Foot pain during or after a run is definitely frustrating, especially if you aren’t sure what’s causing it. Your feet are pretty complex, with each containing 33 joints, 26 bones and more than a hundred muscles, tendons and ligaments. Very clever biology, but a lot of opportunities for things to go wrong.
It’s no good simply wrapping your foot in a bandage and ‘running through it’ – never a good idea! What starts as a small pain can soon become a much bigger one, or worse, an injury that forces you to take a longer rest and recovery period than you want to.
So let’s do a deep dive on all the types of foot pain you might experience when running, the causes of each one, the symptoms, the treatment options, and – what we’re all about here at The Feets – the opportunities for prevention.
We believe preventative, active foot care can keep your feet feeling their best so you can achieve your biggest goals. To keep you in the know from heel to toe, here are 9 common foot problems runners may encounter, and how to prevent them from ruining your training.
Fat Pad Atrophy
Fat pad atrophy affects the thick pad of fat located under the heel. This pad aids in shock dissipation, which comes in handy with forces of 110% of body weight when walking, and 250% of body weight when running. The fat pad can absorb up to 80% of the energy at foot strike.
Fat pad atrophy means the heel can become thin and irritated due to repetitive stress or trauma, and the result is heel pain that can make it difficult to bear weight on the affected foot. This is the second most common cause of heel pain (14.8%) after Plantar Fasciitis (53.2%).
The heel fat pad tends to become thicker from ages 5 to 44 years old, and thinner from ages 44 to 96 years. As the fat pad thins, there is reduced shock dissipation and therefore greater stress on the heel bone, known as the calcaneus.
Repetitive stress, trauma, or an inability to cope with shock dissipation can cause the heel fat pad to become irritated, with degenerative changes occurring. This can lead to even greater stress and reduced shock dissipation. Women tend to have a naturally thinner heel pad than men, which could place them at greater risk of injury.
If you notice a deep, bruise-like pain in the middle of your heel when you stand, or when you press on it with your finger, this could be fat pad atrophy. The pain may also increase the longer you stand, walk or run.
Factors like age, body weight and family medical history can all contribute to fat pad atrophy, plus your occupation could play a role if it involves standing for long periods of time or taking part in repetitive activities. Excessive over-striding with high braking forces (the energy directed into your leg, from front to back, when your foot first hits the ground) is one of the main contributing factors to heel pain when running, as well as walking at fast speeds. This is due to fatigue of the tibialis anterior eccentrically slowing the foot down from foot strike through to mid-stance, and therefore increasing stress on the heel fat pad.
Treatment for this condition is mainly rest, applying ice, wearing cushioned footwear, and using orthotic insoles. If you’d rather prevent it in the first place (good call!), avoid walking or standing for long, walk slower if you are at risk of this condition, pay attention to your choice of footwear (more specifically, the cushioning in the sole), and ensure you have good running technique that reduces over-striding. You may also want to do exercises to strengthen your tibialis anterior if you have increased risk of developing fat pad atrophy.
Athlete’s Foot
Athlete's Foot is a common fungal infection affecting the skin of the feet, causing discomfort and pain during and after a run. It can cause itching, stinging, burning and cracked and peeling skin between the toes and elsewhere.
Athlete’s Foot is contagious and tends to grow in warm, moist environments… like those sweaty shoes you never disinfect. You can catch it in places like a public pool, shower or anywhere you share space with someone who has it and is walking around barefoot. If you’re regularly running in wet grass and mud for hours at a time (just like me) then you might also be more prone to this.
If you do catch it, it’s unlikely to go away on its own, so you might need to visit a doctor to prescribe topical antifungal treatments, or you can purchase them over-the-counter. But I prefer preventing it in the first place, and so a regular hygiene routine is key if you are prone to Athlete’s Foot; wash your feet with soap every day, dry your feet thoroughly and in between your toes properly (do this after running on wet terrain, too), never re-wear socks, dry your shoes every day (put them in the airing cupboard), and avoid being barefoot in public areas.
I also like to use a tea tree foot anti sweat powder to help keep my feet dry on runs - prevention is always better than trying to handle something after it happens. There are plenty of great natural antifungal drying powders on the market - I’d recommend having a look around and finding one that works for you.
Ingrown Toenails
An ingrown toenail is basically what it sounds like; a toenail that grows into the skin where it’s not supposed to grow. This may seem like a small issue, but it can quickly become a big one, and can cause a dull throbbing pain or sharp pain. The surrounding skin may be inflamed and painful, and this may become worse as you run and continually put pressure on the toe. It could also look red, swollen, hot, or may be secreting pus. Safe to say that ingrown toenails aren’t pretty!
They tend to happen when nail trimming is done incorrectly or infrequently, or due to tight-fitting shoes or a foot injury. You can treat ingrown toenails by soaking your foot in warm water until the skin around the toenail becomes soft enough to lift, and you can trim the affected nail with some good quality clippers or toenail scissors. When doing this, remember to keep the area clean.
In some rare cases, ingrown toenails can be severe and may need intervention from a podiatrist. Don’t worry though, you can prevent ingrown toenails by trimming them regularly, never cutting them too short, cutting straight across and avoiding the edges, and wearing shoes that fit comfortably.
Bunions
Bunions, otherwise known as Hallux Abducto Valgus, are bony bumps that usually form at the base of the big toe, causing it to point inward toward the other toes. Bunion pain can occur during and after a run, and can also be a problem when walking due to possible joint inflammation and deformity.
The signs of a bunion include a bulge or bump on the side of the foot near the big toe, swelling or redness in the affected area, and limited movement of the toe. They can be caused by a combination of factors, including a family history of bunions, an imbalance in the foot's structure, or excess pressure on the big toe over years (perhaps caused by poor fitting shoes, both casual and running).
Initial treatment for bunions includes:
- Cushioned bunion pads or orthotic devices, especially if there is instability
- Medications to reduce inflammation
- Surgery, in extreme cases with a notable deformity
When it comes to future prevention of bunions:
- Ensure your footwear has sufficient depth and width to accommodate your feet, and that the toe box shape of your shoes matches the shape of your foot. Remember, shoes can vary in size by up to a full shoe size, depending on the brand and type of shoe. For this reason it is important to get your feet measured while trying on footwear and ensure they fit correctly.
- Spend as much time as possible barefoot, as this helps your toes to spread more naturally. It can also help to elevate your feet regularly.
- Invest in orthotic insoles and do foot exercises to realign your feet - we did a whole other blog on bunion exercises that's well worth a read.
- I also use toe spacers, as this seems to help push gaps into the toes where they were not before - there’s actually not really any scientific evidence to support this as a method of bunion prevention, in fairness, but I feel like it helps!
Metatarsalgia
Metatarsalgia is essentially an umbrella term for pain that affects the forefoot, meaning the front of the foot or the ball of the foot. The most common forms of forefoot pain in runners are stress reactions/fractures, bursitis of the metatarsal heads, a plantar plate injury, and Morton's Neuroma.
Metatarsalgia often occurs due to things like overuse, high-impact activities (like running!), shoes that don’t fit properly, or issues with the structure of the foot. With metatarsalgia, you might experience pain in the ball of the foot specifically, which can feel like a sharp pain, an ache, or a burning sensation. You might notice it gets worse when you stand, walk or run.
Other symptoms of metatarsalgia include bruising, swelling, inflammation, numbness, or a feeling of having a pebble in your shoe. It’s mostly caused by sporting activities that result in overuse and pressure on the front of the foot. Running is a prime example of this, but you can also experience it due to wearing ill-fitting shoes or high heels, or foot abnormalities like high arches, bunions, and so on.
Treatment for metatarsalgia includes physical therapy, wearing orthotic insoles, and wearing shoes that better support your foot. If treatment at home doesn’t work, it’s best to visit a podiatrist so they can rule out different diagnoses and understand the mechanism of your injury. To prevent metatarsalgia from forming in the first place, try avoiding shoes that are too tight or too loose, and give your feet a break from high heels. You can also buy metatarsal pads from a chemist, which can help protect this area of the foot and avoid excess pressure.
Plantar Fasciitis
Plantar Fasciitis is a common foot condition causing inflammation and pain in the tissue along the bottom of the foot, known as the plantar fascia. According to research, 1 in 10 people will experience plantar fasciitis in their lifetime. It can cause a dull ache or stabbing pain in the heel or along the bottom of the foot which can feel worse when taking your first few steps in the morning or after sitting down for a long period of time.
Plantar Fasciitis can develop from repetitive stress to the plantar fascia, which is the tissue that runs along the sole of the foot. Women are at a higher risk of developing Plantar Fasciitis, and other key risk factors include being over the age of 40, or having reduced ankle mobility, calf muscle tightness, a reduced fat pad, or a high BMI.
Treatment for this includes stretching, ice, massaging the plantar fascia, orthotic inserts, anti-inflammatory medicines, and shockwave therapy, which has been shown to be the most effective method of reducing pain and speeding up recovery. Research suggests that with treatment, 80% of Plantar Fasciitis patients will see their symptoms improve in 12 months. This is good news, but if you don’t want up to 12 months off training, remember that prevention is better than cure!
You can prioritise prevention by always wearing highly cushioned footwear, reducing the load and stress on your feet by ensuring your BMI is in a healthy range, ensuring you have good ankle mobility and calf strength, and – if you want to increase your training volume or intensity – increase this gradually rather than suddenly. Adding other types of exercise such as cycling can also help to avoid overuse of the same muscles in the feet. There are a number of exercises you can also fold into your training to help prevent Plantar Fasciitis, and we’ll be writing a post on this in future.
Hallux Rigidus
Hallux Rigidus is a degenerative condition that affects the joint in the big toe, causing it to become stiff, or limit the movements you can do with it. According to a study of 604 individuals over 50 years old, Hallux Rigidus affected around 26.7% of participants.
Hallux Rigidus can cause symptoms like pain, stiffness, enlargement of the big toe joint, or you may lose range of motion in your toe. It’s caused by wear and tear on the joint, which can occur from things like standing for too long, cold or damp weather, ill-fitting shoes, or excessive stress on the joint (from running, for example).
Treatment may include changes to the shoes you wear to relieve pressure on the joint, applying ice, soaking the feet, and limiting the movement of your toe with pads or by avoiding certain activities. Various anti-inflammatory medications or natural solutions can also reduce pain and swelling, or prescription medications like corticosteroids can reduce inflammation.
Foot orthoses can also help delay the progression of the condition, and when choosing footwear to prevent Hallux Rigidus, look for shoes with a low heel to toe drop, a stiff forefoot section to reduce flexibility, a rocker style forefoot, and a thick cushioned midsole.
Hallux Rigidus can also develop slowly as you age, so it’s best to take steps to prevent it by regularly exercising so the big toe joint remains mobile, but isn’t overworked – we have a blog post on this coming soon! Also, getting plenty of rest after physical activities, and ensuring you are always wearing shoes with space around the toe area can help.
Achilles Tendinopathy
Tendonitis is a condition in which a tendon in the body swells after injury, and Achilles Tendinopathy means this happens to the achilles tendon that runs from the calf to the heel. Achilles tendinopathy causes pain and stiffness in the heel and/or tendon when walking or running, as well as impaired performance, and swelling in and around the tendon. It can be categorised as insertional (at the heel) and non-insertional (tendon body - that’s the bit where it doesn’t meet the bone!), and is essentially a failed healing response when repetitive loads are above what the tendon can typically cope with.
Typically, it affects those who are over the age of 40, suffer from obesity, have ankle instability, or have lower limb strength deficits, specifically of the calf muscle. If you are a runner, training errors such as running long distances or uphill can lead to Achilles Tendinopathy, as can starting to run mid-forefoot without gradually working up to it.
To treat this condition yourself, you should continue exercising but with a reduced load, so as not to further irritate the area. Ice, compression and elevation can also help with pain if it is insertional (but not for non-insertional). If symptoms are severe, you should rest for 2 to 3 days to relieve pain and allow for recovery, and if the pain is chronic, shockwave therapy and isometric strengthening exercises can help. If you would like a medical opinion on Achilles Tendinopathy, visit a podiatrist or physiotherapist, who may suggest further interventions.
In future, you can reduce your risk of Achilles Tendinopathy by doing exercises to strengthen the calf muscles and improve tendon stiffness to reduce biomechanical risk factors. If you want to increase the volume and intensity of your training, it is best to increase this gradually rather than suddenly. Also, avoid zero-drop shoes (these are flat, so your heel and forefoot are on the same level). Instead, opt for thicker, rocker style midsole shoes that reduce stress on the tendon - but remember that some shoes aren’t appropriate for some types of terrain, so check where you’re planning to run first.
Stress Fracture
A stress fracture is a small crack or bruising in the bone which tends to happen as a result of repetitive stress on a bone or overuse. Since the feet take a lot of impact during sport, they are susceptible to stress fractures; according to research, stress fractures make up over 10% of all sport-related injuries and are estimated to be as high as 30% for runners.
You may find that a stress fracture starts as a dull ache in the foot, but over time this can get worse and pain can increase. The main symptoms of stress fractures include pain that gets worse when running, swelling in the affected area, and consistent pain that continues when resting.
Stress fractures are usually caused by overuse without sufficient time to recover. They can develop over time due to repetitive motions, and treatment includes resting and elevating the foot (no more running for a while!), applying ice, and wearing a compression bandage. Also, over-the-counter anti-inflammatory medications can help with swelling and pain relief, but I prefer more natural anti-inflammatory products such as curcumin or CBD oil. In severe cases, your doctor might suggest using crutches to keep weight off the foot.
You can prevent a stress fracture by stopping exercise as soon as you feel any pain (it never helps to keep running), and doing a sufficient warm-up and cool-down before and after any physical activity.
What to do if you have foot pain
If you experience foot pain while running, don’t ignore it. Using some of the tips above, you may be able to identify the issue and take steps to improve it.
Stress fractures tend to be one of the few conditions that actually cause runners to rest and recover, but every condition mentioned on this list can benefit from taking steps to improve recovery – treat your feet well and they will continue to help you achieve your physical goals.
If you think it could be something that requires a proper check-up from a doctor, such as a stress fracture or metatarsalgia, don’t delay visiting your GP, podiatrist, physiotherapist or another healthcare professional. The longer you ignore a little niggle or injury, the more pain it could cause in the future.
The sooner you address foot pain, you can take the necessary steps to get back on your feet and continue running towards your goals.
So, go get it.
Logan
We’re The Feets. We know what it’s like to set the alarm for 5am, drag yourself out of a warm bed, lace up the shoes that are starting to show the miles, and head out in the grey morning to clock a few Ks before work. We’ve been there, we are there, and we’ve got your back. Follow us on Instagram or Tiktok for stories, motivation, tips and tricks, or just to be part of the growing community of those wanting to make something of themselves.
