Plantar Fasciitis, Medial Tibial Stress Syndrome, and Achilles Tendinopathy in runners are all often caused by training errors and poor mechanics throughout the kinetic chain and are common running injuries. Increased mileage without proper training, without proper shoes, over-striding, and over-pronation could be the end of your running season.

Pain in the lower leg

Pronation and Supination

Common Overuse,  Lower Leg Injuries in the Runner

Plantar Fasciitis, Medial Tibial Stress Syndrome, and Achilles Tendinopathy are the three most common overuse, lower leg injuries we see in runners. Although anatomically these injuries involve different structures, there are similarities in etiology and common contributing factors. As I highlighted in my last blog discussing ITBS and PFPS, poor running mechanics impact the entire kinetic chain! Repetitive stress with increased mileage, faulty mechanics, inadequate recovery, and with under lying muscular imbalances all contribute to an over use injury.

Photo of runner squatting

Runners Squat & Deviated Squat causing Injury

Muscular imbalances refers to muscular tightness, and corresponding muscle weakness. This tug -of -war alters our movement patterns placing detrimental stress on our bodies, often exceeding certain structures ability to manage the load resulting in tissue failure. Specific to lower leg injuries, culprits often include over-striding, over-pronation and bad shoes. Experts recommend changing shoes every 300 – 500 miles. There is such a large gap in mileage recommendation due to patient / client – specific factors, such as running mechanics, shock absorption technique, wear-pattern, and past injuries.  Not everyone needs to be placed in a shoe with extra support designed for “over pronators”; and not everyone needs an over – the – counter or custom foot orthotic. Speak with a physical therapist, and / or foot / ankle specialist for specific recommendations. We would recommend Dr. Michael J. Chin at The Running Institute a board certified sports-medicine podiatrist they can also be found on Facebook and Instagram  

If you have seen an expert already, we would recommend you check in with our friends at Road Runner   and Universal Sole  to make sure you are in the right shoe. 

Plantar Fasciitis: The plantar fascia is a thick band spanning from the heel to the base of the toes, supporting the entire arch and all of the 26 bones of each foot. During repetitive activities, micro tears can occur throughout the plantar fascia leading to  heel or arch pain. Commonly, plantar fasciitis is caused by tightness throughout the calf muscles, weakness of the foot intrinsic muscles and poor mechanics up the kinetic chain.

Medial Tibial Stress Syndrome: “Shin splints”  are a repetitive-stress injury of the tibia and surrounding musculature in response to repetitive muscle contractions and tibial strain with inadequate recovery. Initially, pain is worse at the start of exercise and gradually decreases during training and then subsides within minutes of stopping exercise. As the injury progresses, however, pain presents with less activity and may occur at rest. It is imperative you monitor symptoms closely and take action sooner rather than later, as a stress fracture can be the end of your training season.  Runners are encouraged to avoid running on hills and uneven or very firm surfaces too soon, too fast, or too often. Running on a track or a uniform surface of moderate firmness provides more shock absorption and cause less strain on the lower limb.

Achilles Tendinopathy: Your Achilles Tendon attaches your two calf muscles (gastrocnemeius and soleus) to your heel bone  (calcaneus). The action of the calf and achilles tendon is plantar flexion, helping you go up on your tiptoes. Every step, and every stride calls on the achilles tendon.  In general, tendinopathy occurs when the tendon is no longer able to manage the load placed on it leading to further irritation and small amounts of damage to the structure. Often athletes will complain of pain along the back of the calf and into the heel; sometimes there may be swelling, tenderness and thickening around tendon.  

Injury Prevention, and Training:

As previously mentioned with ITBFS and PFPS, many risk factors are avoidable with an individualized, and  balanced training program. Long story – short, Runners please participate in a cross training program and be committed to a well -deserved recovery day!

During the first half of stance phase (when your limb touches down) your body is working really hard to decelerate that limb and absorb the energy generated during your stride. The muscles that decelerate the limb are at higher risk for injury during this phase when there is the greatest eccentric demand; these are the calf/achilles, and quadriceps muscles.

Foot with shoe lifting heel off the ground

Heel Raises

Slowly lower your heel down from a raised position

Eccentric Calf Raises

We spend a lot of time on variations of calf raises, and exercises to support the arch of your foot to maximize distal mechanics. You can load the Achilles tendon eccentrically by standing off of a stair, raise up to your tip toes and lower back down slowly until your heels slowly drop down past the step. There are a few progressions to this exercise that will help to improve the capacity of the achilles tendon to manage the demands of running. First, progress by  increasing the number of reps with both feet working together to go up and down; and then moving to both feet up and one foot slowly down; and finally one foot does all of the work up and down.

Again, the key to any training program is balance between strength, stability, flexibility and tissue mobility.  We always recommend that our runners participate in cross-training programs throughout the year to facilitate strength and mobility in muscle groups that running doesn’t utilize.  Runners, check out our new group training class specific to the Endurance Athlete! Each class will be sixty minutes of cross training to maximize strength, stability and flexibility / recovery.  TFI Group Class Schedule. 

Rehabilitation: The goal of treatment should focus on modifying training regimens and addressing impairments in strength, flexibility and motor control from trunk stability down to the arch of your foot. Manual therapy is used to improve symptoms, increase the tissues healing potential and capacity to manage future load. Exercise prescription should be specific to your movement pattern, and progress to be specific to your activity (i.e.: long distance running requires endurance parameters)

Recovery:   Runners are encouraged to incorporate low-impact exercises, such as pool running, swimming, yoga / pilates on “off days”.  Clinicians can work with athletes to develop an effective and efficient training program to maximize long runs, short runs, cross training and recovery days.  

Self management strategies to facilitate recovery include myofascial release techniques. You can roll out the arch of your foot with a tennis ball, or rubber ball.  See my previous blog ITBFS and PFPS in the Runner for specific recommendations to self myofascial release tools. For my patients, I often recommend frozen water bottle rollouts and / or ice cup massage. These are cost effective recovery tools that are more active than a traditional ice pack, but more specific to your area of discomfort.

As always, contact The Fit Institute with any questions.  We offer a complimentary injury screen and Dartfish  running analysis for all runner’s training for a race this upcoming season.  We look forward to seeing you in clinic!

Stephanie Ferro – Doctor of Physical Therapy. Graduate of Northwestern University Feinberg School of Medicine. Former collegiate soccer player at Florida Atlantic University.

The FIT Institute is a physical therapy and sports performance facility in North Center. We increase the of an athlete’s career by teaching proper movement patterns that often lead to overuse injuries, we do this by bridging the gap between physical therapy and sports performance.