Sometimes going up a size in your trainer or choosing a wider fit will help. A complete change of trainer brand and style might also be the answer. It can take time to find the perfect fit and our feet do change over the years, so it’s not necessarily one brand and size for life.
Nerves can also be compressed by the surrounding structures, such as swollen or tight muscles, cysts or bony overgrowths. Often the place where they are compressed is higher up the body than where the numbness is felt. A good example of this is a numbness under the foot which comes from a slipped disc in the lower spine. Sometimes a foot numbness can be due to a thickening of nerve tissue called a Morton’s neuroma (see here).
Rarely, foot numbness, also called peripheral neuropathy, can be due to an underlying medical condition. Peripheral nerves (those in the extremities of the body) can be damaged and not function properly due to a range of underlying causes, including diabetes (most common cause), an underactive thyroid, excessive alcohol and deficiencies of certain vitamins, particularly vitamin B12. If both feet are numb, then this makes a medical condition more likely. If you’ve tried to solve your foot numbness yourself with no luck or you have other symptoms alongside it, then you should see your doctor.
Q Why do my feet hurt when I run?
A Pain in the feet can come from a variety of causes depending on which structure is the source. Here are some of the commonest causes:
• Muscular pain Pain from strained or over-worked muscles. It’s common if you’re building up distance, running on uneven ground or in the wrong shoes. Pain and tenderness is usually felt over the affected muscle, and pain is aggravated by using and stretching the muscle.
• Plantar fasciitis Pain in the heel and sole of the foot (see here).
• Tendonitis Pain from inflamed or strained tendons from over use or injury. Pain at the back of the foot may be due to Achilles tendonitis. The tendons running just below the knobbly bits on the inside and outside of the ankle (medial and lateral malleoli) are common sites too, resulting in pain in the side of the foot arch where they attach to the foot bones.
• Metatarsalgia Pain in the heads of the metatarsal bones. Felt in the ball of the foot, this may give the sensation of standing on a pebble, and is usually due to increased intensity and volume of running. There are multiple other causes, including obesity, high-heeled shoes and arthritis.
• Morton’s Neuroma Another cause of metatarsalgia. This is common in runners (see here).
• Nerve pain A compressed nerve can cause pain, tingling and numbness. Nerves can be trapped, irritated or over-stretched at any point along their journey from the spine to the foot, so even if the pain is felt in the foot, the problem could be in the back. This is often painful at rest.
• Stress fracture An over-use injury, stress fractures are more likely in those who have osteoporosis (low bone density). They tend to occur in the metatarsal or calcaneus bones of the feet. They require prolonged periods of rest and a gradual return to running (see here).
• Arthritis A ‘wear and tear’ arthritis or a more aggressive arthritis such as rheumatoid arthritis can affect foot bones. Pain, stiffness and swelling result from loss of cushioning cartilage. It’s still important to exercise as much as you are able to (see here).
Clearly, differentiating between all of these can be tricky and foot pain can take time to diagnose. If you’re unsure, then try a brief period of rest and a gentle return to activity. If your pain persists, seek a diagnosis from a health care professional.
TRY THIS
AT HOME
Foot-strengthening exercises
Often you don’t need support in your running shoes, you just need stronger feet! Here are four simple things you can do to improve your foot strength:
1 Walk barefoot whenever you get the chance.
2 While sitting on a chair, put both feet on the floor (barefoot is best). Raise your heels, keeping the ball of both feet on the ground. Hold for five seconds. Then raise the ball off so your weight is just on the tips of your toes. Hold for five seconds. Slowly lower your foot, working back through the toes and the ball of the foot on the way down. Repeat ten times.
3 While sitting at your desk, place both feet on the ground and scrunch your feet up, drawing your toes in and foot arch off the floor. Hold for five seconds then relax. Repeat ten times.
4 Sitting or standing, put a large piece of paper or tissue on the floor. Place your bare foot on it, and try to grip the paper and lift it off the ground. Place it back down again. Repeat ten times.
Q I’ve been told I have plantar fasciitis. What exactly is it and do I have to stop running?
A Under the skin on the sole of your feet there’s a tough connective tissue, extending from the heel bones right up to near the base of the toes, called the plantar fascia. When you add ‘itis’ on to anything in medicine it means inflammation, but we no longer think that much inflammation is involved in plantar fasciitis (PF) beyond the early stages of the condition. The plantar fascia helps to support the arch of the foot and absorbs some of the force when the foot strikes the ground. Acting almost like an elastic tissue, the fascia turns strain into propulsive energy, pushing you forwards as the tension is released when the foot leaves the ground.
We don’t understand why PF happens. It has been thought to be due to the force of landing, but that doesn’t explain why people with sedentary lifestyles suffer from it too. Studies looking at the relationship between PF and the Achilles tendon show that when PF is present, the Achilles is often thickened and the muscles at the back of the leg are often tight. This is a bit of a chicken and egg situation, because we don’t know which came first. It seems to happen in runners who increase their distance or intensity of training rapidly, so beginners often get it. It’s almost certainly linked to running biomechanics, possibly the strength of your foot arch, how your foot hits the ground, your shoes and a host of other factors that are very individual.
When you get PF it becomes painful to put your foot on the ground – or you might be unlucky and have both feet affected at the same time. Pain is usually felt around the heel, especially when you first get out of bed in the morning and when walking barefoot. Initially the pain eases up with gentle walking, but sometimes PF progresses until it’s felt continuously.
So, what can you do about it? PF usually goes away eventually, but it can take six months to a year. It’s best to rest initially and let any inflammation settle down. Avoid doing anything that aggravates the pain. You’ll probably have to stop running but if running isn’t making it hurt then there’s no real reason not to carry on. You can use ice packs and anti-inflammatories such as ibuprofen in a gel or tablet form. Heel pads can take the pressure off the fascia and choose whichever shoes feel most comfortable.
Stretch out the fascia by doing exercises such as sitting with your legs outstretched in front of you and using a scarf looped around the ball of your foot to bring your foot towards you. Rolling a frozen water bottle or a golf ball under your foot can give relief too. Because of the link with the calves and Achilles, it’s a good idea to do stretches that lengthen your calf muscles. An assessment by a physiotherapist will help identify any specific triggers from your own biomechanics. Other possible treatments include steroid injections, night splints such as the Strassburg Sock, which keeps your foot flexed and stretched while you sleep, and Extracorporeal Shock Wave Therapy, where low-energy sound waves are passed through the skin to the injured area of the foot in order to increase blood flow and speed up the healing process. However, results can be very varied. Go back to running gradually, when you’re pain free, and continue with the stretches to help keep it at bay.
Real-life runners
Without over-exaggerating, I felt plantar fasciitis was the end of my running year and so I tried everything to get rid of it as quickly as possible. My physio put me straight, there was no quick fix. Time was the best healer but I feel the Strassburg Sock and transitioning to low drop shoes [where the diffe
rence between the thickness of the sole at the toe and heel is small] helped. Everything else I did in those eight months was pain management.
Darren Smith, writer and runner
Q My GP thinks I have a Morton’s Neuroma. Has running caused this?
A Morton’s Neuroma is one of many causes of metatarsalgia (pain in the metatarsals). It’s caused by thickening of one of the nerves that run between the metatarsal bones, usually the second, third or fourth metatarsals. Pain, tingling or numbness can be felt in the area of the affected nerve and people say it feels like there’s a pebble under the ball of their foot when they walk. It usually presents in one foot, around age 50, and is more common in women than men. Runners are at high risk of a Morton’s Neuroma due to compression and irritation of the nerve when the feet repeatedly strike the ground. The pain can come and go or be continuous. One third of people get better with rest, comfortable footwear and metatarsal pads inserted into shoes (these are available to buy over the counter). Steroid and local anaesthetic injections can help relieve symptoms and there are surgical procedures to cut out or make more room for (decompress) the nerve if symptoms are ongoing.
Q Which part of my foot should I land on when I run?
A The issue of how your foot should strike the ground when you run is a very controversial one. There are essentially three options: forefoot, midfoot and hindfoot. With a forefoot strike you land on your toes and ball of your foot. Midfoot means landing on the centre of your foot (your heel and ball of the foot strike the ground simultaneously) and with a hindfoot technique your heel strikes the ground first. Start observing people’s feet and you will see runners using all three of these landings. Beginner runners and those who run more slowly over longer distances often use the hindfoot landing, also known as heel striking. The faster you run, the more likely it is that you’ll have a forefoot landing, it’s hard to find a sprinter who heel strikes.
Heel striking has had very bad press and runners (myself included) have been encouraged to move to a midfoot strike. The reasons for this make a great deal of sense to me. With a marked heel strike, when you land you are essentially putting on a brake. Your body weight is behind your foot and you have to overcome that backwards force in order to move forwards. That’s not helpful when it comes to running efficiency. The leading leg is outstretched, often with a locked-out knee at the time of impact, putting pressure on the knee joint in a direction that it wasn’t designed for. In addition, you can’t benefit from the propulsive power of your foot arch to help you spring forwards. Compare this to a midfoot landing where your body weight is directly over your knee as you land, everything is aligned, and the foot arch can then flatten onto the ground and propel you forwards as it shortens when you lift off.
Heel striking is very common because of our sedentary lifestyle. When we sit for long periods we develop weak glutes and tight hip flexors. Instead of being upright and having our pelvis tucked underneath us when we run, our hips sink down, bottom sticks out and we run as if we’re still sitting on a sofa. We run as if we’re walking and the two are different. Running is actually jumping, because there’s a time when both feet are off the ground.
With a marked forefoot landing, bodyweight is usually ahead of the landing leg. If you take your shoes off and run barefoot you’ll probably find that you land on your forefoot or midfoot. Most people do. Many choose to run barefoot or in very minimalist shoes, believing we’re designed to run barefoot, and because they have found they have fewer injuries and better running performance. However, while heel striking can lead to knee injury, there’s significant concern that a strong forefoot landing leads to more Achilles injuries. If you watch someone who is purely forefoot running, you’ll observe that their calf is continuously under tension and it’s easy to see how that can lead to Achilles tendon problems.
Q Should I try to change my foot strike?
A Some people argue that, no, you shouldn’t. Everyone is different and just do what comes naturally. Some running is better than no running, regardless of how you land. To a certain extent I agree and I certainly wouldn’t advocate changing your foot strike yourself without the advice of an experienced running coach. It should only ever be done very gradually and it can take years for it to become natural. However, if you have certain issues or injuries, want to address a plateau in your running speed or just feel that your running isn’t optimal, then it’s worth seeing a running coach who has experience in running gait. There are other simpler things they may suggest prior to focusing purely on your feet, including improving your posture, shortening your stride and increasing your running cadence. These in themselves may be enough to give you the outcomes you want. All of these will most likely encourage your body away from a heel strike and towards a midfoot strike. In the meantime, I continue my personal endeavour to master a subconscious midfoot strike.
Did you know?
There are 28 bones and over 100 ligaments in each of your feet.
Q I’ve got pain at the back of my ankle. Is it my Achilles and can I carry on running?
A This could well be pain from your Achilles tendon as it’s a fairly frequent problem in runners. You need to be a bit careful here, because ignoring it and just carrying on running risks long-term damage. The Achilles tendon connects your calf muscles (the gastrocnemius and soleus) to your heel bone (the calcaneus). When the calf muscles contract, the tendon helps to lift the heel off the ground. Running can put a lot of stress on the Achilles, particularly if you increase your frequency or distance of running too quickly, and if you do a lot of hill running or speed work. You might have heard of Achilles tendonitis, which was thought to be a simple inflammation of the tendon from over use, but we now know that although there may be some initial inflammatory changes, over time, microscopic injury, including tears, occur in the individual tendon fibres. The tendon may thicken and become stiffer to protect itself. This is more accurately called Achilles tendinopathy. The structure and strength of the tendon is altered, and if ignored then it can ultimately lead to weakening and, at worst, complete rupture (tearing) of the Achilles.
Don’t ignore Achilles pain, swelling, thickening or lumps. Taking early action can prevent a lengthy recovery, prolonged time off running or a potential tendon rupture. First you should rest to take the strain off the Achilles. Apply ice (15 minutes several times a day), gently massage or foam roll your calf muscles to relax them and consider taking an anti-inflammatory. This should help to ease the initial symptoms, but you then need to move onto a longer-term strategy to strengthen your calf muscles and look for underlying causes. If it was simply increasing your distance too quickly, then a period of rest and a gradual return to running with adequate rest days may suffice, but it may be more complicated than this. Poor biomechanics, muscle imbalances, tightness and weakness can all lead to Achilles problems. This is a specialist area and I highly advise seeing a physiotherapist who can tailor a recovery programme to your exact situation. With careful management you can avoid or at least reduce your chances of long-term Achilles problems.
Real-life runners
My Achilles issues were improved by getting some professional help from a specialist chiropractor. She taught me great stretching techniques and, being a runner herself, understood the mental side too – the drive to have to run! Following her advice, learning techniques to improve my stability and mobility, plus my investment in some compression socks, has really helped.
Mike Whelan, runner and Leinster Rugby fanatic
Q I’ve sprained my ankle. What’s the best way for me to get back to running as quickly as possible?
A Don’t underestimate the common sprained ankle. Even though no bones have been broken, a sprain can cause significant problems. Ligaments stabilise joints and when sprained they get overstretched and torn, for example by going over on your ankle. The pain, swelling and any instability of the joint needs careful management to get you back running as soon as possible. Good rehabilitation of ankle injuries is crucia
l if you want to return to full strength.
Use the PRICE protocol (see here) as first-aid for your ankle and assess how severe your injury is. If there’s no swelling, and you can still weight-bear without too much difficulty, then you’ve got a minor sprain and might be running again after two weeks. If the pain or swelling is immediately very severe, or you’re still unable to weight-bear after two days of PRICE, then you need to be medically assessed in case you have broken a bone. Assuming no fracture is seen, then it’s a case of working hard and being very patient, because severe sprains can mean four to six months off running.
Rehabilitation focuses on getting flexibility, strength and stability back in your ankle. It’s best to be up and about, gently mobilising, as soon as you can. In the first couple of days start by gently flexing and extending your ankle several times through the day. Try using a towel looped under your foot to gently pull it towards you. Build up to rotating it and writing the alphabet in the air with your foot by the end of the first week. Then you can start to do some strength work, gently pushing your foot into the ground, aiming to be able to stand on one leg. Try going up and down on your toes (calf raises), with both feet at once in the early stages. You can do this sitting in a chair if standing is too hard initially. Once you feel confident and strong with up and down movements, then add in some sideways and twisting ones, such as standing on one leg while twisting your body, side stepping and walking in a figure of eight. If at any point your ankle begins to swell more then it’s a sign that you’re doing too much. Elevate it, reduce your activities and then slowly build up again. You may want to invest in an ankle support or get a physiotherapist to advise you how to tape your ankle.
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