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Foot pain in runners - A quick guide

Updated: Dec 6, 2021

Foot pain in runners can present in two ways. It can develop suddenly e.g. you go over on your ankle or you feel a sudden sharp pain while running – also known as traumatic injuries. They can also develop slowly over time and the cause for this type of injury is often not that clear. In this article we're going to focus on the second group of foot injuries – the ones that seem to develop for no apparent reason. We'll also share the top three treatments that we find work best for treating each of these foot injuries. Remember, if you need more help with an injury you're welcome to consult our team of sports physios via video call.

Foot pain in runners: A quick guide to the diagnosis and treatment.

In this article:

We've also discussed this topic in this video:

Pain on the outside of the foot


Pain on the outside of the foot can be Peroneal tendinopathy, Sinus tarsi syndrome or a stress fracture.

Sinus tarsi syndrome

Despite its impressive name this condition is more painful than harmful. It is caused by chronic inflammation in the soft lining of the ankle joint.


The pain is usually located  just in front of the lateral malleolus (ankle bone), in a very similar place to where your ankle ligaments run and it often gets mistaken for a ligament sprain.


Here's a video where we discuss Sinus Tarsi Syndrome in a lot more detail:



Causes:

It often develops after you’ve sprained your ankle. Ankle ligaments usually take about 8 to 12 weeks to heal so if your pain continues for longer than 12 weeks, sinus tarsi syndrome may be to blame.


Another common cause is if your foot rolls in excessively (over-pronation) when you walk or run. When this happens you tend to squash the outside of the ankle joint which can cause it to flare up. Some of the most common things that can cause your foot to roll in too much include muscle weakness around your ankle or hips, wearing trainers that are too soft or running on a camber.


Our top 3 fixes:

The main goal with treatment is to improve the foot’s position and stop it from rolling in excessively while walking and running. You can achieve this through:

  1. Wearing supportive shoes ALL DAY LONG. This injury may have been caused by running, but if you want it to recover you’ll have to look after it throughout the day.

  2. We usually also prescribe supportive insoles for our patients (see examples below). In severe cases they may even benefit from wearing an ankle brace for 4 to 6 weeks while we strengthen up the muscles. Again, the aim of this is to stop the foot from rolling in.

  3. Foot arch strengthening exercises as well as strengthening the stability muscles around the hips are important to prevent this from recurring.

You can find a more detailed discussion about the treatment of sinus tarsi syndrome here.



Peroneal Tendinopathy

Your peroneal muscles run along the outside of your lower leg. Their main function is to turn your foot out. Their tendons wrap around the back of the bone on the outside of your ankle. If these guys are to blame for your foot pain, you’ll often feel the pain over the outside of the foot – below the ankle bone or towards the outside border of the foot.


Here's a video where we discuss Peroneal Tendinopathy in a lot more detail:



Causes:

The main cause for this type of injury is usually something that makes your foot roll out more (excessive supination) while running.


Our top 3 fixes:

  1. Check your running shoes – is it time to lay them to rest and get a new pair?

  2. How tight are your calves? Tight calves (especially soleus) can make your peroneal muscles take more strain.

  3. Have you been running on cambers that made your foot roll out more? Change your running route so that you run on the flat.

You can find more information about the treatment of peroneal tendinopathy here.


Pain on the inside of the foot


Pain on the inside of the foot can be tibialis posterior tendinopathy.

Tibialis Posterior tendinopathy


Your Tibialis Posterior muscles (Tib Post) is one of the main muscles that support your arch and stop your foot from rolling in or pronating excessively. Tib Post tendinopathy causes pain on the inside of the heel and along the inside of your foot’s arch. The muscle belly of the Tib Post lies in your calf and it can sometimes even produce pain along the inside of your shin bone.


Here's a video where we discuss Tib Post Tendinopathy in a lot more detail:



Causes:

The main cause of Tib Post tendinopathy in runners is when your foot rolls in too much while running (over-pronates). As mentioned above, over-pronation can be caused by several different things including the wrong running shoes, lots of downhill running, muscles weakness around the ankle or higher up in the leg etc.


Our top 3 fixes:

  1. Check your running shoes (starting to see a pattern here??) – are they too soft or are they worn out? Do they provide enough support?

  2. Use supportive insoles or orthotics to take some of the strain off the Tib Post tendons. (See examples below)

  3. Strengthen your muscles in your foot and ankle as well as the stability muscles around your hips.

Here are some examples of supportive insoles that we found on Amazon – similar to the ones we use in clinic:



You can find more information about the treatment for tibialis posterior tendinopathy here.

Pain over the front of the ankle


Pain over the top of the foot can be Tibialis anterior tendinopathy or Morton's neuroma

Tibialis Anterior tendinopathy

This tendon runs down the front of the ankle joint and wraps around the inside of the foot. It flexes your foot upward but also helps to stop your foot from rolling in too much. If the pain in your foot is coming from this tendon, you usually feel it in the area where your foot joins your ankle.


Causes:

The number one cause for Tib Ant tendinopathy that we see in clinic is when runners tie their laces too tight, causing the tendon to rub as they run. Running in shoes that are a lot heavier or doing a lot of downhill running can also cause the Tib Ant to flare up.


Our top 3 fixes:

  1. Check if your shoelaces are a problem. You may have to tie them extremely loosely to help your tendon recover. I caused mine to flare up while hiking in Scotland a few months back and it took about 4 weeks of careful management before it settled down again.

  2. If you’ve recently changed running shoes you may have to check that they’re not too heavy.

  3. Check if it’s better if you run on flatter terrain for a while.


Pain under your heel


Plantar Fasciitis

We’ve previously written a whole series of blog posts on how to treat this pesky problem, but here are the highlights. The plantar fascia is a thick fibrous band of tissue that runs from your heel to your toes. Its main function is to support your foot’s arch and stop it from collapsing when you put weight on it. Plantar fasciitis is essentially an overuse injury that develops when you strain the plantar fascia where it attaches to the heel bone. It can be extremely painful and stop you from running and walking.


Here's a video where we discuss Plantar Fasciitis in a lot more detail:



Causes:

Anything that puts extra strain on the plantar fascia e.g. unsupportive shoes, gaining weight, upping your running distance or intensity too dramatically. We’ve explained the causes of plantar fasciitis in more detail before.


Our top 3 fixes:

  1. Wear supportive shoes with arch support inserts ALL THE TIME. You may have developed this injury through running, but you will have to nurse it all day long if you want to make a quick recovery.

  2. Identify what’s making it worse and try to avoid it while you strengthen your foot arch and other leg muscles.

  3. Do not go back to running too soon. You should have at least 4 pain free weeks and be able to walk 10km pain free (and without pain the next day) before you go back to running.

Read the complete guide to treating Plantar Fasciitis here.

Pain under the foot can be Plantar fasciitis or metatarsalgia.

Pain in the front of your foot


Metatarsalgia

This is pain under the ball of your foot. Our patients often also describe it as feeling as if they are walking on a pebble. It is caused by inflammation in the little joints where your toes attaches to your foot.


We've also made a video where we discuss the treatment of metatarsalgia in more detail: