It makes sense that foot problems are as common as any other issue in runners since it’s the body part that carries the most weight. It’s the first point of impact, too, so you can imagine how it looks on the inside with the dozens of components that make up just one foot. Yikes! Well, plantar fasciitis is on the top of the list of common running injuries and usually the most frustrating one to deal with. Read on to learn more about how I healed mine for good.
Read moreRun Fast and Recover Faster with Apolla Performance Socks
From racing shoes to headlamps and everything in between, runners can be quite picky about their gear. As time goes on and technology advances, runners want the best of the best to be able to perform well, stay away from injury, and recover as fast as possible. Believe it or not, socks play a significant role in foot health for athletes. They are not just made to add a layer of cushion in between the skin and shoe seams. They can provide the feet, and pretty much every joint up the body, with support and injury prevention no matter what your lifestyle dictates.
Comfort is Always Number One
The first thing we aim for when picking out any piece of an outfit, shoes, or socks, is comfort. Runners, in particular, don’t care as much about looks, as long as they can feel comfortable on their long runs and avoid issues like achy joints, blisters, and heaviness. This all can be solved with a good pair of socks. In comes Apolla Performance. Initially created for dancers, who we can all agree get the most beating to their feet, these styles are equally perfect for any lifestyle. Just recently a research study concluded their effectiveness in reducing force and received the American Podiatric Medical Association Seal of Acceptance.
Apolla Performance socks are all made in the USA with REPREVE, which is certified sustainable yarn. Runners are sure to be happy with the Amp (no-show), the Performance (crew), and the Infinite (mid-calf), since they all provide the perfect thickness to protect from impact, blisters, and moisture, without feeling suffocated in running shoes. Each has energy absorption padding in the heel and ball of the foot which helps cushion during both push-off and landing—the parts of the running cycle that damage the feet the most. If you suffer from plantar fasciitis, you will be grateful for this feature!
Instability is the Enemy
As a physical therapist, I am an advocate for creating the most stable surface during the running cycle. This means being extra picky about the shoes and socks you wear. Weak, overused, or tired ankle and foot muscles can lead to ankle rolls and strains in the tiny muscles of the foot from the constant work when your foot and ankle are not supported well. Apolla Performance socks are made with targeted high compression where you need it the most—around the ankle joint and the arch of the foot. The arch actually has three zones of compression to lift and stabilize, which makes a significant difference if you suffer from plantar fascia issues. In these cases you want to prevent your arch from getting too stretched out, which will end up tugging on your heel bone. It’s a tough condition to treat, so you want to do anything you can to avoid too much pressure to this area!
Work Hard, Recover Harder
The mid-calf Infinite Sock from Apolla Performance is the best choice for both recovery runs and your rest days. Providing your feet and lower legs with compressive support is ideal to help with circulation—the key to recovering faster. This is best done with graduated compression up the calf, which is exactly what this pair provides. Using compression socks during and after runs, especially speed workouts and long runs, is ideal for those suffering from achy calves, shin splints, Achilles tendinitis, and any other foot and ankle conditions. You want good blood flow and comfortable cushioning if you want to be fully ready for your next workout. If you are looking for happy and healthy feet, Apolla Performance has you covered!
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.
Balance Training: A Key to Injury-Free Running
Most runners are primarily focused on improving their endurance and speed during their training cycles. Strength and flexibility are usually a secondary focus, especially if the runner has had a history of an injury and has been educated on the importance of these components. Balance training, on the other hand, seems to be of less importance to runners. In general, balance declines as we get older—by up to 75% by the time we are 75 years old. This is why older people are prone to falls, which is currently the leading cause of injury and death in the geriatric population. Balance is fundamentally the skill of keeping the body aligned and upright by reacting to changes in our center of mass at all times. Taking this definition into consideration, it seems balance should also be a primary focus during training, since after all, running is basically a one-legged balancing act.
Balance is (Almost) Everything
Most people will think of running as an activity involving a push-off phase, forward propulsion, and a landing. These are all most definitely parts of the running cycle, but about 50% of running is an action of falling forward. Thankfully, we developed the ability at an early age to stabilize ourselves against falling while running. This natural reaction gets harder to control as we run longer and faster, since the muscles in charge of this action get fatigued. And if running straight with no disruptions gets harder to control when we are tired, then the task of maintaining our balance is that much more difficult when having to make a sharp turn, stepping over uneven surface, or having to make a sudden stop to avoid a collision with a person or object. Improving our body’s balance directly will not only improve running form and posture, but it will also decrease injury risk and pain.
How to Train Balance
Balance is controlled by proprioceptors in our muscles and joints, which are basically tiny sensory nerves that can anticipate changes in our body’s center of mass. When we step on a pebble that causes a loss of balance, the proprioceptors fire this sensation to our muscles, so that they can react as quickly as possible to stabilize our joints and avoid a fall. For the case of running, the main proprioceptors to focus on when working on balance training are the ones located in the feet, ankles, and hips. It is always best to start working from the ground up as the feet and ankles are the first to sense any position changes from running on uneven surface, for example.
Exercise (and Run) Barefoot
One theory of why Kenyans are one of the fastest and most efficient runners is because they grew up walking and running barefoot on uneven terrain, therefore constantly strengthening their proprioceptors and intrinsic foot muscles that control balance. This enables these runners to devote the majority of their energy to forward propulsion while running. Unlike the Kenyans, most of us have grown up running in some good-looking shoes with excellent support and cushioning. On top of that, we opt for road running when training for a marathon. This means we leave our proprioceptors pretty quiet during our entire run. The only time those nerve receptors are active is when there is a sudden change in our position that we are not prepared for.
Strengthen Balance Muscles
A part of every runner’s strengthening program should include core, hip, ankle, and foot exercises. Most of us occasionally incorporate upper leg strengthening, which is important, but often forget to directly strengthen the joints and muscles below. The foot and ankle joint are probably one of the most important body parts for runners, as they carry the entire weight of the body at all times. The feet absorb the initial impact of striking the ground, which makes them extremely vulnerable to injury.
Easy exercises to work the ankle stabilizers can be done with resistance bands, strengthening the four main movements of the joint. For the intrinsic muscles of the feet, towel curls are an effective strengthening exercise. Place a small towel on the floor and try to pick it up with your toes for 10 to 15 repetitions at a time.
Simple exercises for strengthening the hip stabilizers can also be done with resistance bands such as clamshells, bridges, standing legs lifts, and lateral squat walks. All of these moves can be done without the bands, along with bodyweight squats, step-ups, lunges, and heel raises. Isolating one leg at a time is also useful, especially if you have experienced a one-sided injury or low back pain in the past. Incorporating a handful of these moves before or after runs is the easiest way to make sure to get them in.
Uneven Surface Training
One of the most effective ways to challenge your balance muscles and proprioceptors further is to perform lower and upper body exercises standing on a wobble board, balance disc, foam mat, or other unstable surface. This will help work the ankle and hip stabilizers, intrinsic foot muscles, and the entire core all at once. As mentioned above, most runners training for marathons limit their runs to the road. Trail running is a beneficial way to strengthen the proprioceptors as you constantly challenge the joints and muscles with the varying terrain.
Keep in mind the reasoning for emphasizing balance training along with your regular marathon preparation. Good balance will help relax the body more while running, leading to better posture and less tension when fatigued. This means less energy wasted and more to use for the push-off phase and increasing speed. Keeping these specific muscle groups and proprioceptors strong will ultimately make you a better runner by allowing your legs to effortlessly move faster, while lowering your chances of injury and pain.
Sources
Scott Mullen, MD, Jon Cotton, MD, Megan Bechtold, DPT, and E. Bruce Toby, MD, Barefoot Running: The Effects of an 8-Week Barefoot Training Program, Journal, Nov 4, 2019.
Anna Brachman, Anna Kamieniarz, Justyna Michalska, Michał Pawłowski, Kajetan J. Słomka, and Grzegorz Juras, Balance Training Programs in Athletes – a Systematic Review, Journal, Nov 4, 2019.
Shoe Review: 361 Degrees Meraki 2
Sponsored by Zappos
All opinions are my own.
As a runner who loves to pack on the miles every week, I am always looking for shoes that not only help me run fast, but are also supportive and cushioned enough to protect my feet. You’ve probably heard all about how important it is to rotate through different types of shoes throughout your training, so you may have one pair specifically for speed work, one for long runs, and one for the rest of your miles. Well, it is actually hard to find a pair that is good for every type of run anyway. Luckily I was able to try out the 361 Degrees Meraki 2 from Zappos, because I absolutely loved them for every single type of run!
I know ordering shoes online is scary, because you may be unsure of the size and fit you are getting or if you even like them in person. The good news is that you don’t have to worry any of this when ordering from Zappos because as a Zappos Rewards member, you get to return them for free (with a 365 day return policy!) and then you can pick out another pair from their extra large selection of styles. Customer service is also 24/7 and they are very knowledge about their products so you can ask all about the shoes you want and be sure to get the right pair.
I am used to wearing a bulky, super cushioned pair of shoes for my every day mileage, and a very unsupportive, yet springy, pair for my track days and speed work. Although I feel protected in the bulky ones and fast in the light pair, I have always wanted to have an all-around shoe—and that’s exactly what the Meraki is about. So far I have tested them out for a tempo run, all of my easy runs, an interval session on the track, and my grueling Saturday 17-miler. Continue on if you are intrigued to know the outcome.
Supportive AND Stylish
Unfortunately, in my opinion, most supportive and cushioned shoes out there are heavy and unattractive—they make me look like I am wearing boats on my feet! Since I cap out shoe mileage very quickly I end up not caring as much about the look. Now that I know there is such a thing as cute AND well-cushioned shoes, I will never go back to an ugly pair again! The Meraki are made with a light, mesh upper that gives it a sleek fit, rather that using a ton of padding to “hug” the foot. The technology behind the fit includes Fitz-Rite both in the outer and inner part of the shoes, which is what secures the foot in place. My foot felt just has protected with this light construction than with any other bulky pair I have used in the past.
Meraki is Fast
What is responsiveness? Well, it is basically when the shoe provides a return in energy when your weight is absorbed into them. The Meraki 2 uses a EVA rubber called QU!KFOAM, which gives it this responsiveness along with cushioning. This technology is made to last throughout the entire lifespan of the shoe, which is a plus, since most other pairs begin to wear out in responsiveness after just a couple hundred miles. The special foam grooves around the balls of the feet so that you can push-off with more ease for a speedier run. I truly felt springy during my speed sessions without the sacrifice of stability.
I tend to normally have achy feet for the rest of the day after long runs, but surprisingly they felt great after last weekend’s 17-miler! I say ‘surprisingly’ because I especially have more soreness after wearing relatively new shoes, and this pair (which I only used for a week before Saturday) left my feet feeling recovered rather than wasted as usual. Since the best experience I had with the 361 Degress Meraki 2 was during my long run, and that’s the run that wears out my shoes the quickest, I think I will stick to making this pair my long run pair. The technology is made to last, and what I was using before gave me only a couple of months of use, so you can bet I won’t be going back to anything else! If you are looking for a shoe that gives you stability, cushioning, speed, and a lightweight feel, these are for you! Try them out, and if you don’t like them, you can blame me and then return them for free with Zappos! Happy Running!
Plantar Fasciitis: The Best Treatment Approach
Does foot pain have you limping every time you get out of bed? Do you find yourself constantly rolling your arch with a water bottle every day with zero relief? If you are dealing with plantar fasciitis, as I have for years, it can be an extremely frustrating condition. Unfortunately this particular foot condition can take a while to get under control, but if you are diligent about management techniques, you can limit the effects plantar fasciitis has on your training program and daily life. What has worked for me may not work for everyone, but there are several tried and true methods that are worth the investment in money and time.
Treat the Cause
To understand how to treat your plantar fasciitis, it is important to know the cause, since treating symptoms will only lead to temporary results. This condition can arise from many different problems, and many are issues that are easily corrected.
Improper shoes: Since foot form and landing style can vary from person to person, the style of shoes you wear for every day use and running will largely impact the wear and tear on your feet. Runners who consistently train in low drop shoes are constantly stretching out the Achilles tendon. This undue strain leads to heel pain since the Achilles attaches to the area where the plantar fascia attaches. Since runners also use the calf muscles with every push-off in the running cycle, the calves tend to get overused and tight. Wearing shoes with a higher heel drop decreases the stress to the Achilles, therefore less strain on the bottom of the foot. All of my running shoes have an 8mm or larger drop, and I always rotate between several different pairs at once to give the different muscles of the foot a break at times.
Muscle Tightness: As explained above, tight calves can lead to heel pain. The lack of flexibility causes tugging on the attachment point at the heel where the plantar fascia attaches. Those who suffer from pain right at the base of the heel versus the arch can have success at relieving their issue by simply adding in more flexibility exercises to their program. Stretching the calves in standing both with the knee straight and bent is necessary in order to stretch all of the muscles that attach to the Achilles tendon. Daily post-run foam rolling is also beneficial for breaking up adhesions in the muscles that are causing the lack of flexibility.
Weakness: There are 26 bones in the foot, which means that many muscle attachments and more. The foot is commonly ignored when strength training, but it is the most important body part for runners since the feet carry our entire body weight through miles and miles. The small intrinsic muscles that control toe strength, stability, and range of motion for the feet and lower legs are constantly contracting and if there is any weakness, you can guarantee that much of the pressure gets applied to the fascia at the insertion points of the balls of the feet and heel, as well as in the center at the arch. Exercises such as the well-known “calf raises” (which is better referred to as ‘heel raises’) strengthen the push-off muscles, but it is important for runners to be incorporating toe raises as well in order to strengthen the shin muscles. To work the tiny muscles of the toes, a great exercise can be done in the sitting position: Place a small towel on the floor under the foot and curl the toes as if trying to pick up the towel. Repeat this motion for 2-3 sets of 10 repetitions a few times per week and you’ve hit the toe flexor muscles and stabilizers of the foot. Stabilizing the foot also involves strength from the inverter and everter muscles, which are basically in charge of controlling lateral movements (think rolling your ankle).
Foot Type:Any foot deformity such as bunions, hammertoe, low arches, or flat feet can greatly impact the pressure through the plantar fascia. Particularly having low arches or flat feet is the most concerning as this causes the fascia to be on a stretch at all times. The best relief for this cause is to make sure to wear the proper running shoes, which help supinate the foot, or lift the inner part of the foot to mimic having an arch. There are many insoles created for this purpose. My favorites are by Profoot, which you can find here. Runners with flat feet should also incorporate more hip external rotation and abduction exercises to help keep the hip, knee, and ankle aligned. Good choices to add into your routine are clamshells, banded lateral leg lifts, and hip hiking off of a step.
Personal Relief Strategies
I have dealt with plantar fasciitis for at least 8 years. I used to try to ignore it as much as possible and I got used to always waking up with heel pain and stiffness and it relieving after a few steps. When it would get bad to the point that it would bother me several times a day I would just stretch my toes sometimes and ice my feet when I wasn’t too lazy. All I was doing was controlling the symptoms at the time. Over the years I have developed a routine of different treatment tactics that have gotten me to the point of being pain-free at least 95% of the time. Here’s what has worked for me:
Using Normatec Compression boots for 45-60 minutes at least 4 times per week—this has helped with my lower leg circulation and relieves general tightness and soreness.
Rolling my foot with a spike ball every night for a few minutes—breaks up tightness and adhesions in the fascia.
Wearing insoles for both running and walking most days—Profoot Plantar Fasciitis have been the best! I also use the toe separators every night for just 5 minutes, which helps stretch all of those intrinsic muscles I was referring to.
Rotating between 5 pairs of shoes for running—currently I use Nike Pegasus Turbo for long runs, Nike Zoom Fly for speed and track sessions, and Saucony Guide Iso 2, Nike Epic React, and Adidas Ultraboost 19 for easy runs.
Leg strengthening: from the hips all the way down to those small toe muscles—I work them all twice per week!
This is a combination of strategies that has helped me personally, which all have treated different sources of my pain. These may not work for everyone, but I will emphasize that you MUST first figure out what is causing your plantar fasciitis in order to find the right treatment for you! Get advice from an orthopedic specialist or physical therapist to evaluate your issue. Not taking care of plantar fasciitis can lead to many problems from ankle injuries to hip and low back pain, which will only keep you from running you best.
Finding the Right Running Shoe for You
Finding the right running shoe can get tricky. We all want to go for the most stylish pair with attractive colors and designs, but many times these nice-looking kicks end up destroying our feet. As a runner and physical therapist I have learned along the way that the single most important gear to be picky about for running (or really any activity that has you standing or walking for long periods of time) are shoes. If you are an occasional runner who gets in a few miles every week just to stay active, one pair at a time is sufficient. But runners training for a distance event, especially those who incorporate different types of runs require a couple of pairs to rotate through. And it involves more than just “cushioned” or “light” when shopping around.
Know Your Foot Type
The first thing every runner should do when selecting shoes is figure out their foot type. Are you a pronator? Do you excessively supinate when you land? Do you have high arches? What does this all mean anyway?!
Pronator: This is when you land on the inner part of your foot when running. Most of the time runners initially land on the outer border of the foot, but quickly roll inward excessively. Those with low arches usually fall in this category.
Supinator: This is when you land on the outer border of the foot and remain with the majority of the pressure on this area throughout the midstance and even into the push-off phase of running. Those with high arches will fall into this category.
There are several running shoe stores that offer a gait analysis that can give you an idea of your foot type, but the best analysis would be by a podiatrist or sports medicine professional that specializes in gait and has access to the technology. A great way to analyze your foot type that can be done at home is checking the wear on your current or an old pair of running shoes. If you notice the wearing is excessive on the outer border, you can assume you are a supinator and you underpronate when you land. A pronator would have excessive wear on the inner border. If your shoes have even wear, you most likely have a neutral arch and pronate a normal amount.
Next Step: Shoe Type
Cushioned: Supinators should opt for cushioned shoes (at least for the majority of their runs). They provide optimal comfort (cushioning) with the least amount of firmness in order to promote a bit more pronation when landing. Cushioned shoes are made to be more flexible, but not all flexible shoes are cushioned! Some cushioned shoe examples are New Balance Fresh Foam, Brooks Adrenaline, and Saucony Omni.
Motion Control: This shoe type is made with more rigid materials in order to control the foot from rolling inward too much. Overpronators or runners with flat feet will benefit from motion control shoes since they include a more dense midsole, which helps raise the arch of the foot. Saucony Kinvara, New Balance 1540, and Brooks Ravena are all great shoes for low arches.
Stability: If you are a neutral runner, then stability shoes are your go-to. Most will have a firm rear and flexible forefoot with a moderate amount of cushioning. Some examples are the Saucony Guide Iso 2 (one of my favorites!), Adidas Ultraboost, and Nike Air Zoom Pegasus.
Shoe Rotation
If you are an everyday runner, alternating between faster paced running, track sessions, and easy runs, it is best to rotate between two or three pairs. Opting for lightweight, flexible shoes are best for speed sessions. Shoes made for the track or even most “racing” shoes such as the Nike Vaporfly 4%, generally do not have much cushioning. As long as you limit the use of this type of shoe to short track repeats and racing, your feet won’t be affected too much. For the majority of your weekly runs (which should be at a conversational/easy pace), it is ideal to use the shoes that are best for your foot type as explained above.
Everyone has different feet and running form varies greatly, so what works for one person may not work for another. Just because you see a “fast” runner using a pair of the brand new Nikes does not mean you should go out and spend the money to use the same style. Well, first of all, a shoe does not necessarily make you faster. If you find you run faster in a given pair of shoes it is your better foot mechanics that are making you faster, not the actual shoe. The best advice if you are having any foot, knee, hip, or back pain during or after running, is to definitely evaluate your running mechanics and foot type. Switching to the right shoe for you can be a simple fix to a nagging problem.
Achilles Issues & How to Fix Them
Some muscles work harder than others during running. One of these star players is the calves. Well, they pretty much work during every movement we do. Crossing both the ankle joint and knee joint, the calf is involved with any activity that requires us to push off of our toes. Not only that but they are also highly active when trying to control our descent during downhill running or walking. Since they play key roles during every part of running, we should be taking very good care of them every day. Strengthening and stretching the calves on a regular basis is an important part of training.
Having limited strength and flexibility in the calves leads to numerous injuries and pain including shin splints, plantar fasciitis, tendonitis, knee issues, and even hip and back issues over time. One common injury experienced by runners and many other athletes is Achilles’ tendinitis. The Achilles tendon is a thick band that connects the calf muscles to the heel of the foot. It is a prominent tendon in most people. All of the forces generated during running, especially during the push-off phase, are transmitted to the Achilles’ tendon. Faster running usually transmits more forces leading to injuries in the area.
What is Achilles’ Tendinitis?
When there is increased strain to the Achilles’ tendon, inflammation, irritation, and degeneration occur. The overworking of the tendon creates tiny microtears that weaken over time and can eventually lead to larger tears and ruptures. The most notable symptoms of Achilles’ tendinitis is visible swelling in the tendon, tenderness, and pain when first getting in up in the morning and when trying to stand on toes. Once it is warmed up the pain will usually subside and runners are able to run through it. As the condition worsens, the pain will gradually reappear and eventually limit the volume and speed of running. Tendon tears and ruptures will either have a visible bump over the area and commonly a gap where the tendon is ruptured.
Biomechanics
Although high volume training, speed training, and lack of strength are all causes of Achilles’ tendon issues, many physiological and biomechanical factors can increase the strain on the tendon and risk developing these problems.
Foot Strike
You have probably heard about how terrible heel striking is for runners. Well, the truth is that the research is inconclusive and heel striking actually works for some people. The reason this type of foot strike is related to Achilles’ tendon pain is that it involves increased stretching of the tendon. So if you already have tight calves to begin with, then the constant pulling during heel striking can lead to overstretching. The opposite type of foot strike, forefoot striking, actually creates a worse strain on the Achilles’ tendon. With this motion, you are basically landing on the toes and pushing off for the next stride all without giving the calves a break.
Pronation
Foot form is different for everyone. Flat-footed people or those with pronated feet (foot is turned inward when standing) will have a more strained Achilles’ tendon, as well as impeded blood flow to the area. There is already an area with limited blood supply, termed the “watershed area”, where the majority of tendon ruptures occur. This area is located about 4cm above the end point of the tendon on the heel. Limiting blood flow further as in the case of pronation will increase the risk of damage and slow healing on the tendon. Using supinated running shoes or inserts to decrease the amount of pronation is a treatment strategy.
Treatment & Prevention
Runners should focus on incorporating calf strengthening a couple of times every week, especially during their training seasons. Heel raises in all planes—toes pointed straight, toes pointed inward, and toes pointed outward are the main exercise for the calves. Seated heel raises or while in a squat position will help strengthen the soleus muscle, which is a muscle found deep under the gastrocs, the main calf muscles, that also connects to the Achilles’ tendon. Eccentric heel raises are the best way to strengthen the calf muscles as this will prepare the tendon for activities in which it is required to control the descent from extreme positions. To perform eccentric heel raises follow these steps:
Stand on a step with both heels hanging off.
Lift both heels together.
Once completely on toes, shift all weight to only one leg and slowly lower the heel to just below the edge of the step.
Repeat 10-20 times on one leg, then repeat the same with the other leg.
Essentially this exercise will create a type of damage in the tendon, which strips away the previously damaged fibers and encourages the development of new fibers as a form of healing.
Runners should also incorporate stretching after every run and activity that highly involves the Achilles’ tendon such as hiking and climbing stairs. Stretching with both the knee straight and bent is important in order to include both the gastric and soleus muscles. Foam rolling is also helpful to break up any adhesions and extreme tightness in the muscles. Although strength training is time-consuming during training season, it is very important in order to prevent injuries. Achilles’ tendon injuries can be frustrating as they are frequently overlooked since the initial stages involve pain-free running. Taking care of Achilles’ issues from the start will involve a short rehab time while waiting until the pain is unbearable and affecting your running can leave you out of the sport for several months.
Sources:
Răzvan Aniţaş And Dan Lucaciu, A Study Of The Achilles Tendon While Running, Journal, Sep 07, 2018