Podiatry & Orthotics Clinic London UK
RUNNING INJURIES: FOOTWEAR AND FOOTCARE TIPS TO PREVENT THEM.
February/March 2023, Christophe Champs
If you are a runner, or planning to take-up or return to running it’s important to do everything you can to prevent injury and stop old injuries from recurring. To do this you need a multi-faceted approach – there is no ‘one solution’.
The human body is not a machine, the BIO part of Biomechanics stands for what’s alive and living. The human body has an incredible capacity for adapting and transforming to suit new situations. Yes, there is the genetic, but there is also the epigenetic; which is how your behaviour and environment can change how your genes work.
If you are preparing for a race, training is essential to get you ready, both physically and mentally. We all know that. We also know that we will make mistakes along the way and, hopefully, will learn from those mistakes. This, in turn, will improve our training and our performance in the race.
However, what we don’t want to do is make a mistake or mistakes that lead to injury, as this is likely to take you out of the race altogether. Getting to the start line is at least as important as getting to the finish line. Then, as the whistle blows and the crowd cheers you on, you can enjoy your best performance possible.
The multi-faceted approach to health – or the jigsaw puzzle
There are three vital parts of the injury prevention jigsaw puzzle that must not be forgotten when preparing for a run: your running shoes; your laces; and looking after the health of your feet.
1) Running shoes
When investing in running shoes, watch out for the marketing fairy tales: cushion, drops, and pronation control.
Cushion:
When you walk, you transfer your weight from one foot to both feet, to the other foot, back to both feet and so on. This means that around 80% of your body weight is reasonably well distributed between your feet.
Running is a different story: one foot, no feet, the other foot, you take off again.
So, running comes with two opposing challenges: the landing and its need to be cushioned versus the propulsion which needs elasticity within the shoe sole.
You already have the best cushion: your fat pad! The plantar fat pad, which is located between your heel skin and heel bone, contains fibro-elastic chambers full of fat globules which have the ability to ‘re-plump’ very quickly.
This is the best fat within the human body, yet we all take for granted. If you’re not convinced, ask anyone suffering from a fat pad atrophy (the breakdown or thinning of the fat pads) how much they suffer, even just standing barefoot.
Any foam, even the best marketed, needs much more time to “re-plump” than your fat pad, which is the reason you should never run two days in a row or do your race recovery run with the same pair of trainers.
Every brand has its way of trying to cheat this fact: NIKE and its encapsulated air, ASICS and its Gel, Mizuno and its Wave / folded plastic sheet. They are all trying to mimic the fat pad on your heel.
Other brands will simply drill holes in the soles, lightening the soles, and use cloud-shapes to tell you that it’s like running on cloud (ignoring the law of gravity)! Watch out for these marketing fairy tales. A good support is essential if you intend to land 19,000 times on your feet within four hours, while applying up to three times your body weight.
Good as the fat pad is, it can do with some extra help and protection; you need a strong heel counter in your running shoes and/or a snug heel cup from your orthotics/insoles that will help cradle the heel and prevent this precious fat pad from spreading out.
Next you need to look at propulsion. This is where the cushion under the front fat pad of your foot needs elasticity which gives you better lift and propulsion as your foot pushes off and leaves the ground.
Drop:
The drop is the difference in height between the heel and the forefoot.
There is a fear of developing injuries from wearing technical footwear, and strong movement to go back to our roots. We read of tribes running long distances without shoes and so some manufacturers have started to make running shoes with no drop. These are often termed ‘barefoot’ running shoes.
Reduced drop shoes are good as an introduction to barefoot running or as an alternative in-between product for people who might doubt their usual running shoes. Looking at this with a clinical eye, while a reduced drop lowers the heel and brings the foot closer to a barefoot position, it misses the point that your calves, Achilles, and plantar fascia all work together. Pull one and it affects the other.
Therefore, by reducing the drop, you create an excess of traction in those structures. Plus, less material means less support. A lighter sole is sometimes flimsy, and this can lead the forefoot to spread and the toe box to feel narrow.
Top Tip: If you live in a city with hard roads and pavements everywhere and you wear shoes most of the time, my advice is to avoid this new trend in your training or at least don’t transition into it overnight. Your muscles need time and training to adapt. Ideally get some professional guidance to help you avoid injury when transitioning.
Pronation control:
In the past, some running shoes claimed to be “anti-pronation” but pronation is your best friend! At a knee, ankle, foot and big toe level, this natural movement helps your body to absorb shock.
More recently brands have renamed their technologies “pronation control”. And the public fear of pronation disappeared.
Pronation control can be helpful and even used on top of orthotics treatment in some cases. It often comes in the form of a firmer foam, or a hard piece added on the medial side of your shoe sole. Sometimes this is indicated on the sole, such as the Duomax on the Asics Kayano.
It is essential for anyone providing pronation control to look at the patient’s feet (shape, hard skin location, curly toes, hyper mobility), shin (medial rotation) and knees (bow-leggedness mainly). Pronation control is very personal – it is not a ‘one size fit all’ adjustment.
2) Laces are underrated
Laces are there to ensure a total fusion between your foot and the footwear.
Before looking for the lacing method that suits you best, I recommend that you check that none of the laces or eyelets are broken.
This is because, the design of your running shoe - its upper part - has been built to strap your foot to the sole of your shoes, when your laces are tied. If this is damaged in any way, then it cannot do its job properly.
The length of the laces matters too, especially if you have a large shoe size and intend to use the extra eyelets with the runner’s loop lacing method.
In stores or online, 46 and 38 size shoes come with the same length lace!
Elastic or not? By elastic, I mean the “pull and go” laces adored by triathletes to save some time on their race, and the laces which look “normal” but actually stretch and allow the upper of the shoe to give.
So, although these laces do save time, you will lose some precious support to control the foot pronation and stabilise the foot. My recommendation would be to train with non-elasticated laces, and just use the elastic ones on race day.
3) Foot care: Socks and moisture
Socks, cream, talcum powder… where to start?
I still recommend to clients on a daily basis to visit Decathlon if they want to understand the differences between all the running socks available on the market. Their horizontal merchandising helps you go up and down the range to fit your needs and your budget.
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Socks are not a one-time investment; change them often. One of my ultra-runner patients sacrifices a pair for his longest and toughest race every year, applying the cream directly onto the socks because the skin cannot store the cream for as long.
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Use socks that have elastic support in the instep, arch and ankle. This helps to position them well and reduce rubbing, which in turn helps to prevent blisters.
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Apply cream on the dry and cushioned areas, around the heel and the ball of the foot. Massage the areas where both corns and calluses tend to build up, to improve your skin elasticity.
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Use a specific FOOT cream to nourish and moisturise. The skin under your foot is seven times thicker than your face skin and four times thicker than your body skin so it needs a specialist cream.
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Do NOT apply cream between the toes. Trust me, athletes foot is not the part of the athlete you wish to acquire when you take up running!
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Talcum powder. Use it between your toes and on the sole of the foot between the previously creamed areas. Talcum powder is not designed to dry the skin but to control the perspiration and it leaves a thin protective veil.
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Cut your nails short and square, smooth the lateral corners with a glass file (those come with a thick and smooth edge, allowing you to file any potential nail spur, without damaging the surrounding skin). In case of recurrent black toenails, try both “black toenails” and “heel lock/runner’s loop” lacing methods available on the “patient resources” tab: https://www.podo.london/patient-resources
Finally, if you come back from an injury or wish to start running, build up slowly to increase your mileage: Run to a time, not a distance! Build up your running skills without over-running, dare to walk if needed and listen to any pain.
Running to a time rather than a distance when training also helps you do more than planned, away from the stress of high expectations. Keep track of your runs to motivate you and give you plenty of small wins to celebrate.
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Besides educating patients and sharing our tips to make your body works better, the Podo Clinic and Workshop, offers a thorough assessment to assess and analyse your posture, gait, and biomechanics. Providing all type of patients with custom orthotics made in-house, directly moulded onto the feet and ready to wear at the end of a single 90 minutes appointment.
Go further with your orthotics
Orthotics are only one piece of the puzzle in helping your body work better.
Below you will find a wealth of information that has been helping patients around the world get the ‘big picture’.
The following resources (articles, videos and tutorials) do not just strive to give out the right advice, they also set the record straight on common misconceptions.