With the Pittsburgh Marathon imminent, runners are ready to go. What common foot and ankle overuse injuries can occur while training and running, and what are tips to avoid these injuries?
Dr. Saar says: “Overuse and inflammatory conditions are extremely common in athletes, especially runners, as they prepare for upcoming events.
“Tendonitis around the foot and ankle – Achilles, Peroneal, etc. – is a common diagnosis in marathon participants. This is a general inflammatory process around the tendons themselves and typically presents with localized pain and swelling, as well as ‘startup’ stiffness and activity-related discomfort. Another soft-tissue condition seen in runners is plantar fasciitis. This condition is usually associated with pain in the bottom or sides of the heel bone. Many patients complain of discomfort with their first few steps in the morning when getting out of bed or when arising from a seated position. The key to treatment in many of these soft-tissue conditions is reducing the inflammation – using ice or anti-inflammatory medication – while also maintaining adequate health of the tendon/fascia by protecting and controlling range of motion and mobilization of the tissue. Supplemental treatment, including physical therapy, and possible injection therapy, may also prove beneficial. Occasionally, if the symptoms are nonresponsive to traditional treatment regimens, a period of immobilization may be necessary.
“Another condition seen in training athletes is stress fractures/injuries. The intensity of a workout may just be ‘too much’ for the various bones in the foot and ankle region, and they may become overwhelmed and ‘break.’ This condition usually presents with very site-specific pain over the area of stress injury and may not improve with the traditional conservative measures noted above. Even more concerning is that initial X-rays may be ‘negative’ in the early stages of a stress fracture. Treatment for stress fractures/injuries, unfortunately, requires periods of complete rest and immobilization using a medical boot or casting.
“The most sound advice to give athletes who are training for upcoming events is to use ‘common sense.’ Adequate stretching and mobilization are key components to keeping joints and soft tissues healthy. Additionally, a progressive but gradual increase in the duration (distance) and intensity of a workout is key. Significant pain or symptoms may indicate that you are doing ‘too much, too soon.’ Techniques such as moist heat to ‘loosen’ tissues, as well as application of icing protocols after activities to help reduce inflammatory responses, may also prove beneficial.”
William E. Saar, DO, is an orthopedic foot and ankle surgeon at Tri Rivers. He treats plantar fasciitis; bunions; degenerative conditions such as progressive flatfoot deformity, hammertoe deformity and Achilles tendinitis; foot and ankle arthritis; and foot- and ankle-related trauma. He performs ankle arthroscopy; reconstructive foot and ankle surgery; and ankle replacement.