rotation of the leg places traction at the attachments of the tendon to the lateral femoral epicondyle. Orthoses are obviously indicated.

Shin Splints: Characterized by pain on the medial distal two thirds of the tibial shaft. It is due to excessive pull of the posterior tibial tendon at its attachment to the tibia. The posterior tibia muscle is a supinatory brake to the midtarsal joint and its overuse is an attempt to decrease or reduce pronation of the foot. In another sense the excessive pronation of the foot puts traction on the tendon and the attachment of the muscle to the bone. This causes an enthesopathy or a “tearing away” of the muscle from the bone. Orthoses are definitely indicated.

Anterior Compartment Syndrome: “Anterior shin splints” are seen when a runner 1. Changes from a flat foot (heel to toe) running style to a forefoot style. 2. Begins interval training on track or hills, and 3. Uses an overly flexible sole. Not related to pronation.

Lateral Compartment Syndrome: Supposedly due to “hyperpronation” and “excessively flexible ankles” causing lateral ankle pain. It is a pre-existing condition that becomes symptomatic when running. Responds to orthoses. Muscle strengthening exercises indicated.

Achilles Tendonitis: Inflammation of the achilles tendon (with or without swelling). The exact mechanism of this inflammation is unknown but the condition is associated with excessive use. Responds to conservative therapy, heel raises, and orthoses if the foot is pronated.

Retro Calcaneal Bursitis: Irritation of posterior aspect of the calcaneus and the overlying bursa due to the rubbing of the heel counter of the running shoe. Responds well to local anti-inflamatory medication and cortisone injection. The irritation is probably due to the rapid and repeated eversion of the calcaneus against the  heel counter. Orthoses are indicated.

Plantar Fasciitis: The most common cause of heel pain (heel spur syndrome). Prolonged traction of the plantar fascia (secondary to the elongation of the foot caused by pronation) pulls the periosteium away from the underlying bone and lays down new bone to fill the void, hence the heel spur. The heel spur does not cause the pain but rather the inflammation is what causes the pain. Once fully formed, the heel spur is asymptomatic. The runner may have plantar fasciitis and no heel pain and vice versa. The runner may have both symptoms. Orthoses indicated. Almost always associated with supination of the long axis of the midtarsal joint.

Medical Calcaneal Nerve Entrapment: Irritation to this nerve causes severe burning pain on the medial plantar aspect of the foot. Poorly recognized condition and frequently confused with the heel spur syndrome. Orthoses are of questionable value.

Sesamoiditis: Inflammation of either or both of the sesamoids beneath the head of the first metatarsal, due to overuse and instability of the forefoot (secondary to unlocking of the midtarsal joint). Stabilizing the foot with orthoses is usually curative.

Pump Bumps: Inflammation and enlargement of the superior portion of the posterior lateral aspect of the calcaneus, most frequently associated with women’s style shoes. Seen often with skiers, it is believed to be caused by the calcaneus rubbing against the shoe counter as the foot pronates at heel strike. Responds very well to orthoses. This is one of the best kept secrets in biomechanics of the foot.

Heel Spurs (retro calcaneal exotosis) – Bone growth due to intermittent aggravation or pressure. May respond to orthotics but if severe may require surgery.

Bone bruises (traumatic periosities) – injury with inflammation of the bones’ protective covering (called periosteum).

Bone Spurs – same as heel spurs – due to intermittent aggravation or pressure.

Shin Splints – muscle (or muscle attachment) spasm or cramping usually the anterior tibial muscle, posterior tibial muscle, or gastrosoleus muscles due to abuse and or overuse.

Stress fracture – hair line crack in the bone due to stress exceeding bone strength or resistance. An overuse or fatigue syndrome.

Bunion – a bone spur due to intermittent aggravation plus instability if the big toe joint (1^st metatarsal).

Runners Knee – Erosion and wearing of the knee cartilage due to mal-alignment of the knee joint and complicated by overuse with mal-alignment (e.g. can be precipitated or aggravated by running on tilted surfaces such as paved roads).

Mortons Toe – Abnormality supposedly resulting from a short and hyper mobile 1^st metatarsal, resulting in undue stress being transferred to the 2^nd metatarsal.

Tailors Bunion – Bone spur on the 5^th metatarsal head resulting from excessive intermittent aggravation or pressure.

Corn plasters – Commercial preparations containing mild acids which are applied to corns for the purpose of chemically “digesting” the excessive callous.

Metatarsal Pads – Pads applied to the foot to relieve specific areas of pain.

Mole Skin – A special tape to adhere to the foot to relieve areas of friction,

Arch Supports – A device (commercial or custom made) to support the arch.

Cushion insoles – Any soft material cut to fit the insoles of a shoe for the purpose of cushioning each step.