Running is a convenient form of exercise that requires little more than motivation, energy and a decent pair of shoes. Because running is a 1-person activity, there is a low risk of trauma with this sport. However, runners are not free from injuries. According to a review article published in February 2015 by "PLoS One," 80 percent of running injuries are due to overuse -- the inability of body structures to keep up with demands placed on them. Some of these injuries affect the arch of the foot, which acts as a shock absorber when running.
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Your arch is primarily supported by ligamentous tissue called the plantar fascia. Running can irritate this structure, causing a condition called plantar fasciitis. According to a study published in September 2015 by "PLoS One," plantar fasciitis is the third most common injury in runners. This condition typically causes pain in the arch, close to your heel bone. In addition to running, you may also experience pain when getting out of bed in the morning or after sitting for a long period. Plantar fasciitis can often be treated with a combination of rest, ice, activity modification, stretching and strengthening exercises and oral anti-inflammatory medications, such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Splints worn at night and shoe modifications can also be helpful for some people. Steroid injections are used for severe cases. Surgery is sometimes recommended if other treatments fail to provide relief.
Posterior Tibial Tendinopathy
Tendinopathy generally refers to a painful condition involving one or more tendons, which are structures that connect muscles to bones. The posterior tibial tendon is particularly prone to injury with running. The posterior tibial muscle in your calf helps propel you forward while running. The tendon of this muscle runs underneath your foot, providing key support to your arch. Posterior tibial tendinopathy (PTT) typically develops over time. However, injuries such as twisting your foot or stepping in a hole can increase your risk of developing this condition. PTT can be caused by muscle weakness or training that progresses too quickly. This condition can often be treated with stretching, strengthening and adjustments to your training program. Other treatments include ice, rest and oral anti-inflammatory medications. Steroid injections are sometimes used to decrease inflammation when oral medications don't work. Severe cases of PTT might require surgery.
Stress fractures are thin cracks that can develop in bone with overuse activities such as running. These injuries typically occur with excessive training, when muscles are fatigued and no longer effectively help with shock absorption. Running on hills and different types of terrain also increases your risk of stress fractures. Stress fractures in the metatarsal bones -- the long bones that make up the front half of the arch -- can cause pain. Early on, this pain might only occur while you are running and resolve with rest. If you continue to run, the fracture can worsen and you might have pain with everyday walking.
Metatarsal stress fractures typically heal with 4 to 6 weeks of activity modification. Initially, running is not allowed. Crutches might be required to reduce pressure through your foot as the bone is healing. Your doctor might recommend wearing a stiff boot to minimize movement of your foot for a couple of weeks. Activity resumption is based on pain. Once you are able to walk normally without pain for at least 2 weeks, running is resumed gradually. As your bone is healing, ice and oral anti-inflammatory medications can help with pain relief. In rare cases, the bone does not heal correctly and surgery might be required.
Other conditions such as osteoarthritis, rheumatoid arthritis and tumors can cause arch pain that might manifest while running, at least initially. In some cases, these conditions might require you to stop running. Osteoarthritis involves breakdown of cartilage -- padding between bones in your joints -- that often develops with age. However, osteoarthritis can develop in younger adults, particularly after trauma such as a broken bone in your foot. This type of arthritis frequently affects the middle of the foot. There is no cure for osteoarthritis, but pain can be treated with oral anti-inflammatory medications or steroid injections. In severe cases, surgery might be required.
Rheumatoid arthritis is a chronic inflammatory condition that occurs when the body mistakenly attacks its own joints. Over time, the joints break down. This condition typically affects more than one joint in the body at the same time. Rheumatoid arthritis is treated medically with steroid medications and other disease-modifying drugs. In severe cases, surgery might be required to address joint damage.
Noncancerous and cancerous tumors can affect soft tissues or bones in the feet and potentially cause arch pain, although this is relatively uncommon. Because other causes are more likely, there may be a delay in diagnosing a tumor of the foot. Tumors in the foot often require surgery. Cancerous tumors are also treated with radiation and chemotherapy.
Arch pain during running can be influenced by many different factors. The way your arch is shaped can affect your foot's ability to absorb shock. The alignment of your hips and knees also affects the way your feet respond to the high-impact forces that occur while running. Shoes that are too flexible or too rigid can contribute to arch problems. Increasing running distance, speed or length of training sessions too quickly can increase your risk of injury.
For best results, see a healthcare professional for an accurate diagnosis of the cause of your arch pain and consult a running professional for an analysis of your running form and footwear.
REFERENCES & RESOURCES
- American Family Physician: Tendinopathies of the Foot and Ankle
- Clinics: Rearfoot Alignment and Medial Longitudinal Arch Configurations of Runners With Symptoms and Histories of Plantar Fasciitis
- Australian Family Physician: The Challenge of Managing Mid-Foot Pain
- TeachMeAnatomy: The Arches of the Foot
- PLoS One: Dynamic Patterns of Forces and Loading Rate in Runners With Unilateral Plantar Fasciitis: A Cross-Sectional Study
- PLoS One: Injuries in Runners; A Systematic Review on Risk Factors and Sex Differences
- Open Access Journal of Sports Medicine: Diagnosis, Treatment, and Rehabilitation of Stress Fractures in the Lower Extremity in Runners
- Sarcoma: Do Malignant Bone Tumors of the Foot Have a Different Biological Behavior Than Sarcomas at Other Skeletal Sites?
- Canadian Journal of Surgery: Soft-Tissue Sarcoma of the Foot
- Arthritis Research and Therapy: The Epidemiology of Symptomatic Midfoot Osteoarthritis in Community-Dwelling Older Adults: Cross-Sectional Findings From the Clinical Assessment Study of the Foot
- BMC Musculoskeletal Disorders: Gait Characteristics Associated With the Foot and Ankle in Inflammatory Arthritis: A Systematic Review and Meta-Analysis