Foot Problems in Runners

Heel pain

One million runners will develop heel pain every year. The most common cause of heel pain is plantar fasciitis, which is the result of excess stress through a long ligament type structure (the plantar fascia) in the bottom of the foot. The excess stress causes tearing and results in inflammation and pain. The classic symptoms are pain in the heel at the first step in the morning, or upon rising after long periods of rest. Runners may only experience the pain at the beginning of a run and many state that the pain will work itself out after about 1 mile, but then return by the end of a long run or at the end of the day.

Achilles Tendonitis

Achilles tendonitis and related calf problems are the most common injuries in runners. Pain develops at the back of the heel or in the calf and can be sharp with activity and feel deep and dull with rest. The pain may be apparent at the first step in the morning or rising after long periods of rest. Runners may experience sharp pain in the heel area at the beginning of a run, which then becomes a dull annoyance during the run. In severe cases, it may be so painful that it will bring running to a halt. Calf injuries and Achilles tendonitis are both aggravated by hills and stairs.

Runners develop plantar fasciitis and tendonitis for a variety of reasons. One of the most common reasons for the development of plantar fasciitis is wearing poor quality or worn out shoes. It is common to grab old “mud” shoes to run in bad weather, or to start Spring training in shoes that were used the entire previous season. The older shoes may have a worn out midsole and may have lost all aspects of support and stability. Improper fit of a new running shoe can also cause fasciitis. Overtraining is another cause of plantar fasciitis. Adding too many miles too quickly, or adding too many hills too quickly can overstress the foot. Abnormal mechanics in the foot is another contributing factor to the development of plantar fasciitis in runners. If the foot overpronates (rolls in) this places a tremendous amount of stress on the tendons in the arch and on the plantar fascia, many times resulting in small microtears and hence plantar fasciitis.

The keys to treating plantar fasciitis and tendonitis are rest, ice, stretching and support. Give your foot a break! Cross train with swimming or biking and avoid impact activity on your foot. If you must run, cut back on mileage, avoid hills and speed work and gently stretch before your run, but after a 10 minute warm-up. Ice the area for 20 minutes, after the run. Try to ice for 20 minutes, twice a day. Stretch the calf and/or the arch multiple times throughout the day. Make sure you start with gentle stretching, and avoid overstretching. For plantar fasciitis, night splints are very helpful. Buy supportive shoes and use an over the counter orthotic for support. If you have flatfeet you may need custom made orthotics. If this is a chronic problem, see your podiatrist.

Stress fractures

Stress fractures most commonly occur in the metatarsal bones. The metatarsal bones are the long bones in the middle of the foot. A stress fracture is an incomplete break of the bone. The pain is usually sharp and develops suddenly, but it is not the result of a specific injury or trauma. Stress fractures are more commonly the result of overuse. If you develop a sudden swelling and bruising on the top of your foot, but can’t remember any specific injury, it is time to see your podiatrist. The typical treatment is a surgical shoe (fully rigid shoe) for 4-6 weeks.

Ankle Sprains

Ankle sprains are another common injury in runners, especially in trail runners. The most common ankle sprain is called an inversion ankle sprain. The ligaments on the outside of the ankle tear when the foot turns in and the ankle turns out. There are three ligaments that hold the ankle joint in place on the outside of the ankle. When the ankle is twisted, one or more of these ligaments may be torn. Most ankle sprains involve partial tearing of one or more ligaments. Severe ankle sprains involve partial to complete tears of two or three ligaments.

Very mild ankle sprains may only need an ace bandage and high top shoes for support for a week or two. For more moderate sprains, a lace-up ankle brace and sometimes an aircast are necessary. If there is a considerable amount of swelling, bruising and pain, a visit to the doctor is recommended. An evaluation will be done to assess the stability of the joint and X-rays will be taken to rule out a broken bone. Mild ankle sprains may only take a week or two for full recovery, but most ankle sprains will take about 6 weeks. More severe ankle sprains typically take 3 months and may not feel 90-100% for almost a year. If you experience a severe ankle sprain, consider a visit to a podiatrist. If you have not healed from an ankle sprain after 6 weeks, see a podiatrist.


Friction blisters are one of the more common foot injuries in runners. Blisters most commonly develop on the back of the heel, the side of the big toe or in between the toes. A blister is a result of friction, of shearing forces on the skin. The blister is actually a defense mechanism of the body, which occurs when the shearing forces separate the outer layer of skin, the epidermis, from the deeper dermal layer of the skin. Fluid collects between these layers, providing a cushion against the aggravating force while a new layer of skin re-grows underneath.

The best treatment is prevention. Blisters can be prevented with the appropriate socks and proper shoe fit. Sometimes, blisters are unavoidable. Small blisters that are not painful and not infected should be left alone. There is no need to pop and drain these blisters. The most important treatment is to reduce friction and look for the cause. Was the sock folded or crumpled at the toes or heel? Is there stitching in the shoe that is prominent or defective? Is the shoe not fitting properly? You can place moleskin directly on top of small blisters to help reduce friction. Drain larger blisters with a sterilized needle (unless you are diabetic) by punctured the side of the blister and placing gentle pressure with gauze to absorb the fluid. Don’t remove the top layer of skin. This layer is the body’s best protection. Dry the area, but don’t use antibiotic ointment over the area. If you plan to continue running, place moleskin directly over the blister. Pat dry with a towel after each shower and the moleskin should stay on for a number of days. Cut the edges of the moleskin if the corners peel up, but don’t pull off for at least 3 days. This will tear the top layer of skin off and create an open wound. Any blister that has redness, streaking or pus may be infected. You should see your doctor immediately.

Foot & Toenail Fungus

Foot fungus is characterized by peeling, redness and itching on the bottom of the foot and in between the toes. Toenail fungus is characterized by white, splotchy areas on the nail or thickness and yellow discoloration of part of the entire nail. Fungus grows in moist, warm environments, which places runners, in particular, at risk. Foot fungus rarely causes any pain or considerable problems, but is mostly an annoyance. Toenail fungus can cause ingrown nails and thickened nails, both of which can cause pain.

Foot fungus can be treated with over the counter anti-fungal medications in combination with anti-fungal powder and spray in the shoes and eliminating the moist, warm environment. Toenail fungus is much more difficult to treat. The treatments range from simple home remedies to expensive oral medications. Prevention is the best treatment. Decrease the amount of moisture by using wicking socks and make sure to have proper sock and shoe fit.

Sock and Shoe Fit

Avoid cotton socks and use socks with synthetic blends, small fiber wool blends or acrylic. Cotton socks absorb moisture and don’t allow for evaporation. It is important for your sock and shoe combination to allow for wicking. The shoes should have some areas of breathable fabric, like nylon mesh. When picking out shoes, make sure to measure your feet with your socks on. Pick a shoe with a rigid midsole, but has flexibility at the toes. Your toes should have some wiggle room. The general rule is one finger’s width between the longest toe and the tip of the shoe. The heel counter (back of the shoe) should be supportive and not too rigid. It should have some flexibility, but should not collapse when pressed towards the front of the shoe. Above all, the shoe should feel comfortable.