Plantar Fasciitis, Shin Splints, and Other Running Injuries

Running Injuries

Running does not guarantee an injury but some of the common running injuries to occur are Plantar Fasciitis, Shin Splints, Runner’s Knee, IT Band Syndrome, Achilles Tendinitis, Sprained Ankle, Stress Fracture, Muscle Strain or Pull, and Blisters. Whether it is a nagging knee pain, foot pain, or hamstring injury, this guide details what each running injury type is, how to treat it, and prevent the injury where possible.

Plantar Fasciitis

A nagging pain in the heel may be more than it appears, and be a condition called plantar fasciitis. This foot pain manifests itself as injuries to the plantar fascia ligament that connects the heel bone to your toes occur. As this critical ligament supports your arches, a strain can cause irritation and swelling resulting in pain with every step.

Continued pushing of this strain may result in tears to the ligament. Those who heavily pronate (rolling of feet inward when walking), have high arches, are overweight, wear the wrong type or worn out shoes, and generally are on their feet for long periods of time are more likely to develop plantar fasciitis.

How to Treat Plantar Fasciitis

The range of “how injured” your heel feels generally aligns to the treatment you will pursue for plantar fasciitis, from backing off your training to complete rest, acknowledging that if you have any doubts you should head to your doctor for a thorough evaluation. They may even recommend you to a podiatrist for deeper evaluation and treatment. While the majority of individuals with plantar fasciitis recover, this requires varying treatment as follows:

  • Back off you running regime and try to limit how long and how hard of surfaces you are walking and running on, while resting and icing as much as possible
  • Anti-inflammatory drugs can assist, but as stated previously should be used with caution due to potential side effects
  • Ensure that you have the correct and non-worn out running shoes. Adding a heel cup to provide additional padding around your heel may also assist. Also note that walking around your home causes impact, especially on slab based homes, so you may want to obtain a pair of “indoor shoes” with good support to help reduce impact
  • Adopt a stretching routine that includes drills such as towel stretches, toe stretches, and calf stretches to strengthen the muscles supporting your arches while gaining flexibility in the plantar fascia ligament
  • In very rare cases (less than 5-10% of the time) surgery may be required to correct plantar fasciitis issues, where the tension on the ligament is reduced. However, more doctors and specialists are likely to only escalate to surgery as a last resort after all other treatment options have failed

How to Prevent Plantar Fasciitis

Prevention of plantar fasciitis is a multi-honed approach that contains common elements you should adopt across your injury prevention plan. This includes:

  • Getting running shoes that are the right type, possibly combined with orthotics while replacing any worn down shoes. Your local running store is a great place to determine if you need new shoes or have the right type of running shoes and support for your foot type
  • Introduce stretching that focuses on the Achilles tendon and generally mobility of your foot muscles. Be cautious not to perform “cold stretching” but rather start warming up with dynamic stretching
  • Ensure that you maintain a proper body weight for your height as the additional pressure will go directly to your feet. Don’t be discouraged if you experience pain in the heel but rather back off the amount of training as your weight loss plan needs to start somewhere and it takes time for your body to adapt. Even if weight loss is not your goal, as you have another reason for running, always gradually increase your running mileage while listening carefully to your body
  • Too much running can be a bad thing, so evaluate cross training activities to shift the focus on repetitive motion away from your heel

Shin Splints

Whether you are a beginner runner or even a seasoned veteran runner, shin splints can sneak up and cause sharp pain up and down the shin as you put pressure on your legs with every running stride. This can extend beyond swollen muscles in the shins all the way to stress fractures along the shin bone.

Shin splints tend to occur as a runner changes their workout by adding more miles or intensity to an existing running plan, does not have the right shoe for their foot type or needs to replace their running shoes as they have become worn, or are running on a different surface. This is a common and treatable injury.

Do not try and “push” beyond this injury as shin splints need time to heal and some are more prone to getting shin splints due to running form, flat feet or over pronation, and weaker muscles in your core.

How to Treat Shin Splints

Shin splints should be iced for at least 20 minutes upwards of 6-8 times a day (taking breaks every 3-4 hours) from anywhere to 2-7 days. This does not mean continue running, but rather give your body time to heal. Setbacks can occur in running, but you can recover given enough time and proper treatment. If you find that the pain is not going away, anti-inflammatory medicine such as ibuprofen or aspirin (commonly referred to as Nonsteroidal anti-inflammatory drugs) may help but be very wary of the side effects such as ulcers or increased risk of bleeding.

If you have any doubts about your treatment path or are not getting better, do not hesitate to contact your doctor. They may prescribe physical therapy, differing painkillers, or orthotic inserts for your shoes. Once you have recovered, work back into your running schedule being careful to not overdo it but rather listening to your body for cues that it has recovered.

How to Prevent Shin Splints

There are several methods to strengthen and support your shins in order to prevent shin splints. These are as follows:

  • Strengthen your muscles by performing toe raises, shin stretches, and heel walks
  • Make sure that you have adequate shoe cushioning or that your shoes don’t need to be replaced. If you aren’t sure if you shoes need to be replaced or changed for a different type, head to your local running store as they tend to be staffed by runners and specialists in running motion. They may even recommend shoe inserts depending on your foot type.
  • Properly warm up by dynamic stretching before you run
  • If you feel any shin pain, back off and rest to prevent the shin splints from getting worse or turning into stress fractures

Runner’s Knee

The aptly named runner’s knee injury typically occurs due to overuse and creates a consistent pain behind the knee cap and will likely increase in pain as you increase running mileage or intensity. However, overuse is just one potential cause of runner’s knee as some runners are more prone to this injury due to their biomechanics, choice of running surfaces, weak core and hips, have the wrong type or worn down running shoes, or experience a sudden injury to the knee. Beyond the knee pain, some runner’s knee injuries result in swelling and you may feel a popping or grinding in your knee, especially while walking down a hill or stairs.

Properly diagnosing runner’s knee will require examination from your doctor and may involve and MRI, X-Ray, or CT scan.

How to Treat Runner’s Knee

Akin to shin splints, rest is necessary to heal from runner’s knee and begins with following the R.I.C.E. method of rest, ice, compression, and elevation of your knee while lying down or sitting. Icing should be done upwards of 6-8 times a day every 3-4 hours as you compress your knee via patellar straps, sports bandages or sleeves. Anti-inflammatory drugs can assist, but as stated previously should be used with caution due to potential side effects.

If you have any concerns or your pain is not going away, please consult your doctor as they may prescribe orthotics and physical therapy. In extreme cases the doctor may need to perform surgery to address issues of worn down cartilage and kneecap position. Given the potential for greater injury, it is imperative that you rest runner’s knee until fully recovered and work back slowly into your running schedule. If its determined that running can’t be your main activity anymore, there are plenty of alternative activities to stay healthy.

How to Prevent Runner’s Knee

Anything that creates too much pressure on your knee or increases your impact as you strike the ground while running should be targeted in your runner’s knee prevention plan. This includes the following:

  • Strengthening your thigh muscles as these are above your knee and assist with stabilization while running
  • Getting your biomechanics evaluated (your local running store is a great place to start) and adjusting to better running form
  • Ensuring that you have the right type or running shoes that aren’t worn down
  • Avoid running on hard surfaces that increase shock such as concrete
  • Be cautious when increasing running mileage or intensity
  • While getting evaluated for the correct running shoes, determine if you require orthotic shoe inserts, especially if you have an history of foot problems
  • If you feel a nagging pain behind your knee, stop and consult your doctor to get ahead of a potential runner’s knee injury

Iliotibial Band IT Syndrome

Iliotibial band syndrome is one of the most debilitating running injuries as it affects the band of fibrosis tissue running from hip and all the way down to through your knee. This manifests itself as pain in the hip or knee as the IT band rubs across your hip or knee bone, and may additionally restrict movement as it tightens. Flexibility is key in this type of injury and that is why it may feel great when properly stretched but quickly return once the band tightens.

How to Treat Iliotibial Band IT Syndrome

Treatment of IT band syndrome is focused on reducing inflammation while increasing flexibility to critical band of tissue intended to prevent dislocation of the knee and hips. Like other running injuries, backing off our mileage and intensity while properly stretching is critical for targeting this injury. Using a foam roller to release the IT band is also a favorite technique of runners, and in rare cases and ITB release surgery may be necessary to lengthen the IT Band.

Instructions for using a foam roller to release the IT Band:

How to Prevent Iliotibial Band IT Syndrome

Preventing IT band syndrome is heavily focused on flexibility of this critical band of tissue while strengthening the muscles around the IT Band. Improper stretching, such as static stretching, may contribute to this issue so it’s critical to adopt a warm up routine that follows dynamic stretching methods. Common stretches once dynamically warmed up or after your run include the basic IT band stretch to using a foam roller. In the basic IT band stretch you cross one leg over the other and lean slowly towards the hip you have planted (not crossed over). It may be helpful to hold onto a chair for balance.

Use the following video for additional reference on how to stretch your IT band:

From a strengthening perspective, hip abduction and core strengthening is critical for controlling the inward movement of the knee that increases friction on the IT Band.

Achilles Tendinitis

While turning up the mileage or intensity in your running schedule is a great way to build new strength and endurance, overuse of your muscles and tendons can result in injury. A typical overuse injury for runners is Achilles tendinitis where the band of tissue connecting your calf muscle to your heel bone become inflamed. Ignoring and pushing through this pain could result in tears to your Achilles tendon and require surgery.

How to Treat Achilles Tendinitis

Achilles tendinitis is not an injury to push through but one in which you should immediately back off your running routine to a lower mileage and intensity, or take some time off, while adopting a strong rest and ice routine to reduce inflammation. Ibuprofen and other pain medicines can be used, but should be undertaken with caution due to potential side effects. If the pain continues despite your home treatment plan, you may need consult a doctor who may prescribe physical therapy focused on strengthening and stretching the Achilles tendon, provide orthotics supporting your tendon, or surgery in extreme cases.

Many runners complain that their Achilles tendinitis never goes away and this may be due to returning to a full running schedule or increasing intensity too quickly. Listen to your body and make a gradual return gauging if you can run without Achilles tendon pain.

How to Prevent Achilles Tendinitis

Prevention of Achilles Tendinitis is a multi-honed approach where any increase in mileage or intensity should be done gradually while ensuring that you properly warm up and back off if you discover any tendon pain. Cross and strength training play a critical role in prevention as strengthening your calf muscles while taking pressure off of the Achilles with lower impact exercise, such as swimming and biking, allow you to absorb more stress on the Achilles while running. Lastly, one of the most important preventative steps across all running injuries is to ensure that your running shoes are not worn out and properly fit your foot type. A local running store is great place to get evaluated for the proper running shoes.

Sprained Ankle

Ankle sprains can occur while running as you twist foot inward. The pain can develop quickly as the injury is sudden and vary from mild to more severe as the ligaments in the ankle have either stretched or torn. Swelling is bound to occur with a sprained ankle, and while it may feel stable enough to walk on, may cause various degrees of pain…. so you need to listen to the pain and get proper treatment for this injury. Additionally, repeated injuries to the ankle may destabilize the area making it prone to weakness and joint issues.

How to Treat a Sprained Ankle

Fortunately, the majority of sprained ankles will recover given the proper rest, treatment, and stretching/strengthening plan. In rare cases surgery will be necessary to remove torn ligament or repair the ligament all together. They key to recovery from a sprained ankle is rest, following the R.I.C.E. methodology of plenty of rest and pressure off of the ankle, an icing regime of 20 minutes every two to three hours, compression of the ankle with elastic bandages (many of which can be found at your local convenience store), and elevation of the ankle.

Additional support of the ankle with a brace may also assist with recovery, but be careful not to become co-dependent on your brace as wearing a brace unnecessarily can cause compensation issues. Pain medicine may also assist with the reduction in swelling and inflammation but should be taken with caution due to side effects such as stomach ulcers and bleeding.

If your doctor deems it appropriate, some stretching and strength exercises can be incorporated as part of your recovery only after the sprain is well on its way to healing. As this injury is one that can re-occur if not properly treated, please seek out your health care provider if you are unsure about anything as it relates to your sprained ankle.

How to Prevent a Sprained Ankle

Prevention of a sprained ankle is part training of your muscle strength and flexibility and part your running gear. Here are a few tips:

Stress Fracture

A stress fracture can be a side effect of too much repeated force on your bones from running that starts as a dull pain and can worsen into severe pain. A typical overuse injury, those with osteoporosis may be at higher risk from developing these tiny cracks in the bone. Due to the nature of running, stress fractures tend to occur in the feet or lower leg bones where the applied repeated pressure of running is focused.

This does not mean to state that running will cause you to have stress fractures, but rather that until muscles are properly conditioned they won’t support your bones enough for the level of impact you are throwing at them. This is why it is imperative to work into any running program and listen to your body. When you have pain, there is good pain that normally occurs as your muscles are sore and bad pain such as something a sudden pain while running. As stress fractures can re-occur, it is better to back off then to increase your risk of re-injury.

How to Treat a Stress Fracture

Stress fractures will normally heal with adequate rest, a routine of regular icing to reduce pain, and slowly working back into your running schedule. If find that the pain continues you should visit your doctor as they may be able to properly diagnose your stress fracture via an MRI, X-RAY, or Bone Scan before placing you on a treatment plan that focuses on reducing the weight placed on the bone while it heals. This may require a brace, walking boot, or crutches depending on the severity of the stress fracture. In rare cases, surgery may be required.

How to Prevent a Stress Fracture

Prevention of a stress fracture is a multi-honed approach. First focus on slowly working into your running schedule to allow your muscles to develop before increasing mileage and intensity. Even the most seasoned veterans get stress fractures as they push too far too quickly. Second, ensure that you have the proper running shoes that fit your foot type and are not worn out. This may include orthotics to support fallen arches. Your local running store is a great place to get fitted with the right running shoes for your foot type. Lastly, low levels of vitamin D or osteoporosis can contribute to stress fractures so it’s critical to speak with your doctor before beginning a new running routine.

Muscle Strain or Pull

A muscle strain or pull can be initially very scary when the injury occurs as some may feel a distinct “popping” sensation. If you have ever seen a professional runner grab at a hamstring injury, it is usually a muscle strain or pull. Caused by excessive pressure on muscles when running, a tear to the muscle may generate swelling, lack of mobility, weakness in the torn muscle and surrounding tendons, and pain while resting. The limited mobility and ongoing pain with possible swelling can be the most frustrating aspect of a muscle strain or pull.

For runners, commonly pulled or strained muscles include the quadriceps, hamstrings, groin, and calves. In extreme cases, you may need to seek immediate medical attention, especially if develop a fever, hear a “popping” sound when the injury occurred, are unable to walk, have any open cuts or swelling. In short, when it doubt get it checked out, as your doctor will need to determine the spectrum of the injury which can affect the treatment plan and possibly necessitate surgery if the muscle is partially or completely torn.

How to Treat a Muscle Strain or Pull

Most muscle strains or pulls can be treated via a strong adherence to the R.I.C.E. methodology of resting, adopting an icing routine of 20 minutes on for every hour that you are awake, compression with elastic bandages (many of which can be found at a local convenience store), and elevation of the injury. It is critical to protect the muscle from further injury by following this plan as soon as it is possible after the injury being careful not to apply too much compression by wrapping the elastic bandages too tightly around the injury, while reducing any activities that utilize the muscle.

The use of anti-inflammatory drugs may assist, but be very cautious of the side effects of theses medicines. As stated previously, if you are not recovering or have any doubts, seek out a doctor for a thorough analysis. Lastly, don’t rush back into your regular running routine, but rather slowly work back into running after completing any necessary physical training and possibly reducing the amount of running you do while cross training until you are confident that the muscle strain or pull has resolved.

How to Prevent a Muscle Strain or Pull

Preventing a muscle strain or pull focuses on a proper stretching routine and strengthening of your muscles. In this instance, adopt a dynamic stretching plan before running while performing static stretching after you run. This allows the muscles to slowly warmup and not be subject to sudden force that could result in a muscle tear. Strengthening your muscles is achieved by not only running, but by cross training and strength training.

Blisters

Blisters not only look painful, but feel painful as well. These fluid filled sacks residing on the surface of the skin develop due to repeated friction against the foot, especially the longer distance you run. These should not be ignored but properly treated as infections can pop up ranging from a bacterial infection requiring increased medical attention to a potentially life threatening condition called Sepsis. If that’s not gross enough, blood blisters can also occur if blood vessels rupture.

How to Treat Blisters

Fortunately, most blisters are highly treatable but require caution to prevent infection. It is important to properly drain your blister with a sterile needle by wiping it clean with alcohol to sterilize it. Do not use fire to attempt to sterilize the needle as this may inject carbon into your skin, further agitating the wound. Before you drain the blister, ensure that you have also thoroughly washed your hands or have sterile gloves on. Once the liquid is drained from the blister, you will want to wrap the affected area with a tight bandage and regularly replace the bandage. It is also advised to leave small and blood blisters intact as the risk of introducing bacteria into your blood stream is increased. If you have a blister residing under your nail or are uncomfortable draining your blister, check with your health care professional for assistance.

How to Prevent Blisters

Preventing blisters while running is focused on proper moisture in your feet, as dry feet are more likely to develop blisters, and wearing the right socks and shoes. Not having the proper or worn out shoes can contribute to blisters, especially if they are the wrong size. There is also a full range of specialty running socks that help prevent blisters due to their reinforced and synthetic nature.

Sources/Further Reading on Running Injuries

Plantar Fasciitis

10 Common Running Injuries: Prevention and Treatment

The 5 Most Troublesome Running Injuries

Iliotibial (IT) Band Syndrome

3 Ways to Conquer IT Band Pain

Achilles Tendinitis

Muscle Strain

Shin Splints

Runner’s Knee

How to Beat Runner’s Knee

Ankle Sprain – Overview

Ankle Sprain – Pain Management and Treatment

Stress Fractures

Blisters

11 comments

    • Team MTF Post authorReply

      Thanks Maureen! This is a great resource that will help others struggling with Plantar Fasciitis.

  1. Malcom Procaccino Reply

    A determination about a diagnosis of plantar fasciitis can usually be made based on a person’s medical history and physical examination. Another treatment technique known as plantar iontophoresis involves applying anti-inflammatory substances such as dexamethasone or acetic acid topically to the foot and transmitting these substances through the skin with an electric current.

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