Attacking Running Pain, You Begin at the body’s foundation.
Written by Tim Maggs, DC   
Wednesday, December 12, 2018 01:25 PM

Running coach Eric Orton said, “The health of our feet truly dictates the health of our running ability.” Many running injuries stem from weak foot muscles or imbalances in the feet that are invisible to the naked eye. Plantar Fasciitis, Achilles Tendinitis, iliotibial band syndrome, patellofemoral pain syndrome, medial tibial stress syndrome, and metatarsalgia are injuries runners suffer from. Some estimates put the number of runners who are sidelined by these injuries annually at 90 percent. 

A 2015 study published in the British Journal of Sports Medicine found that runners who avoid injury land lightest on their feet, reducing the force of impact. Researchers suggest that runners consciously think about landing more softly and adjust their stride to land closer to the midfoot. This is easier said than done. Most runners are heel-strikers, and there are some indications that runners with excessive pronation or high arches, who attempt to transition to a forefoot strike pattern, might be more susceptible to injury.  

At birth, 99 percent of feet are normal, but problems develop quickly. By the first year, 8 percent develop foot problems, and the number jumps to 41% at age 5 and 80 percent by age 20. By age 40, nearly everyone has a foot condition of some sort. Data shows that 77% of people have excessive pronation where the foot excessively rolls inward due to the arches flattening out.

Many foot conditions can lead to many different injuries in runners and if not addressed, can eventually contribute to pain in the knees, hips, back, and neck. Spotting and addressing a potential problem originating in the feet can prevent other injuries from affecting a runner’s training and overall health. 

Runners often will attempt to treat pain through stretching or exercises targeting the area that hurts, though the source of the pain might be another part of the body. Often, the source of the pain is an imbalance in the feet due to excessive pronation or high arches.  

Look at back pain, for example. The Framingham Foot study found that pronated foot function was associated with low back pain in women. The feet and lower extremities can have a major impact on back pain for the following conditions:

Metatarsalgia. This is foot pain in the ball of the foot. Metatarsalgia may be due to a number of factors: overuse of the foot during sports, improper footwear, or excessive weight to name a few.  Pain in the forefoot often leads to altered gait, which in turn can produce stress and pain in the pelvis and low back. 

Excessive pronation in the foot. Collapsed arches in the foot cause the foot to excessively roll inward. As a result, the foot and ankle are not able to stabilize the body and absorb ground shock properly. This causes recurring misalignment of the vertebrae and adds stress to the leg, hip, pelvis, and low back.  

High arches in the foot. This results in a foot that is more rigid and hits the ground harder. The foot is tighter, stiffer and doesn’t flex and bend to accommodate variations in terrain. The poor shock absorption and lack of flexibility can work together to cause injuries in the knees, hips, back, and neck. 

Heel pad atrophy. As the human body ages, the fat pad that cushions the heel gets thinner. The heel pad no longer feels thick and rubbery, and it may have a flat appearance. Atrophied heel pads provide less protection from heel-strike shock. This shock can aggravate and perpetuate low-back pain, especially in patients with degenerative changes in the lumbar spine.

Heel Spurs. A heel spur is a degenerative outgrowth of bone on the heel bone. A heel spur demonstrates that there has been chronic tension on the plantar fascia. Whether it is currently symptomatic must be closely investigated, since some heel spurs are not associated with pain. 

A significant factor in reducing pain is the use of custom orthotics. Custom-made orthotics help align, stabilize, and support the feet so they can have healthy movement patterns. This can reduce pain not only in the feet but the knees, hips, back, and neck. 

Orthotics specifically designed to cushion the impact incurred from running can reduce pain. Shock-absorbent material is especially helpful in reducing the impact from heel strikes when running and can be of help when there is instability, chronic degeneration or inflammatory arthritis in the joints.

No runner wants to be sidelined because of an injury, especially if it is someone who has finally found the motivation to lead a healthier, more active lifestyle. The use of custom-made orthotics is an effective treatment for these conditions and contributes significantly to the reduction of pain for runners.  


References

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2.    Gatterman MI. (1990) Chiropractic Management of spine-related disorders (p.413). Baltimore: Williams and Wilkins.

3.    Farokmanesh K, Shirzadian T, Mahboubi M, Shahri MN. Effect of foot hyperpronation on lumbar lordosis and thoracic kyphosis in standing position using 3-dimensional ultrasound-based motion analysis system. Glob J Health Sci. 2014;6(5):254-60

4.    Hartley A. (1991). Practical Joint Assessment: A Sports Medicine Manual (p.573). St Louis: Mosby Year Book.

5.    Levitz SJ, Whiteside LS, Fitzgerald TA. Biomechanical foot therapy. Clin Podiatr Med Sug. 1988;5(3):721-36.