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Injury Prevention

Foot Injuries

Dr. Larry W. McDaniel, Matt Ihler, and Callin Haar discuss common


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There are a number of sports injuries that runners suffer and many of these
injuries may result from overuse. Other foot problems may be related to
chronic injuries that develop over a period of time. This paper will focus on a
number of common injuries suffered to the foot. According to Mike Walden, a
former teacher of sports injuries, sports massage, and sports science "the
average runner has between 37-56% risks of injury during the course of a
year's training." (Walden 2005)
The specific injuries that will be discussed include common runner's foot
injuries such as Plantar Fasciitis, Metatarsal Stress Fractures, Metatarsalgia,
Blisters, Turf toe, and Morton's Neuroma.


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Plantar Fasciitis is characterized by pain in the inferior heel or the origin of the
arch ligament when weight is placed on the foot. The pain is most commonly
felt at the attachment of the heel bone. Tenderness and swelling under the
heel may be associated with the injury.(Prentice 2006, page 541-543)

According to Buchbinder (2004) , Plantar Fasciitis is

not only the most common cause of pain in the inferior
heel, but is responsible for approximately 10% of all the
injuries in connection with running. In addition, Plantar
Fasciitis accounts for 11 to 15% of all foot symptoms
among adults requiring the care of a professional.
This injury is most commonly seen near the origin of the Plantar Fascia at the
medial tuberosity of the calcaneous. Plantar Fascia (Plantar Aponeurosis) is a
broad flat band of dense connective tissue that runs the entire length of the
sole of the foot. The non-elastic band of tissue connects proximally to the
medial surface of the calcaneous. The main function of this tissue is to provide
support to the foot and protect the longitudinal arch.
Plantar Fasciitis develops as a result of tension that occurs in the Plantar
Fascia during extension of the toes and depression of the longitudinal arch
during weight bearing activities. The development of Plantar Fasciitis is not
well understood, yet there may be several factors that play a role in the
development of the condition. Some of these factors include: obesity,
excessive pronation of the foot, heel spurs, prolonged periods of standing,
reduced ankle dorsiflexion, and high arches.
The individual usually experiences the most pain in the morning or with
increased activity over a period of time. The pain may subside as the foot
warms up, but may worsen during the day due to extended periods of

walking. Since Plantar Fasciitis is a frequent ailment among runners, it is

commonly assumed that it results from repetitive microtrauma. (Prentice
2006, page 541-543)


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Metatarsal Pain

Metatarsal stress fractures are common foot

injuries that occur most frequently in running and
jumping sports. This type of stress fracture may
be classified as an overuse injury. According to
Prentice and Arnheim (2005, page 325) , this
type of injury most commonly occurs because of
structural deformities in the foot, changes in
training surfaces, training errors, or wearing
inappropriate shoes.
Additional causes may include a sudden change in
training patterns, running hills, running on hard surfaces, or increasing the
amount of mileage the athlete runs.

As stated by Prentice Prentice (2006, page 544) , the most common type of
metatarsal stress fracture involves an injury to the shaft of the second
metatarsal. This particular injury is referred to as the March Fracture (such as
soldiers marching).Athletes that suffer from conditions such as flat foot,
structural foot Vargas, Hallux Valgus, or a short first metatarsal may be at an
increased risk for this type of injury or fracture. Another commonly seen
stress fracture affects the fifth metatarsal and takes place at the intersection
of the Peroneus Brevis Tendon. The athlete typically complains of tenderness
along the bone in the mid-foot.

Blisters are common among runners. Blisters are
formed by shearing forces or repetitive friction that
acts on the skin. Soft skin accompanied by the
shearing stress to the skin may produce a blister.
When this happens, fluid accumulates below or within
the outer skin layer known as the epidermis. The fluid
may be clear or bloody hence the name blood blister.
(Prentice 2005, page 331)
A superficial blister contains clear fluid compared to a
blood blister in which the deep tissue is disrupted, causing the rupture of
blood vessels. Blisters may cause runners a significant amount of pain if not
treated properly.
There are many preventative measures an athlete may take when it comes to
blisters. By applying a skin lubricant to the area of the skin where the
repetitive friction occurs, wearing correctly fitting shoes, and making sure
there are no wrinkles or folds in the socks that are worn may prevent the
development of blisters. In case of a friction area or hot spot, an athlete may
place a material known as second skin or a piece of moleskin on the hot spot
which reduces the amount of friction in the covered area.
The individual may also apply ice to the hot spots; these methods have
proven to be effective in the prevention and treatment of blisters. As a blister
forms, the athlete may complain of feeling a hot spot or a sharp burning
sensation in the area. The pain that is accompanied by a blister is due to the
accumulation of fluid and pressure it exerts on the nerve endings near the
skin. The application of ice may reduce the accumulation of fluid, reduce the
size of the hot spot, and relieve pain. (Prentice 2006, page 953)

An athlete who suffers from Metatarsalgia
complains of having pain at the distal portion of
the mid-foot directly over the ball of their foot.
(Orthopedic Institute)
Some of the primary causes of Metatarsalgia
Gastrocnemius and Soleus muscles, a fallen
metatarsal arch, or cavus deformity. This type of
injury results when the normal skin becomes
pinched against the inelastic callus; therefore, the
athlete experiences pain when placing weight on
the forefoot. (Prentice 2006, page 546)
Pain may occur during palpation and when running or jumping. (Orthopedic
Institute) The most common site of this injury takes place beneath the head
of the second and third metatarsals. A heavy callus may form in the area as a
result of the condition. The athlete experiences pain due to the flattening of
the transverse arch causing the depression of the heads of the second, third,
and fourth metatarsal bones. The symptoms associated with this condition are
increased with the mechanism of hyperextension. (Prentice 2006, page 546)


According to Prentice (Prentice 2006, page 546) , a

Morton's Neuroma usually takes place between the
heads of the third and fourth metatarsal and is the
most frequent nerve problem of the lower extremity.
This location is where the nerve is the thickest;
therefore, it receives branches from both the Medial
and Lateral Plantar Nerves. It is caused by the growth
of a nerve or Neuroma.
A Neuroma is defined as a mass that occurs in
relation to the nerve sheath of the common plantar
nerve at the point at where it separates into two
digital branches of the adjacent toes. The injury may
be characterized by the inability of the great toe to
Dorsiflexion. Severe pain starts from the distal metatarsal head, spreads to
the tips of the toes accompanied by burning numbness between or in the toes.
(Prentice 2005, page 329)
In addition, the collapse of the transverse arch may irritate the injury by
stretching the Transverse Metatarsal Ligaments and compressing the common
digital nerve and vessels. (Prentice 2006, page 548)

Turf toe is a hyperextension injury which results in a sprain to
the Metatarsophalangeal joint of the Great Toe commonly
known as the "big toe". This type of injury may result from
repetitive overuse or by an individual trauma to the foot.
(Prentice 2006, page 548)
The most common mechanism that causes Turf Toe is the
application of a downward force. Turf Toe accounts for more
than 80% of toe injuries. These injuries cause the Great Toe to
become Dorsiflexed beyond its biomechanical limits; therefore
resulting in a tear of the capsule. An athlete with Turf Toe may
experience a significant amount of pain and swelling around the injured joint.
(Prentice 2006, page 548)
As stated by the staff at the Orthopedic Institute, the pain occurs at the
Metatarsophalangeal joint where the big toe attaches to the foot. The amount
of pain increases when the athlete pushes off their foot. Pain may occur when
the foot is moved in extension or while running or jumping. (Orthopedic

Select this link to read the article where the authors discuss rehabilitation of
common foot injuries.

1. BUCHBINDER, R. (2004) Plantar Fasciitis. The New England Journal of
Medicine, 350 (21), p. 2159-2167.
2. Care and Prevention of Athletic Injuries (2006) Lecture presented at
Sports Medicine for Coaches Workshop 17th Nov, Orthopedic Institute
Sports Medicine Center, Sioux Falls, SD.
3. PRENTICE, W. and ARNHEIM, D. (2005) Essentials of Athletic Injury
Management (6th ed.). New York, NY: McGraw-Hill.
4. PRENTICE, W. (2006) Arnheim's Principles of Athletic Training: A
Competency-Based Approach, 12th ed.. New York, NY: McGraw-Hill.
5. WALDEN, M. (2005) Running Injuries. Update, 71, p. 24-27

If you quote information from this page in your work then the reference for
this page is:
McDANIEL, L. et al. (2009) Runner's Foot Injuries [WWW] Available
from: https://www.brianmac.co.uk/articles/article047.htm [Accessed

Dr. Larry McDaniel is an associate professor and advisor for the Exercise
Science program at Dakota State University, Madison, SD USA. He is a former
All-American in football and Hall of Fame athlete & coach.
Matt Ihler and Callin Haar are students enrolled in Exercise Science at Dakota
State University. Both are interested in careers related to Sport Medicine.

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