Most runners will find themselves sidelined with a foot ailment at some point. Anything from a simple blister to a more complex stress fracture can put a halt to training plans.
Keep reading to learn more about the most common foot problems in runners, why they occur, how to identify them, and how to treat and prevent them.
As any runner can attest, the feet take most of the heat when pounding the pavement. If you overtrain, ignore pain, or neglect preventative care, you may find yourself with one of the following foot problems experienced by runners.
Blisters may not be a serious injury, but they sure are painful.
“Blisters are caused by excessive friction within the environment of the shoe due to excess wetness with sweat while the skin will soften, leaving high-pressure skin areas at risk,” says Donna Robertson, Ped, ATC-MS, a certified pedorthist, athletic trainer, and teaching consultant for Foot Solutions.
She recommends wearing shoes with:
- heel control
- the right midfoot base
- appropriate toe room for spreading and gripping actions
- the right shoe flex to match your metatarsal flex
Also, be aware of any irritating seams, stitching, or enclosures that cause skin friction.
Some runners can experience toe rubbing against the front of the shoe if the shoes are too small or the foot is sliding forward, especially when running downhill.
Robertson says this is common in runners training for long-distance events. “When this happens, the nail is pushed down into the nail bed, becoming bruised and inflamed, often leading to loss of the nail,” she says.
The base of the big toe is home to the metatarsophalangeal (MTP) joint, which bends each time you take a step. According to the American Academy of Orthopaedic Surgeons (AAOS), if this joint stiffens, running can be especially painful.
Experts call this hallux rigidus or “stiff big toe.” Arthritis of the big toe MTP joint can lead to hallux rigidus, and according to the AAOS, it may result from an injury to the toe or overuse.
Plantar fasciitis is a painful condition that causes inflammation of the plantar fascia.
According to Andrew Schneider, DPM, a board certified podiatrist, the plantar fascia attaches to the heel bone and extends across the bottom of the foot. With each step, it pulls on the heel, and significant repetition, such as with running, may cause it to become inflamed.
Schneider says plantar fasciitis is common in runners who have flat feet, but it can also be seen in runners with high arches. “Plantar fasciitis is an overuse injury, caused by the stress a runner places on the feet,” he says.
Stress fractures can occur from overuse without enough time to heal, says James Gladstone, MD, associate professor of orthopedic surgery at Mount Sinai. “A stress fracture that’s not appropriately addressed can become a complete fracture where the bones break through and can displace,” he says.
Gladstone says stress fractures typically occur:
- at the end of the metatarsals (long bones in the foot)
- at the base of the fifth metatarsal (pinky toe)
- in the bones of the ankle joint
Robertson says metatarsalgia is a painful irritation of the tissue, muscles, tendons, ligaments, and joints surrounding any of the five long metatarsal bones of the foot that connect or articulate with the toes (phalanges).
When this happens, the areas covering or surrounding the metatarsals can become irritated and inflamed after running. Robertson says the cause is usually excessive contact with the ground while running, leading to the breakdown or trauma of the metatarsals.
A Morton’s neuroma is an inflammation of a nerve in the ball of the foot.
Schneider says it is common in runners because of the repetitive pressure on the forefoot while running. “The nerve gets trapped between the adjacent metatarsal bones and a ligament, which causes the nerve to swell, becoming inflamed and causing pain,” he says.
A Morton’s neuroma is common in runners with a high arch who strike the ground with their forefoot and runners who wear shoes that are too narrow. Narrow shoes add pressure on the nerve and increase the pain.
If you have consistent foot pain, the best thing to do is to see your primary care physician, a podiatrist, or an orthopedic foot and ankle specialist. They can diagnose the problem and recommend treatment options.
Left untreated, many common foot problems can get worse, especially if you continue running while in pain.
If running injuries such as stress fractures, impingement, and tendonitis aren’t given a chance to heal, Gladstone says they can be worsened to the point where recovery with rest, immobilization, or physical therapy is no longer possible and surgery is required.
Depending on your injury, Gladstone says recovery can be as little as 2 weeks when you’re talking about tendinitis or as long as 6 weeks to 3 months when dealing with a stress fracture.
Whether you’re nursing an existing injury or trying to prevent one from happening in the first place, practicing preventative measures goes a long way in caring for your feet. Here are some tips for how best to care for your feet.
Wear the right shoes for you
Wearing shoes that fit right and feel good on your feet is the first step to taking care of your feet. According to Nelya Lobkova, DPM, running shoes should be carefully chosen according to running dynamics, performance level, and terrain.
“Proper fitting of shoes involves understanding what foot type is present — for example, a flat foot type often requires the shoe to be wide enough at the ball of the foot and support in the midsole or arch of the foot to limit the collapse of the arch,” she says.
But a high-arched foot, she adds, generally requires a shoe with at least slight heel elevation and cushioning under the toes to dissipate pressure under the ball of the foot.
Ask about orthotics
“Orthotics are the only devices that place the foot in neutral by providing the correct tilt in the heel as well as arch support,” Lobkova says.
Although over-the-counter orthotics may help, Lobkova points out that many people don’t buy the right ones. Orthotics made of flexible material, for example, provide limited support.
“Custom orthotics, if made correctly, can provide the support needed for multiple activities and performance levels without problems,” she says.
Check your running mechanics
Proper running mechanics are critical to keeping your feet in shape.
Gladstone says that while some people have natural mechanics, most need to learn them. He recommends seeking out a running coach or physical therapy clinic that specializes in running mechanics.
Consider the running surface
While it might be easy to lace up and head out the door for a run, too much time pounding the concrete or asphalt can take a toll on your feet.
To help keep your feet healthy, Schneider recommends running on a rubberized track or crushed gravel path. He also says to find as level a surface as possible and minimize running up and down hills or on a banked or sloped track.
Stretch before and after runs
Another way to prevent running injuries is with adequate stretching.
“Stretching wakes up the muscles and tendons by bringing blood flow to those areas and increases heart rate,” Lobkova says. Waking up these muscles and warming them up helps prevent overuse injuries during running, such as tendonitis, sprains, and tears.
Before a run, Lobkova recommends dynamic stretching since it forces the muscles and tendons to move and warm up in ways that static stretching can’t.
“Dynamic stretching mimics all the movements in the run while static stretches increase range of motion after the body has already been warmed up,” she says. Approximately 15 minutes of stretching before a run is sufficient.
During your cool-down, spend at least 5 to 10 minutes performing running-specific static stretches targeting the quadriceps, glutes, hamstrings, calves, and hip flexors.
Don’t wait to see a specialist
Pushing through the pain isn’t a good idea, especially when it comes to your feet. That’s why Schneider says you shouldn’t wait to get your foot pain checked by a specialist.
“The longer you wait, the more advanced the injury becomes, which can increase the risk that you will have to stop running for a period of time,” he says.
The good news? Physical therapy and custom orthotics are both excellent ways to treat a lot of common running injuries. They may also be helpful in preventing running injuries from returning in the future.
It’s not uncommon to experience pain, discomfort, or an injury to your feet while running. If you’re a distance runner or new to the activity, pay special attention to how your feet and toes feel during and after exercise.
Some problems, like blisters, are minor and require minimal rest and possibly a change in footwear. But other conditions, like a stress fracture, often need several weeks of recovery and specialized treatment to get better.
If you experience any kind of pain, discomfort, or irritation to the skin, it’s a good idea to rest and see a foot specialist if symptoms don’t improve.