COMMON OVERUSE INJURIES

By: Sara John, C.Ped (C)., C.Ped Tech (C)

During running or jumping, there is a considerable amount of force produced during each moment the foot makes contact with the ground. Repetitive strain or excessive use of muscles and joints result in fatigue, pain, discomfort and various overuse injuries. Some of the common injuries and pedorthic solutions are outlined below:

Plantar fasciitis
Symptoms:
- Early morning heel pain
- Pain in the arch and along bottom of foot
Causes:
- Excessive pronation or supination
- Prolonged tension/inflammation of plantar fascia
- Walking and/or standing on hard surfaces
- Standing for longer periods of time
- Lack of flexibility in calves / hamstrings
- Improper footwear or inadequate support in footwear

Achilles Tendonitis
Symptoms:
- Pain, swelling and/or burning sensation on the back of the heel and higher up into the tendon
Causes:
- Stress on the tendon that attaches on the back of the heel
- Lack of flexibility in calves and hamstrings
- Increased pronation

Ilio-Tibial Band Syndrome (ITBS)
Symptoms:
- Pain along the outside of the knee or thigh usually worse during the athletic activity
Causes:
- Running on different terrains
- Excessive pronation can lead to irritation from friction on the head of femur
- Bowing of legs can cause more irritation
 
Patello-Femoral Stress Syndrome (Runner’s Knee)
Symptoms:
- Pain and discomfort behind or around the knee cap during athletic activity
Causes:
- Lack of flexibility in calves and hamstrings
- Stress on the tendon / ligaments from stabilizing rotations and force at the knee
- Increased loads from excessive pronation increases the shear forces

Patellar Tendinopathy (Jumper’s Knee)
Symptoms:
- Pain below the knee cap worsens with activity
- Stiffness after rest
Causes:
- Repetitive running or jumping on hard surfaces
- Continuous multi-directional movements
-  Improper or inadequate support

Shin Splints
Symptoms:
- Aching pain and discomfort along the front or side of the shin
- Pain when leg muscles are used
Causes:
- Overpronation or flat feet that strain the muscle
- Inadequate stretching
- Weak stabilizing muscles
- Excessive or repetitive stress
- Running predominantly on harder training surfaces

Stress Fractures
Symptoms:
- Pain during weight-bearing that increases with activity or exercise
Causes:
- Repeated stomping of the foot as in athletes/long distance runners, military personnel etc
- Accumulated trauma from repetitive activity leads to fatigue-induced fracture
- Lack of proper cushion/shock absorption in the footwear

Metatarsalgia
Symptoms:
- Pain in the ball of the foot or forefoot
Causes:
- Excessive pronation
- Improper footwear / inadequate support

Bunions
Symptoms:
- Inflammation and deformation of the big toe joint
- Reduced range of motion in the big toe joint
Causes:
- Excessive pronation
- Improper footwear
 
Morton’s Neuroma
Symptoms:
- Pain in the forefoot or between toes (usually 3rd and 4th Metatarsal bones)
- Burning sensation in the forefoot or between toes
Causes:
- Compression of the forefoot
- Footwear with narrow or pointed toe box
- Pronatory foot motion that causes irritation of the nerves that run between metatarsals which can lead to pain and inflammation around the nerve

Hammer Toes
Symptoms:
- Bent joint in toe (usually 2nd toe)
- Pain and irritation friction in the shoe can cause corns on the top/tip of the toe
Causes:
- Excessive pronation
- Contracted muscles of the foot makes the toes to ‘grip’
- Neurological conditions, arthritis etc

What are the treatment options?

Footwear Solutions:
·         Wearing incorrect footwear causes blisters, corns and calluses as well as lead to more serious conditions including repetitive stress injuries.
·         Purchase footwear designed for the specific demands of the sport.
·         Buy shoes that fit properly. Too short, too long or tight shoes can affect the function of foot and can cause irritations. Poorly fitting or inappropriate   footwear can lead to overuse injury.
·         For runners, footwear which can absorb shock and help propel forward is advised.
·         Replace athletic shoes regularly. When shoes wear down, they lose their cushioning and are less capable of absorbing the impact of the foot landing with each step, so more force is transmitted to muscles, bones and tendons causing risk of injuries.
·         Prevent additional damage by ensuring that the footwear has deep toe box to accommodate contracted toes (as in hammertoes)
·         Wider forefoot can accommodate the altered shape of joint (as with bunions).
 
Role of Orthotics:

·         Orthotics help to maintain proper support at all times
·         Relieve pronation-related tension and issues
·         Reduce stress and tension of the plantar fascia
·         Can properly redistribute pressure across the metatarsal bones
·         Controls the rearfoot and stabilize the foot
·         Properly align and cushion the foot

Talk to your physician and visit a Canadian Certified Pedorthist for a biomechanical evaluation and footwear selection guidance to enjoy a pain-free running experience.