Injuries While Training: Running a Marathon

Grab a pair of sneakers and go.  That’s all it takes to run, right?  Maybe that’s why more people than ever are running marathons.  Running a marathon is an admirable goal, but the philosophy of just grabbing a pair of shoes and running may be why I’m seeing more running injuries than ever before.  Training for marathons has turned into big business.  You can join a club, buy a magazine, or purchase a plan online.  My problem with these training schedules is a lack of individual attention.  Remember my saying, “feet are like snowflakes, no two are the same”.  Some people have feet that can run 26 miles, but does that mean your feet can?  Well there’s two mind sets:  1. you’ll never know until you try, or 2. I’ll follow a training program.  But what’s missing?  Neither approach is designed with you in mind, so when you get hurt you end up needing me.

Recently three people came to see me for the most common running injuries.  Even though these people had different pain, were different ages, lived in different cities, and had different lifestyles, they all had similar stories about training for a marathon.  All three had not run for exercise consistently in more than 5 years.  A friend had convinced each one to train for the marathon.  Not one of the 3 had a training program made specifically for them, but all were using a group training schedule from either a magazine, the internet, or joining a training group.

The first patient complained of heel pain that was worse with the first steps out of bed then again in the evenings especially after running.  I diagnosed this patient with plantar fasciitis and relieved her pain by teaching her how to stretch and ice, gave her foot orthotics to support her sudden increase in activity, and plantar fascia night splint for the morning pain and stiffness.  Plantar fasciitis is a common overuse injury.  The muscles in your arch stretch beyond their limits when you walk or run.  A sudden increase in activity, change in shoes, or an injury is usually related to the start of pain, but very few people realize this until I point it out.  In this case the patient had a new activity, running.  She also had new shoes that she bought for this training.  Had I seen her before she started training I could have watched her walk on slow motion video and analyzed how her foot might be effected by running.  Stretching could have been started before training began and help individualizing her training program could have been arranged.  Her heel pain and time away from training could have been avoided, but she will be able to run the marathon.

The second patient came to me with the complaint of pain and swelling in the top of his foot.  He was training for a marathon and noticed the pain increasing gradually as his distance increased.  Pain was present all day long, worse in shoes, and swelling increased the more he walked.  Running had stopped because of the pain.  X-rays showed a stress fracture of his 2nd metatarsal.  This is the bone behind your second toe and is commonly the bone involved in stress fractures of the foot.  Stress fractures are broken bones that happen gradually when you have a sudden increase in activity.  The sudden increased pressure on the bone causes inflammation that weakens the bone, but you’re still not aware of it so you keep on training.  When the weak area of the bone breaks you get the big ouch.  Treating the fracture early is easiest.  A removable cast and anti-inflammatory pills relieve the pressure and inflammation allowing the fracture to heal.  Once you heal the real treatment begins.  There is a reason the fractured bone has more pressure than the others and it’s my job to find out.  Detailed exam of your foot structure including video gait analysis will be done so that custom foot orthoses can be made.  This will correct the pressure problems in your foot and prevent further fractures.  Unfortunately in this case the patient came to me once his bone had broken.  His goal of completing a marathon will have to be postponed until later in the year.

The third patient wasn’t far along in her marathon training when she developed pain in her lower legs.  This pain was very bad when running and improved with rest.  She wanted to run the marathon so bad that she trained until until her leg started to swell.  By the time I saw her my major concern was a stress fracture of her tibia, the main bone in the lower leg.  The beginning of her story was more like shin splints, but I had to make sure so a few tests were done to prove this was not a stress fracture and she improved with treatment for shin splints.  Medial tibial stress syndrome is the newer term used in sports medicine for shin splints.  The cause is always related to pronation, see my article “Are You a Pronator”.  Most foot problems can be related to pronation, but medial tibial stress syndrome occurs in the leg.  To make a long story short, it’s the rotation of your lower leg when you run that causes this pain.  Custom foot orthoses are the only way to make this go away and stay away.  I had to modify this patient’s training program and get her help to strengthen her thigh muscles, but she will be running in the marathon.

Running is good for you!  No one will argue that point, but getting started is the hard part.  Buying a running shoe from a specialty store is a good idea, but now a lot of stores are using pressure mapping to tell you how your foot works.  First of all, you cannot tell how the foot works by standing still on a pressure plate.  At Desert Foot Surgeons I use video gait analysis to see exactly how your foot works while you run or walk barefoot and in shoes.  Second the study of foot motion is called biomechanics.  This takes years of study to master and is only provided in podiatry schools.  I have many friends in the running shoe business and have learned a lot about shoes from them.  Likewise I have taught my friends a lot about biomechanics.  I won’t pretend to know more about shoes than these professional salespeople and all of my friends will not pretend to know more about the function of the foot than I do.

Come see me before you start running.  I can help you with more than just shoes and orthotics.  I can get you personalized training or even physical therapy.  If you have shoes already video gait analysis will show if they are working for you.  Preventing injuries is much easier than treating injuries.  Running is good for you, just do it smart!