Most runners have a love-hate relationship with their feet. Because runners' feet endure the brunt of the repetitive pounding of the sport, black or missing toenails, blisters and callouses can result from a long run or race. But there are more sinister ways that foot pain can stop runners in their tracks: stress fractures, tendonitis and soreness that isn't "normal."
The foot is an incredibly complex extremity made up of a network of bones, tendons, ligaments and muscles that all have to work together in harmony. One disgruntled cog, and the whole machine can stop functioning.
Nearly every runner knows the plantar fascia tendon that runs lengthwise across the bottom of the foot. Plantar fasciitis is that sharp, stabbing pain at the bottom of your foot. As with all tendonitis issues, the beast can rear its ugly head sometimes out of nowhere and drag on for what feels like an eternity.
An overuse injury, plantar fasciitis can be caused by a biomechanical issue, improper running shoes, increasing training volume or intensity too quickly, or even from tight or weak calf muscles—the body is an interconnected machine, after all.
Treating plantar fasciitis is a matter of identifying what your root cause is, making sure you're running in shoes that offer enough support, and possibly using an insert or orthotic.
Stress fractures are a bone issue or fissure that can be present in any of the many bones comprising the foot, but fractures occur most typically in the metatarsals. Stress fractures tend to be a slow-building issue, but then all of a sudden a moment comes when you feel a sharp pain of the bone fissure. Afterwards, it can be hard to distinguish if the foot pain is a bone or tendonitis problem. Even X-rays can be unreliable; it's possible that nothing will show up until there is actual healing going on in the bone. Your doctor may order an MRI or bone scan to look for a stress fracture.
Stress fractures are usually caused by rapidly increasing training volume and/or intensity, but they can also happen if you're unlucky enough to step awkwardly on a rock, root or pothole.
If you have a stress fracture, there's no way around taking time off from running. It takes about six weeks of non-weight bearing activity for the bone to heal properly. Cross-train like a champ, wear a boot, and enjoy the mental break from running. The good news: Unlike a tendon issue, once a stress fracture heals the pain should be gone for good.
Tendons run across the top of the foot, extend down from the muscle in the front of the shin, and split off into each digit. These tendons work to straighten each toe, pull each toe up, and to help move the entire foot.
Just like any other tendon in the body, the tendons in the feet can become inflamed. When they do, the symptoms can be very similar to the pain of a stress fracture. How can you tell the difference between the two? Because the extensor tendons raise the toes, if you have someone apply pressure to your toes as you raise them and that isolates your pain, chances are you have a tendonitis issue rather than a stress fracture, which would be more pain on impact.
Causes of inflammation can be traced to improper shoes, a tight Achilles, and weak or tight calf muscles. Ice the tendons to reduce inflammation, make sure your shoes have enough support—again, an insert may help—and be diligent about stretching your calf muscles and completing calf-strengthening exercises.
Adductor and Abductor Hallucis
The adductor hallucis is a muscle that runs horizontally across the top of the foot, forming a V-shape with its center at the big toe. The abductor hallucis runs lengthwise on the medial inside of the foot along the arch. Pain in either of these two areas can feel like extensor tendonitis or plantar fasciitis pain. But, runners can clearly identify a tight and sore abductor hallucis from a plantar problem because the muscle isn't on the bottom of the foot but rather on the inside of the arch.
Problems with either of these two muscles can result from not having enough arch support in your shoes, but most typically if you have bunions. Expert sports massage therapist and Rolfer Allan Kupczack, who treats recreational runners and elite athletes like Kara Goucher, explains that a tug-of-war that can occur. Treatment for this problem is a two-pronged approach in order to keep both muscles happy.
Check out some exercises that may help you with frequent foot pains:
- Abductor Hallucis Toe Pull:Keeping your ankle fixed at 90 degrees, grab your big toe and pull it up. You want to feel this stretch on the inside of your arch.
- Seated Toe Stretch:Get on your knees and place your feet behind you, bending your toes. Gradually lean back until your bum rests on your heels. You should feel a deep stretch along the inside of your arch. Work into the stretch by leaning forward. Keep your weight in front of you if resting your bum on your feet is too painful at first.
- Resistance Band Toe Pulls:Seated in a chair, loop a resistance band around both big toes of your feet. Start with your toes pointed forward and, keeping your heels planted, rotate both feet out and away from each other. Hold this position for 30 seconds, return to the starting position, and then repeat. Start with two to three sets once a day, and work up to two to three sets twice daily.
- Arch Raise:Standing, roll your left foot up and to the side. Try to think of pulling the ball of your foot towards your heel; you're contracting (shortening) the adductor hallucis muscle. Complete 10 to 15 raises on each foot.