With so much focus on pace, distance, gear, cross-training, and recovery, it’s easy to forget that healthy feet are the linchpin to running success. Sore feet make it close to impossible to have a good run.
In just one foot, you have 26 bones, 33 joints, and more than 100 muscles, tendons, and ligaments. When you run, every one of these structures plays a role, and if any one of those are off, not only will your feet hurt, you’ll begin to notice alignment issues elsewhere.
Most foot injuries are not solely (pun intended) a result of dysfunction at the foot but are related to imbalance and weakness up the kinetic chain. “Injuries occur when the foot has to work too hard to compensate,” says Rebecca Johnson, a physical therapist who frequently treats runners.
We spoke with podiatrists and physical therapists about how to prevent and fix foot pain in runners.
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The Best Ways to Prevent Foot Pain
Buy new shoes.
You should be replacing your running shoes frequently. According to Jane Andersen, DPM, that means after 350 to 500 miles of running.
“The number one cause I see of injury is shoes past their prime,” she says. “If people would replace their shoes more frequently, it would prevent so many of the injuries we see.”
For those who also wear their favorite runners as everyday kicks, be sure to track those miles as well. Andersen says it’s as simple as checking daily steps on your phone or fitness tracker. If you ran four miles and walked two more with the dog, at the grocery store, and at the playground, that’s six miles of wear and tear on your footwear.
But it’s not just enough to buy new, you also need to buy the right running shoes for you. Megan Leahy, DPM, stresses the importance of visiting a specialty running store when it’s time to purchase new shoes. Knowledgable salespeople will be able to analyze your gait, determine the best type of support for you, and make sure you’re in the right size. They will know everything about the latest models and what might work best for your feet.
If you have a history of injuries from the knee down or are an overpronator, Leahy says you may need to add supportive inserts or custom-made orthotics to your shoes. A podiatrist or physical therapist will be able to help with options.
According to Leahy, foot pain is never normal. If you are suffering, it’s time to visit your doctor. For any pain from the knees and below, a podiatrist can help.
You also need to pay attention to your sock size and purchase a pair that works for your foot. They shrink over time, wear thin, and can lose their elasticity, all of which set feet up for blisters. Avoid 100 percent cotton socks, which hold fungus-friendly moisture, and plan to refresh your sock drawer at least once a season.
Your everyday shoes are important, too.
According to Andersen, a former half-marathoner who now prefers spending time exploring trails with friends, months spent in flip-flops result in a late-summer spike in patients with foot pain. “If you want to keep running, you need to make good shoe choices when you aren’t running,” she says.
Improve single leg balance and control.
“Running is a single leg activity,” says Eric Oliver, physical therapist and founder of Beyond Exercise, “so single leg coordination and strength development cannot be overlooked.” He recommends practicing single leg squats and lunges as a way to reduce stress down at the feet. Focus on strengthening the gluteus medius near the outer part of your hips, your gluteus maximus muscles, and the smaller hip rotator muscles, as well.
The Most Common Foot Ailments in Runners
“Often times, pain in the foot and ankle can be tracked to improper movement in other joints of the foot,” says Oliver. Read on to learn where specific types of foot pain may be coming from.
Lateral foot pain.
Pain on the outside of the foot often occurs when this area is overloaded. “Ideally you should roll off of your foot between the first and second metatarsal. If you’re relying more on the outside edge of your foot, there’s often an imbalance higher up the chain,” Johnson says. For instance, if the hip-pelvis muscles aren’t doing their job as functional stabilizers, the fallout can include compensation at the lower leg and foot.
There are multiple conditions that can cause this: Peroneal tendonitis, or inflammation of the peroneal tendons that run from the back of the calf to the lateral foot, typically feels like a sharp or aching sensation along the side of the foot. Stress fractures of the fifth metatarsal, the long bone that connects to the pinky toe, can also occur with abnormal foot placement. With a stress fracture, swelling and pain intensify as soon as you start to run and never completely go away. Oliver also commonly sees stress fractures in the smaller metatarsal bones.
Other common lateral foot injuries include stretched, torn, or pinched nerves and pain related to unhealed ligaments from a previously sprained ankle.
Treatment varies for each of these conditions, but one thing Johnson recommends is looking for clues as to why you might be overloading your lateral foot. Strengthening the muscles at the hips and releasing tension up the leg may help disperse forces more evenly when you run.
Pain in the ball of the foot.
Several factors can contribute to this pain, including wearing shoes that are too narrow; having tight calves, which increases the time you spend on the ball of your foot; and lacking hip extension, which can cause you to compensate by pushing off with the ball of your foot.
“A lot of people think they need to push off the ball of their foot when they run, but the structures in the foot are not meant to do a heavy push-off,” Johnson says.
Excessive stress to the ball of the foot can lead to metatarsalgia, a general term for pain and inflammation under the metatarsal heads of the foot where the toes attach. It can start as an annoying discomfort, but if left untreated, it can become so painful that it hurts to bear any weight on your foot.
Another injury is Morton’s neuroma, a thickening of the tissue around one of the nerves that go to your toes. Morton’s neuroma can cause a sharp, burning pain and can feel like you have a pebble stuck inside your shoe.
For treating both metatarsalgia and Morton’s neuroma, Johnson recommends a multifaceted approach that includes modifying how much weight you’re putting on your foot, stretching and bodywork for the calves, releasing the sciatic nerve and strengthening both the feet and up into the kinetic chain.
Pain on top of the foot.
In most cases, tight shoelaces are the simple cause of pain on the top of the foot, formally known as extensor tendonitis. “It’s all about finding the right marriage of your shoes, shoelaces, socks and orthotics if you wear them,” Johnson says. “If you alter any one of these, be aware of whether you need to make any adjustments.”
Pain on the top of the foot, however, could be caused by stress in the midfoot. “Excessive stress to the midfoot can lead to irritation of the ligaments along the top of the foot that support the tarsal bones,” says Oliver. He adds that this ailment can many times be traced to stiff ankles, an excessive amount of force on the foot from a poor running form, or excessive training load.
Mobilize, Strengthen, and Retrain Your Feet
Having strong and mobile feet can limit your risk for foot injuries, but it’s also important to strengthen the muscles higher up the chain that affect how your foot hits the ground and your weight-bearing pattern. Add the following exercises and stretches into your normal routine.
- Hamstring and calf stretches. Stretch out three ways: with toes forward, turned out, and turned in.
- Toe alphabet. From seated in a chair, straighten one knee and write the alphabet with your same-side foot.
- Glute bridges. Do this move once with your toes turned in and once with them turned out.
- Roll out. Gently roll the bottom of your foot on a massage, lacrosse, or tennis ball.
- Mobilize the midfoot. Simply grab the middle of the foot and rotate it inward and outward.
- Mobilize the rearfoot. Place your foot on the opposite knee. Grab the heel and rock it inward and outward.
- Toe stretch. Stretch your big toe upward, on its own. Improving range of motion in the big toe extension can help with pain felt in the forefoot.
- Wall stretch. Stand with feet forward facing a wall and place your hands on the wall for support. Lift the heel of one foot off the ground so that only the ball of the foot rests gently on the ground. Begin to slide this foot backward, first emphasizing contact with the big toe. Return the foot to the starting position. Repeat four more times, each time focusing on a different toe.