Keep Your Feet Happy with Superfeet ADAPT Run Insoles

This post is sponsored by BabbleBoxx on behalf of Superfeet

Foot pain—one of the most common limiting issues, not just for runners, like me, but for anyone who spends much of the day on their feet. After all, the feet are what carry our entire body weight all day, so they are bound to take a beating. I’ve dealt with plantar fasciitis for over 10 years and I’ve tried all types of recovery tools. As a physical therapist, I’ve learned how it’s truly a combination of treatment strategies that helps manage foot problems.

After trying a variety of shoe insoles, I’ve had a hard time finding a pair that can comfortably fit in my sneakers without feeling tight. Most will end up digging into my heel and causing even more pain. Luckily I got my hands on a pair of Superfeet ADAPT Run Insoles, which are extremely thin and feel like they are barely there. The heel cup of the insole is cushioned, so instead of increasing pressure throughout the run, they actually help maximize energy by dispersing the impact with every step. This is important for runners because significant impact that is localized to just one point of the foot can lead to strains and other injuries higher up in the body such as patellofemoral pain syndrome (runner’s knee), IT band syndrome, and low back pain.

My other favorite part about the Superfeet Run Insoles is the flexibility, which moves with the foot from heel to toe, so it doesn’t limit pace when I want to run fast. I’ve tried countless insoles that feel extremely stiff, making it hard for your foot to move naturally through the running cycle. The Adaptive Comfort Technology of these allows them to bend sufficiently to assist with push-off and have a good amount of cushioning at the balls of the feet. After using these for several runs, I noticed my foot joints were much less achy post-run thanks to the dispersion of the overall impact and cushioning at the right places.

The ADAPT Run Insoles are also made with the best materials when it comes to running. MoistureWick™ does an amazing job during these hot and humid summer months to help keep your feet dry, which is ideal to prevent blisters and odor. I’ve had to avoid wearing other insoles while running because of the lack of odor and moisture control, so I am happy I found this perfect pair for my injury-prone feet! If you’re looking for a comfortably light insole that you can wear with any shoe, including zero-drop styles, AND a pair you can wear right away without breaking in, I highly recommend Superfeet ADAPT Run Insoles!

Feeling Sore Days After an Intense Workout? It's Probably DOMS. Here's How To Beat It

Soreness can be a sign of a good workout, but not all soreness is a good thing. When you first begin an exercise program or get back into it after a long break, experiencing a bit of muscle pain later that day or the next is normal. This specific pain should not be so uncomfortable that it limits being able to move around as usual and should subside within a day or so. If the soreness causes you to not be able to lift your arms or go downstairs without severe pain, and lasts longer than two days, your workout may have caused delayed onset muscle soreness (DOMS for short).

Causes and Symptoms

Typically, delayed onset muscle soreness begins within 8 to 12 hours after intense exercise and peaks to its worst symptoms at 24 to 48 hours. The pain from DOMS subsides by around 72 hours, but may last longer for some individuals. This pain is normally felt with active movement and stretching the muscles. Along with muscle pain, other symptoms that come along with DOMS are a temporary loss in muscle strength, decreased range of motion, and possibly swelling in the muscles involved in the exercise. The sore muscles may feel as if “bruised” when touched with light pressure. This combination of symptoms may even last up to 10 to 14 days in severe cases.

What exactly is the “intense exercise” that can causes DOMS? Studies show that the usual type of exercise that causes this condition is eccentric movements, which is when the muscles lengthen during the contraction (think: the movement on the way down from performing a bicep curl). Although this is the most common exercise to cause DOMS, many other forms of workouts can lead to this intense soreness, such as running downhill, high intensity sprinting or plyometrics, and heavy weight lifting. Most of the time, this condition arises after performing new exercises at too high of an intensity that the body is not used to.

What Exactly is DOMS?

In the past, it was believed that delayed onset muscle soreness was the result of the so-called lactic acid buildup in the muscles during exercise. This buildup occurs during any exercise, but returns to normal levels as soon as an hour after the completion of the workout. Therefore, DOMS is not related to the lactic acid accumulation in muscle that occurs during physical activity. Unaccustomed eccentric exercises cause damage beginning at the muscle’s cell membrane, which results in inflammation that expands out to the entire muscle and surrounding areas, creating metabolic waste. This waste product stimulates the nerves surrounding the muscles causing pain. Keep in mind this type of damage occurs with certain forms of exercise as explained above, not with all exercise as with the regular lactic acid buildup.

Treatment

Although the first line of defense used when feeling this kind if pain is to take an anti-inflammatory pill, it may not be the best option. This route may help ease symptoms in most cases, but is shown to have the unattractive side effects of stomach issues and can eventually lead to poor healing capabilities in the future. The best initial treatment options are rest and ice—which is a safe, natural anti-inflammatory agent. Another go-to pain reliever sought out by most athletes is massage. Gentle massage helps ease DOMS pain, swelling and tightness in most individuals, reducing the severity and duration of symptoms. Massage has been shown to help decrease the compound in our muscles that causes inflammation. Deep tissue massage that is typically used by athletes for tight muscles is not advised for this condition due to the intense pressure that may exacerbate the pain.

Another helpful treatment option is light exercise such as cycling, pool exercises, and gentle stretching. These approaches will help maintain good circulation and keep the muscles warm to be more prepared for the addition of intense exercise once the DOMS has subsided. Intense exercise, especially the type of workout that initially caused the pain, should be avoided, as one of the symptoms of DOMS is a temporary muscle weakness. This decrease in strength causes delayed shock absorption, which can lead to injuries such as a muscle strain or tear.

Prevention

Performing a proper warm-up before any exercise is the first thing that should be done to prevent delayed onset muscle soreness. A warm-up, as in its name, basically increases the temperature of muscle, which improves its elasticity, making it more resilient to tearing. The effects of a proper warm-up lead to improved muscle contractions and better performance during the workout. Research states that warming up for an eccentric-type workout with concentric moves is effective in helping prevent DOMS. A good warm-up for running consists of more dynamic moves such as walking lunges, legs swings, and military marches. Static stretches, where you hold a fixed position for several seconds is not recommended, as this will cause muscles to elongate and remain in a more relaxed state. Save these for after your run.

If you are beginning a running or exercise program for the first time or after a long break, it is advisable to gradually ease into the intensity and make sure to include that warm-up. It is important to note the difference between DOMS and other causes of muscle pain. If you are experiencing pain during a specific exercise, it is most likely due to improper form, a muscle strain, or other injury. DOMS symptoms occur between 8 and 12 hours after the completion of exercise. You are able to perform lower intensity exercises with DOMS without continued muscle damage, whereas with a muscle strain, further exercise will continue to impair the muscle.

DOMS is not necessarily a bad condition since it involves a natural effect of new exercise, but it should be avoided when possible as it prevents any higher intensity exercise to be performed for several days or weeks. If you want to go “all-out” during your track day with brand new sprint intervals that you have never done, and you develop DOMS, expect to not be able to get your long run done even if it is a couple of days after the track workout. A good rule of thumb when increasing intensity of your workout program is to increase sets, reps, resistance, or mileage by only 10% or less each week. This is the safest way to help prevent the unwanted limitations of DOMS.

Sources

Miles MP, Clarkson PM, Exercise-induced Muscle Pain, Soreness, and Cramps, Journal, May 6, 2020.

Connolly D, Sayers SP, McHugh MP,Treatment and Prevention of Delayed Onset Muscle Soreness, Journal, May 6, 2020.

Zainab Zainuddin, Mike Newton, Paul Sacco, Kazunori Nosaka, Effects of Massage on Delayed-Onset Muscle Soreness, Swelling, and Recovery of Muscle Function, Journal, May 6, 2020.

Running & Rehab: Peroneal Tendon Injuries

A true runner without a history of pain or injuries is one in a million. The constant pounding on the ground through all of the joints in the body is bound to put stress on some area of weakness and eventually cause discomfort. If you have searched for the most common running related injuries or pain, you have probably come across knee or IT band issues. The ankle and foot are almost, if not just as common as those two. It makes sense why—the feet take on the most pressure during running since they carry our entire body weight throughout the running cycle. Foot structure and deformities are one of the main reasons injuries to this body part occur. Unfortunately once you injure the foot or ankle once, you are prone to getting injured again, especially if you do not take care of the cause.

Besides foot structure, general ankle instability is a problem for runners, causing a large percentage of traumatic injuries such as sprains and tears, as well as overuse injuries and pain like plantar fasciitis and tendonitis. An overlooked and often misdiagnosed issue is peroneal tendon dysfunction. The two peroneal tendons run along the outer side of the lower leg, one connecting to the side of the foot and the other underneath the foot. These tendons are responsible for eversion of the foot, which is the movement of rotating the foot out to the side. It is quite common for peroneal tendon issues to be mistaken for ligament injuries (sprains). Understanding the causes and how to address instability is key to full recovery from and prevention of peroneal tendon dysfunction.

Types of Peroneal Injuries

Tendonitis

This diagnosis presents itself with inflammation in one or both tendons and is usually caused by activities that involve repetitive overuse of the peroneal tendons. Trauma, such as an ankle sprain, can also cause tendonitis since when rolling the ankle the tendons must powerfully try to control from rolling too far. Pain is normally felt behind or underneath the outer ankle bone during activity, and subsides with rest. Treatment involves using anti-inflammatory pain medication, rest, and activity modifications. If the tendonitis is severe, immobilization for four to six weeks in a walking boot may be necessary.

Dislocation

Also called ‘subluxation’, this injury consists of the tendons snapping out of place over the outer ankle bone. There is a sheath that holds the tendons in place at all times that may tear with traumatic events and cause this dislocation. Already present deformities such a shallow or nonexistent groove where the tendons lie or a loose sheath to begin with can also be the cause. After the initial trauma, it may be difficulty to diagnose this issue since there is subsequent inflammation throughout the entire joint. The snapping is felt during forceful dorsiflexion and inversion, or flexing the ankle joint upwards as if raising the toes while rotating the foot inwards. Runners will feel the snapping during the push-off phase of running since it is a forceful movement from heel strike or a neutral position to pointing the toes downward.

Treatment for initial encounter subluxations can and should be treated conservatively with rest, immobilization in a cast or boot, and anti-inflammatory medications. For injuries involving a tear of the sheath, chronic dislocations due to ankle deformities, or failed conservative treatment, surgery will be the only option to repair the cause. After surgical repair, physical therapy will be necessary to manage pain and inflammation and restore motion and strength. Individuals who experience chronic dislocations of the peroneal tendons should seek treatment as soon as possible as this consistent snapping can lead to tears.

Tendon Tears

This peroneal tendon diagnosis can be a result of an acute traumatic injury such as a severe ankle sprain. Chronic issues such as consistent dislocations or weakness and instability in the ankle joint can also cause tears by means of overuse leading to fraying and splitting of the tendon. Individuals with high arches are more prone to this type of overuse and should consider using arch support orthotics in their shoes especially for running and other high impact sports. Surgery is usually required to repair the torn tendon, followed by immobilization and physical therapy.

Ankle and Foot Strengthening

Since instability and weakness are a main cause of most foot and ankle issues in runners, it makes sense to incorporate direct strengthening exercises for these areas. A simple strategy is to perform a few before an easy run about three times per week. Resistance bands can be used to target the main movements of the ankle as shown below. Heel and toe raises will also strengthen the calves and dorsiflexors (muscles along the shins). The smaller muscles of the foot can be strengthened with toe curls using a towel on the floor and trying to pick it up with your toes for up to ten repetitions for two to three sets. More advanced exercises consist of using unstable surfaces such as a balance disc or foam mat to perform exercises.

Ankle pain and instability is often diagnosed as a sprain, especially if there was a trauma. It is important to keep in mind that sprains can also involve tendon injuries. If you are diagnosed with a lateral ankle sprain and have done all treatment correctly but continue to have pain, the next step should be to follow-up with your doctor to check for any peroneal tendon injuries. Most cases with minimal symptoms do well with conservative management. Unfortunately if there is a greater loss of function, especially for athletes who want to continue their demanding sport, surgery may be necessary. As mentioned above, the foot and ankle joints are very important for runners, therefore any instability or weakness should be taken care of to avoid injury. If not taken are of, foot problems tend to lead to issues in higher joints such as the knee, hip and back. It is useful to remember that healthy feet leads to healthy running!

Sources

Kinner Davda, Karan Malhotra, Paul O’Donnell, Dishan Singh, and Nicholas Cullen, Peroneal Tendon Disorders, Journal, Apr 28, 2020.

Awkward Tightness in the Legs? It May Be Compartment Syndrome

The most common area of the body in which runners complain of pain is the lower leg. Of course when you think about the mechanics of running, the lower leg receives the majority of the impact since it carries the most weight throughout the running cycle. This is why conditions such as knee pain, and more commonly plantar fasciitis are frequent. One of the more misdiagnosed conditions seen in recreational runners and elite athletes is chronic exertional compartment syndrome (CECS). During exercise blood flow increases and muscles expand. The pain from CECS is felt when the lower leg areas become swollen during exercise, if the fascia, which is basically a sheath that wraps around the muscles, does not expand with the muscles.

Symptoms

The type of pain usually felt with CECS is aching or burning in a specific area of the lower leg that begins at a certain time after beginning activity. Most commonly, the pain occurs in both legs and either in the posterior compartment (calves) or anterior compartment (shins). Along with pain, numbness or tingling, as well as tightness can be felt that worsens as you continue the exercise. These symptoms usually subside within 10 to 20 minutes after stopping the activity.

Differential Diagnosis

The reason this condition is misdiagnosed is because it resembles other more common conditions such as shin splints and tibial stress fractures. Shin splints are caused by overuse of the muscles connected to the shin bone, causing small tears which result in the muscle being “pulled” off the bone. The pain from shin splints is felt along most of the shin bone, whereas a tibial stress fracture is felt at a localized point in the bone. Both of these conditions, along with CECS, result in pain in similar areas and are usually caused by either improper biomechanics or overuse from adding mileage or intensity too soon during training.

If you are experiencing pain during exertion, especially if it begins within the first 10 to 20 minutes of a run and relieves within 10 to 20 minutes after stopping, get evaluated by a professional. If along with the pain is a sensation of significant tightness in the lower legs, CECS is most likely expected. An MRI will help rule out specific muscular issues. There are newer, more advanced MRI exams that can assess how much fluid accumulation there is in the compartments of the lower leg during activity, which has been found to be accurate in diagnosing CECS. It may limit the need to use the more invasive approach of diagnosing which is compartment pressure testing where needles are inserted into the muscles to evaluate the amount of pressure present.

Treatment

The goal of treating CECS is to relieve the pressure in the affected compartment during exertion. Unfortunately, the first step in treatment is avoiding aggravating activities, such as running. Doctors may prescribe NSAIDs and an icing regimen to help decrease the inflammation. During this rest time from activity, it is effective to include techniques to keep the muscles and fascia flexible such as massage and stretching. Once the symptoms are more controlled, it is important to ease back into running VERY gradually to be able to monitor returning symptoms. As you do this, strengthening all lower leg muscles, including the feet, should be incorporated.

Calf stretching should include performing with the knee straight, to stretch the outer muscles, and bent to stretch the deep soleus muscle.

The simplest way to keep the anterior dorsiflexors (along the shin) loose, is to use the foam roller or other deep tissue massager.

The first exercise most athletes include for the lower leg are basic heel raises. As mentioned above, the calves also include a deeper muscle called the Soleus, that often lacks sufficient strength. You can target these muscles by performing the heel raise exercise with a bent knee, or sitting adding weight to your lap.

Weakness in the ankle and foot may also contribute to lower leg issues. To target these ankle and foot stabilizers, using a resistance band is effective. Other exercises include single leg standing on a stable and unstable surface such as a foam mat or balance disc.

Unfortunately, in the majority of the more severe cases, a surgical procedure, called a fasciotomy, is required. Basically the fascia itself is cut open to relieve the tension in order to allow normal blood flow and muscle expansion to cause less pressure during activity. The recovery time after this procedure is quite short and allows athletes to return to their sport within 6 to 12 weeks. Post-surgical rehabilitation requires the same treatment as the conservative approach mentioned above.

Prevention & Maintenance

Biomechanics, or running form, is commonly blamed for lower leg dysfunction, such as CECS. Research has been done on evaluating foot strike patterns in runners and how these patterns may cause mechanical issues in joints from the lower leg to the hip and spine. When one uses the heel strike for landing during running, the anterior compartment muscles, the dorsiflexors, must act eccentrically to control the foot from slapping onto the ground with every step. This causes overuse and inflammation in the area. Many studies have evaluated the outcome of changing this foot strike pattern to a mid-foot or forefoot landing, and have concluded that this may help control and even resolve CECS. This is a change that should be done gradually, such as beginning with 5 minutes of forefoot strike in a single run and adding 5 minutes every few runs.

Another prevention option is running with shoes and/or orthotics that limit pronation of the foot. Overpronating requires even more work for the dorsiflexor muscles and causes increased tightness to the entire lower leg compartment muscles.

The exercises mentioned above should be incorporated to help prevent CECS and other lower leg dysfunction, as many times weakness and inflexibility are the cause. If you have been diagnosed with CECS or are experiencing symptoms, make sure to back off of the aggravating activities and always ease back into it during recovery. Seek medical advice if symptoms do not resolve or become severe. Remember, the quicker you take care of your pain, the quicker you will be back to doing what you love.

Sources

Tucker, Alicia K, Chronic Exertional Compartment Syndrome of the Leg, Current Reviews in Musculoskeletal Medicine, April 2, 2020.

Gallo, Robert A., Michael Plakke, and Matthew L. Silvis, Common Leg Injuries of Long-Distance Runners: Anatomical and Biomechanical Approach, Sports Health, April 2, 2020.

Gibson, Alexander, Chronic Exertional Compartment Syndrome and Forefoot Striking: A Case Study, International Journal of Athletic Therapy & Training, April 2, 2020.