Member Case Study: Foot and Leg Pain

author : AMSSM

comments : 0

My issue started out as a foot pain, I kept running on it for four months while training for a marathon. Boston training is supposed to start now. What should I do?

Member Question from SSMinnow

My issue started out as a foot pain, close to the insertion point of the PF. Over time, it became a sporadic leg pain--adductor/gracilis and outer leg which made it difficult to go up and down stairs and every running step hurt. I kept running on it for four months while training for a marathon (stupid, I know). I have had an MRI of the femur an X-ray of the foot and both are clean. The MRI showed some edema around the trochanter/vastus lat, but nothing more. I have been videotaped and have done multiple rounds of PT. I have been told I have some pelvic imbalance brought on by weaker glute med/max muscles on the injured side and I am working to strengthen them.

There is also discussion of a leg length discrepancy. This week, I had my first round of prolotherapy in the foot and hip. I have been off running for two weeks, feel fine biking and swimming, but my first love is running and I would like to get back to it. Boston training is supposed to start now.

One last piece of information, I was hit by a bike in August while running. This problem came on within a week of that episode.

Answer from Troy Smurawa MD
Member AMSSM

What started out for you as a three hour tour has you being stranded on the lonely island of injury. The weather started getting rough with the development of plantar fasciitis. The shipwreck occurred when you had your bike accident and continued to run on it for four months while training for a marathon.

Due to the repetitive nature of running, small changes in running biomechanics can amplify minor physiological stresses on the body. Stresses on the lower extremities in a runner can lead to subtle changes in biomechanics and greater stress on injured tissues. An injury, even minor, on one leg can lead to compensatory changes on a different part of the leg and even the opposite leg. Not only must you treat the existing injury, you must identify the root problem that lead to your demise. Otherwise, the injuries will continue to pile up.

You have already attempted to identify and address underlying problems. Below I have listed three areas to address any chronic running injury:

First, evaluate and correct any running biomechanical problems. Video capture motion analysis is a very good way to pick up on subtle biomechanical problems. Leg length difference can cause hip and pelvic problems as well as changing foot biomechanics. Orthotics is a good way to address these problems. Muscle imbalances and poor running posture can also occur from injuries. Focus on regaining hip and core strength and stability with the appropriate exercises. Gait re-training with a running specialist is also very helpful to correct poor running form and compensatory changes that have occurred.

Second, chronic soft tissue injuries often result in scar tissue, adhesions, tightness and diminished muscle firing. I often tell my injured runners that “the more chronic an injury becomes, the more chronic an injury becomes.” Therefore, address any problems - even minor problems immediately. There are different types of therapies that can be helpful. Physical therapist can provide modality treatments, strengthening exercises and stretching exercises. Manual therapy such as massage therapy and myofascial release such as A.R.T. (Active Release Technique) is often very helpful. They also can be coupled with adjunctive therapies such as Prolotherapy, Acupuncture and Kinesiotaping.

Third, you need to realistically assess and evaluate your training program. You may need change it in order to be able to train for the Boston Marathon. Having run the Boston Marathon several times, the only really challenging hill is heartbreak hill. I would suggest avoiding hill running in training if it aggravates your condition. Your speed work should be progressive and build up your intervals and intensity with adequate recovery rest. Also, focus on implementing form drills into your program. This will help improve running mechanics that often falter as you become fatigued. Lastly, do not abandon the importance of cross training. Deep water running and cycling are excellent low impact activities that will continue to provide the training effect you will need to train for the Boston Marathon.

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date: March 19, 2009