Foot And Ankle Injuries – Why And How to Prevent Them

The human foot is a masterpiece of engineering and a work of art – Leonardo da Vinci

The intricate structure of the foot is fascinating, each foot contains 26 bones, 33 joints, 107 ligaments and 19 muscles which means total one-fourth of all bones of the body is in our feet. With 2,50,000 sweat glands, the feet has a large concentration of sweat glands producing 500-600 ml of sweat every day.  This amazing biomechanical structure adapts to different surfaces and environments keeping us connected with the ground and helping us to move from place to place. The two feet carry the whole body weight and take the maximum pressure when we are standing, walking or running.

General strengthening of full body along with specific strengthening of legs are very important.

Good Running Practices (GRP)

Like a GMP (Good Manufacturing Practice), GRP is defined as Good Running Practices. A runner has to integrate Good Running Practices into his running and for that a runner should know about his body and how it works during the entire process of running. In the previous article, we discussed about running as an adapted skill, to achieve GRP, it is important to understand and correct our running practices. How to inculcate Good Running Practices will be dealt in a separate article, but here are some key points one needs to consider:

• A Running Cycle has four phases: Toe Off – Swing – Strike – Support. One should get a running gait analysis done through video filming in slow-motion from different angles and check interplay of body, its biomechanics, pressure points in different phases of running. One should know his/her running style and areas of improvement, so as to avoid stress, strain or injury. Take the help of a qualified professional or coach.

• Everyone should know about his/her pronation – neutral, under or over pronation – strike pattern forefoot, mid-foot or heel strike and support phase stability for optimum propulsion and running.

• Except for barefoot runners, selection of the right shoe is always a top priority. You can follow a principle of 3F – Fit, Feel and Function for selecting running shoes. Shoes should fit properly without any unwanted pressure, it should not be too big or too small, one should feel comfortable wearing shoes and most importantly it should be able to function properly. Some of the important functionalities include, toe box width, flexibility at toe area, volume of shoe vis-à-vis foot and shoe should be as per the surface one planned to run on as shoes differ depending on the running environment like track, train, road etc. Also during run, feet works more resulting in additional blood flow in the legs, this leads to expansion of feet. So buy shoes always in the evening and a half size bigger to ensure they will not be constricting the feet during long runs.

• Check the arch of feet, are they high, normal or flat. It’s an important indicator in case one requires orthotic support to achieve optimum running form.

• Apart from above points, one has to maintain healthy feet by regularly cutting toenails to prevent runner’s toe, moisturising feet every day to prevent dry, cracked skin or calluses and regularly massage the feet to relieve tension and keep up the mobility thereby reducing the risk of injury.

Once you know about your body, how your feet moves during different phases of running, where all you need a corrective action, you have set the stage for a satisfying and rewarding running life. Every good thing takes time so stick to the plan to achieve your best running version.

Running Injuries – Foot and Ankle
Injury/ ConditionWhyHow to Prevent and Treatment
Runner’s Toe
(Black Toenails)
Blackening of the toenails due to bleeding under the nail due to compression or bruising caused by unsupportive or improperly fitting shoes.Avoid too tight or too large shoes. Shoes should be able to adjust to swelling of feet during long run. Trim toenails regularly.It takes days or weeks to correct black toenails. There are fair chances of bacterial infection in black toenails, so one needs to be extra cautious to avoid any infection.Adjust the running schedule accordingly.
BlistersBlisters are caused by heat built-up from friction or pressure. Skin heats up and the outer layers separate, with fluid filling in the gap. Not a serious problem but blisters are painful and if left untreated, they may get infected.Keep skin moisturized, use petroleum jelly to avoid friction.Do not break blister. Keep it clean, wash with clean water and pat dry.Keep the blister covered with blister plaster for comfort.
CallusesCallus is an area of thickened skin that forms as a response to repeated friction, pressure, or other irritation.Generally formed under the ball of the foot, near big toe or around heel. Keep a track of the same.Treat calluses by soaking the foot in water for 10 to 15 minutes to help soften the callus and then gently file it down with pumice stone, do not file all the way down and never use blade or razor to cut the callus.
BunionBunion is a bony bump that forms on the joint at the base of your big toe. It causes the tip of big toe to get pulled toward the smaller toes and forces the joint at the base of the big toe to stick out.One can use toe spacers or bunion socks which helps in mild symptoms and help in realigning the big toe.Soft tissue massage to the medial foot and mobilization of joints.In severe cases, one can opt for surgery as a permanent solution.
Plantar FasciitisPlantar fascia is a thick band of tissues that support the foot arch. As running puts stress on the underside of the foot, which bends the toe joints, putting pressure on the heel end of the plantar fascia. This causes inflammation and damage to plantar fascia.Do exercises for strengthening plantar fascia. Rest and stop running to subside pain. Ice reduces swelling and taping, heel pads, orthotics, flexibility exercises are helpful in relieving symptoms. In severe cases, surgery is performed.
Achilles TendonAchilles tendon connects two big muscles of the calf gastrocnemius and soleus and attach them to the back of heel bone. Role of Achilles is to propel runner forward. Due to tight muscles and Achilles become inflamed, tear or rupture.Post run stretching to release tightness in calf will be helpful to avoid this. Followed by heel lift, oral anti-inflammatory, cross-training, strengthening and flexibility exercises. In severe cases of tendon rupture, surgery remains the only option.
Ankle Sprains / Ankle Ligament InjuriesAnkle sprain or ankle ligament injuries happened in the ligaments that surround and connect the bones of the leg to the foot. This type of injury happened by accidental twist or turn of ankle, resulting stretch can tear the ligaments that hold ankle bones and joints together.Follow the PRICE protocol. Always consult a doctor for ankle sprains. As ankle sprains are graded, so depending on the grade of ankle sprain the treatment will proceed. While Grade 1 resolves within a few days. Grade 2 sprain is severe and involve tear and healing with scar tissue. They are prone to re-injury. Grade 3 sprain is most severe with complete tear, creating unstable ankle and need surgical intervention.
Metatarsal Injury (Stress Fracture)Small cracks in the surface of bone due to stress and overuse. They generally happen in the weight bearing area and if left untreated, they can have fatal consequences.Training to be stopped and PRICE protocol to be followed. Orthotics or casting is required. Removing weight bearing from injured site for early recovery. Use metatarsal pads, using insoles or arch supports. Wear shoe with more cushioning.