Running Injuries of the Foot and Ankle

The numerous health benefits associated with the sport of running make it an extremely popular fitness activity among individuals of all ages.

There is, however, a high incidence of lower extremity injuries incurred by runners as a result of repetitive and cumulative trauma to the musculoskeletal system, particularly the lower leg.

With the average runner striking the ground about 600 times per kilometre, the potential for developing overuse injuries such as patellofemoral pain syndrome and plantar fasciitis exists in running due to constant exposure to shock accelerations.

This can overload the musculoskeletal system, especially of long-distance runners, and reduce its ability to sufficiently absorb shock waves that are transmitted from the foot to the head during foot strike.

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It is essential to gain an understanding of both intrinsic and extrinsic risk factors that can contribute to the development of running injuries and subsequently affect training and performance.

This information can prove valuable in the designing and implementation of successful rehabilitative strategies that can help the individual regain strength in the lower extremity and return to the sport without the risk of recurrences.

Intrinsic characteristics such as biomechancial components and injury history can increase the predisposition of a runner to lower extremity injuries and therefore, must be evaluated for abnormalities that can be treated and managed.

Bennett et al. conducted a study to examine the relationships between isotonic ankle plantar flexor endurance, foot pronation and exercise-related leg pain.

For this purpose, the authors recruited 77 competitive runners from five collegiate cross-country teams and used standing heel-rise and navicular drop tests to assess isotonic ankle plantar flexor endurance and foot pronation respectively.

The findings of the study proved that excessive pronation i.e. navicular drop greater than 10 mm in addition to a history of exercise-related leg pain were significantly associated with in-season occurrence of exercise-related leg pain localised to the medial leg.

As described by Nicola et al., initial treatment protocol for running-related lower limb injuries should involve protection in the form of devices to restrict movement or provide cushioning to the injured region.

This should be followed by an adequate period of rest, cooling of injured tissue, effective compression of distal lower extremity injuries and leg elevation to prevent build up of edema.

Core strengthening, especially in the pelvic core, can help prevent misalignments in the pelvis which can otherwise increase the risk of hamstring injuries and Achilles tendinitis while running.

This can be in conjunction with flexibility and balance training which also help reduce injury rate by improving foot intrinsic musculature, range of motion and muscular mobility, allowing for increased stabilisation on landing.

A multifaceted treatment and rehabilitative programme should also include MASS4D® foot orthotics because the additional stress of an abnormal foot posture on the kinetic chain can facilitate the onset of overuse injuries.

This would help in minimising unhealthy movement of the lower body which increases the risk of injury when combined with the repetitive movements of the lower limbs in running.

A customised orthotic intervention should be incorporated to reduce excessive pronation in runners in order to improve performance and provide protection from musculoskeletal disorders in the long-term.

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References:

1. Bennett, J. E., Reinking, M. F., Rauh, M. J. (2012) The Relationship Between Isotonic Plantar Flexor Endurance, Navicular Drop, and Exercise-Related Leg Pain In A Cohort of Collegiate Cross-Country Runners. International Journal of Sports Physical Therapy: June 2012, Vol. 7, No. 3, pp. 267-278.
2. Nicola, T. L., El Shami, A. (2012) Rehabilitation of Running Injuries. Clinics in Sports Medicine: April 2012, Vol. 31, pp. 351-372. DOI: 10.1016/j.csm.2011.10.002

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