A Painful Beginning: Common Foot and Ankle Injuries

author : AMSSM

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Injuries do happen, and we would like to discuss a few injuries that are common. All of these injuries can fall under the category of what are commonly called overuse injuries.

A Painful Beginning: common foot and ankle injuries when beginning or increasing a workout program.

Beginning training for a long-distance event can be a daunting task. Not only are there obstacles to overcome mentally, there are physical problems that can interrupt even the earliest training. There are multiple things that one can do prior to working out that can help avoid these injuries. However, injuries do happen, and we would like to discuss a few injuries that are common. Obviously, if you have any medical problems or require daily medication, please speak with a qualified sports medicine doctor prior to initiating your training regimen.

If you have previously been leading a sedentary lifestyle, have limited flexibility, use tobacco, or are over 50 years old you are at increased risk for exercise related injuries.
 
Here are some recommendations to minimize your risk:

• Stretching- In a study of military recruits, the incidence of muscle and tendon injuries were significantly lower in a group that stretched than for a group that did not. Other studies have debated the necessity of stretching, however we still feel it an important part of any exercise routine.
   
• Footwear- As one ages, the foot becomes wider and flatter. Therefore, each time a new pair is purchased, the shoe size (particularly the width) should be reexamined. Both shoes should be tried in the store and worn while weight-bearing. Properly fitted shoes should fit well out of the box, including the heel. If you have an orthotic, you should try the shoe on with the orthotic. Most will recommend that shoes be changed every 300-500 miles.
   
• Shoe inserts- Over-the-counter shoe inserts are adequate for most runners. These can help decrease the frequency of overuse issues and poor running form. Some runners need custom fit orthotics, which require a prescription from your doctor.
   
• Ankle Braces- If you have a history of prior ankle injuries, it is a good idea to wear ankle braces. A lace-up ankle brace will provide more support than an elastic slip-on brace.
   
• Distance- Lower extremity injuries are primarily related to training hours and the accumulation of excess miles, as well as rapidly increasing the intensity of exercise.

The following is a brief discussion of some of the common foot and ankle injuries.

Plantar Fasciitis
The plantar fascia is a tough band of fiber on the bottom of the foot. With increased training or standing at work for most of the day, that band of fiber can flatten and become inflamed. As you age, the fat that covers the heel can decrease, causing more trauma. Typically, the pain is worse in the morning after training the previous day, or after sitting for an extended period of time. The pain is located on the bottom of the heel and can extend slightly forward in some cases. To treat the problem, new shoes with adequate arch support, stretching the foot, and anti-inflammatory drugs are good treatment. If the pain persists, then a visit to your doctor can help.

Tendonitis
Tendonitis is another very common injury to those increasing their exercise routine. Many episodes of tendonitis occur in the ankle area, with one of the most common being Achilles tendonitis. These arise because of the multiple muscles from the calf, which have tendons crossing at the ankle. A covering over these tendons, called a tendon sheath, may experience inflammation as a result of repetitive activity or unaccustomed extra work, like running more. These can present as a mild to moderate aching pain over the affected area. There is also commonly pain with passive stretching of the tendon or with active ankle movement.

Shin Splints
In moving up the leg slightly, one can encounter another painful injury commonly referred to as shin splints or medial tibia stress syndrome. This generally refers to pain and discomfort of the lower leg following repetitive overuse. Initially symptoms are relieved with rest, but may become more constant in nature. Pain is commonly described as a dull ache that gradually worsens and is usually located on the inside portion of the shin just behind the tibia. Often it is diffuse in nature and difficult to localize. X-rays or other imaging studies may be necessary to differentiate this from stress fractures or other more serious conditions.

Stress Fractures
Stress fractures may occur in the tibia, fibula, or small bones of the foot. The pain is often similar to that of shin splints when located around the tibia. Treatment and prevention vary widely depending on where the stress fracture occurs. Most will heal by resting and changing the exercise routine to a non-impact type. If pain is not relieved by rest or is localized to one specific area, you should see your physician. Refer back to a recent article in January that was dedicated to stress fractures for more information on these injuries in particular.

Friction Blisters
Another very common cause of pain in new athletes is friction blisters. These may be caused from improperly fitting shoes, old shoes that are due to be replaced, or lack of proper cushioning from socks or insoles. Simply simply getting properly fitting shoes and breaking them in accordingly may avoid most friction blisters.

All of the above injuries can fall under the category of what are commonly called overuse injuries. Treatment for all may initially be conservative using rest, ice, wraps, and braces as needed. Anti-inflammatory medicines such as ibuprofen or naprosyn may also be helpful. As with any injury that is worsening or not improving with conservative treatment, consult your general physician or local sports medicine physician for aid to get you back to your training regimen.

Christian Millward MD, member AMSSM
David Cassat MD, member AMSSM
Utah Valley Family and Sports Medicine
Provo, Utah

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date: July 30, 2006