Running injuries affect 80% of runners each year so it is vitally important to understand how to prevent and treat common running injuries. At The Foot Hub, we’re continuing our two-part blog series by highlighting the diagnosis, anatomy, biomechanics, and treatment of another three common running injuries.
For information on the first three running injuries we covered, check out Preventing and Treating Common Running Injuries Part 1.
Common Running Injury #4 – Medial Tibial Stress Syndrome
Medial Tibial Stress Syndrome 
(MTSS) – commonly referred to as shin splints – is a pain along the inner edge of the shinbone (tibia). MTSS is the most common cause of exertional leg pain, commonly plaguing younger and inexperienced runners. Podiatrists and health professionals tend to avoid the term “shin splints” since there can be multiple causes of exertional leg pain (such as Tibial and Fibular stress fractures, chronic exertional compartment syndrome, arterial or nerve entrapment, deep vein thrombosis, fascial herniations, muscles strains and tears etc.) that can go misdiagnosed. Medial Tibial Stress Syndrome predominately develops in female runners than male runners due to thinner bones. MTSS occurs from exertional repetitive activity. With increased duration or intensity of these exercises, the pain worsens, however, disappears shortly after exercise completion. If the pain is felt for extended periods after the exercise it may instead be a Medial Tibial Stress Fracture.
Q: Why do runners get MTSS?
A: When running your feet strike the ground aligned to the centre of your body, as opposed to walking where your feet strike to the sides. Because of this, your centre of gravity is out of alignment causing a ‘running limb varus’ and a bend in the tibia bone due to the increased force placed on the skewed ligament.
PREVENTION & TREATMENT
- Reducing the force on the medial tibia prevents MTSS and is best accomplished by implementing foot orthoses and/or supportive footwear.
- Stretching is important for any exercise as it is vital to prepare the body for constant physical exertion. Furthermore, strengthening exercises are essential for the tibia due to the running limb varus.
- Gait retraining to widen the running base of gait reduces the force placed on the tibia.
- Reduce training mileage and intensity to lessen the constant force placed on the tibia.
- During the treatment process, initial temporary orthoses may be implemented to add support to the stressed tibia.
- Ice therapy helps reduce inflammation in medial tibial.
- Our Sydney podiatrists can assist in designing long-term treatment programs to prevent symptoms from returning.
- If treatment or prevention methods prove unsuccessful, a bone scan or MRI may be required to ensure it isn’t a tibial stress fracture.
Common Running Injury #5 – Iliotibial Band Syndrome
Iliotibial Band Syndrome (ITB syndrome) is one of the most common causes of knee pain in runners. The pain occurs at the lateral knee, overlying where the iliotibial band runs along the side of the thigh, stretching from the pelvis to the tibia, crossing both the hip and knee joints. The iliotibial band is an important stabilising structure of the lateral part of the knees as the joint flexes and extends – which is why it is prone to stress while running. Pain may also occur in the thigh and hip. Runners with pronated or high-arched feet commonly have Iliotibial Band Syndrome. ITB syndrome is possibly related to the increased varus forces on the knee during the early support phase of running, further causing increased demand on the iliotibial band.
PREVENTION & TREATMENT
- As a preventive measure, orthoses benefit runners who deal with ITB syndrome due to pronated feet or high-arches.
- Worn out shoes cause discomfort when running so it’s important to ensure your running shoes are in a suitable condition. Don’t know when it’s time to replace your running shoes? Check out our blog on the top 5 signs you need to replace your running shoes.
- Stretching is beneficial as both a preventive and treatment method; particularly gluteal strengthening and ITB stretching exercises. Since the iliotibial band crosses both the hip and knee joints, it’s important to focus on these two areas. Gluteal strengthening exercises are essential as the muscles work along with the iliotibial band, helping reduce tension strain while running.
- To reduce inflammation, icing therapy and anti-inflammatory creams (eg. Voltaren) provide relief.
Common Running Injury #6 – Patello-Femoral Pain Syndrome
Patellofemoral pain syndrome (PFPS) – originally called “chondromalacia patella” but is now commonly referred to as “runner’s knee” – is a pain originating from the contact of the posterior surface of the patella (back of the kneecap) with the femur (thigh bone). Pain occurs after the knee is repetitively bent at an unnatural angle causing pressure between the kneecap and femoral groove. With PFPS, the patella tends to not track properly on the femoral groove, wearing away the cartilage, causing bone bruising. Patellofemoral syndrome is most commonly found in women due to the increased “Q” angle due to wider hips. Furthermore, weak thigh muscles, tight hamstrings or tight iliotibial band contribute to a misaligned patella. Pronated feet cause increased internal tibial rotation, internal femoral rotation, and lateral motion of patella on the femur.
PREVENTION & TREATMENT
- Stretching is the ideal preventive method as it prepares the body for strenuous and consistent exercise; specifically stretching and strengthening the thigh muscles, hamstring, and iliotibial band.
- Anti-pronation running shoes provide support to prevent your foot rolling in and dislocating the patella from the femoral track. Likewise, orthotics will provide customised support to ensure optimal stability when running.
- Taping the patella increases support to the knee ensuring the patella doesn’t misalign from the femoral groove.
- To reduce pain and inflammation, icing therapy on the knee.
Running increases the impact force on the skeleton causing far more stress on tendons, ligaments and bones, which is why injuries frequently occur. However, with knowledge on how these increased forces commonly affect the foot and lower extremities, we can take the proper preventive and treatment measures to ensure you’re back on the running field in no time! Medial Tibial Stress Syndrome, Iliotibial Band Syndrome, and Patella-Femoral Syndrome are only three of the six common running injuries we’ve covered in our two-part blog series. For information on the first three running injuries we covered, check out Preventing and Treating Common Running Injuries Part 1.
If you are suffering from a running injury or would like to take action in preventing an injury from occurring, book an appointment at The Foot Hub today!
The experienced podiatrists at our Sydney foot clinic are ready to help you prevent or overcome your running injury today.
