Running Injuries of the Foot and Ankle: Prevention and Treatment

Running offers plenty of health benefits, yet it also places considerable stress on the lower limbs, making foot injuries common among enthusiasts. From persistent to sharp ankle pain after running, these issues can potentially disrupt training and daily life. This blog post aims to shed light on the common foot and ankle injuries, emphasising the role of both prevention and management in ensuring an optimal return.

Common Foot and Ankle Injuries in Runners

Runners may encounter a range of injuries affecting the foot and ankle[1], possibly stemming from the repetitive impact and cumulative stress associated with the sport. Understanding these common ailments is the first step towards management and recovery.

• Ankle Sprains: A prevalent foot injury, an ankle sprain occurs when the ligaments supporting the ankle are stretched or torn, possibly from a sudden twist or roll of the foot. Symptoms often include immediate pain, swelling, bruising, and difficulty bearing weight.

• Plantar Fasciitis: Characterised by heel pain that is often worse in the morning or after periods of rest, plantar fasciitis[2] involves inflammation of the plantar fascia, the thick band of tissue running along the bottom of the foot. Repetitive strain from running is a primary contributor.

• Achilles Tendinopathy: This condition involves pain and stiffness in the Achilles tendon[3], the large tendon connecting the calf muscles to the heel bone. It often arises from overuse, sudden increases in training load, or inadequate recovery. The pain can be sharp or aching and may worsen during or after running.

• Stress Fractures: These are tiny cracks in the bone[4], most commonly found in the bones of the foot (e.g., metatarsals) or lower leg (tibia, fibula). They result from repetitive impact without adequate time for bone remodelling. The pain typically worsens with activity and eases with rest.

• Shin Splints (Medial Tibial Stress Syndrome): This term describes pain along the inner edge of the shin bone, often due to overuse of muscles and tendons that attach to the tibia. It is common in new runners or those increasing their mileage too quickly.

Biomechanical Factors and Footwear

Subtle biomechanical factors and your footwear may also affect your susceptibility to foot and ankle injuries. Understanding how your body moves and how your shoes interact with that movement is fundamental to injury prevention.

Your foot structure and gait pattern[5] can influence the forces transmitted through your lower limbs. For instance:

• Overpronation: This occurs when the foot rolls inward during the landing phase of your stride. While a degree of pronation is natural for shock absorption, overpronation can lead rotational forces up the kinetic chain, contributing to issues in the ankles, shins, knees, and even hips.

• Supination (Underpronation): Conversely, supination occurs when the foot rolls outward, offering less natural shock absorption. This can place increased stress on the outer ankle and foot, potentially leading to ankle problems.

• Pelvic Instability and Muscle Imbalances: Weakness in core muscles, hip abductors, or gluteals can lead to poor control of the pelvis and lower limbs during running. This instability can cause compensatory movements in the foot and ankle, increasing their workload and vulnerability. Similarly, limited flexibility in muscles like the calves or hamstrings can alter gait mechanics, placing undue stress on the foot and ankle.

Choosing the right running shoes based on your foot type, arch height, and gait pattern is also advisable. A professional gait analysis at a specialised running store or a physiotherapy clinic in Singapore can help assess your foot mechanics and recommend shoes that provide appropriate cushioning, support, or motion control.

For individuals with significant biomechanical imbalances or specific foot conditions, custom or off-the-shelf orthotics (insoles) can provide additional support and alignment. These devices help to redistribute pressure across the foot, improve shock absorption, and address gait irregularities.

Physiotherapy Treatment Approaches

Ankle sprains are a common musculoskeletal injury experienced by people of all ages and activity levels. From a simple misstep to a sports-related twist, a sprained ankle can lead to pain, swelling, and limited mobility. If you’re looking to get back into any activity, it’s advisable to understand the nature of ankle sprains to minimise potential recurrences.

Understanding Ankle Sprains

The ankle joint[1] is formed by the connection of bones in the lower leg (tibia and fibula) with a bone in the foot (talus). These bones are held together by strong ligaments, which are bands of connective tissue that provide stability and limit excessive movement.

However, when these ligaments are stretched beyond their capacity or torn, it may result in a sprained ankle. This usually happens when the foot twists, rolls, or turns awkwardly, forcing the ankle joint out of its normal position.

Ankle sprains are classified into grades[2] based on the type and severity of ligament damage:

• Grade 1: Mild sprain with stretching of the ligament fibres but no tear. Symptoms may include mild pain, swelling, and tenderness.
• Grade 2: Moderate sprain with a partial tear of the ligament. Symptoms may include moderate pain, swelling, tenderness, and some instability.
• Grade 3: Severe sprain with a complete tear of the ligament. Symptoms may include severe pain, swelling, tenderness, and marked instability.

The Importance of Early Intervention

Early intervention is key to addressing ankle sprains and setting the stage for a smoother recovery. Seeking prompt care, especially from a licensed and qualified physiotherapist, can influence the healing process. Here’s why early intervention is recommended:

• To help minimise inflammation and pain
• To prevent chronic instability
• To improve the range of motion
• To accelerate the healing process

Early intervention with physiotherapy for ankle pain can also help you regain function sooner and reduce the risk of long-term problems.

Physiotherapy Treatment for Ankle Sprains

Physiotherapy offers a comprehensive and individualised approach to addressing ankle sprains. When you visit a physiotherapy centre in Singapore, a sports injury specialist will conduct a thorough assessment to determine the severity of your sprain and recommend a treatment plan.

Common physiotherapy approaches for ankle sprains[3] include:

• RICE Protocol: In the initial stages, the RICE protocol (Rest, Ice, Compression, Elevation) may help address pain and swelling.
• Manual Therapy: Hands-on methods like soft tissue mobilisation may help manage pain levels and improve joint movement.
• Exercise Therapy: A tailored exercise programme can help improve ankle function and prevent recurrence. This may include strengthening, range of motion exercises, and balance training to help improve ankle stability and minimise potential sprains in the future.
• Proprioceptive Training: This specialised training may help improve your ankle’s awareness of its position in space, enhancing balance and coordination.
• Taping and Bracing: Taping or bracing may provide support and stability during the healing process and return to activity.