RUNNERS TAKE
YOUR MARK!
April, 2002, Warrenville, IL - Now
that the cold and gloomy weather of winter is behind us,
many area athletes have been dusting off their running
shoes and getting ready for the summer. While many are
eager to improve their personal best times, it is important
to train effectively in order to prevent some common running
problems that may spoil their goals.
Three common problems that may affect runners in the
early spring and summer training season are shin splints,
plantar fasciitis and Achilles tendonitis.
The first common problem, shin splints, is a form of
medial tibial stress syndrome. This is a condition that
commonly affects runners but may also affect athletes
in other sports. It is marked by pain along the inside
border of the middle and far end of the lower leg bone,
known as the tibia. Typically pain is exacerbated by exercise
and partially relieved by rest. Occasionally there is
swelling in the lower leg as well. Causes of shin splints
may be related to overload, excessive training, excessive
flatfoot or pronation, or running on indoor track banked
surfaces. It is usually due to an inflammation of the
thick outer covering of the muscles of the lower leg and
the covering of the bone, known as the periosteum. Treatment
of shin splints usually involves rest, well-cushioned
shoes, exercise and stretching. A soft arch support may
be helpful in runners who tend to over-pronate. Different
braces are also available that runner can wear during
the rehabilitative process to help lessen discomfort and
pain.
The second problem, plantar fasciitis (fah-shee-i-tis),
is a very common cause of heel pain in runners and non-athletes
alike. The plantar fascia is a thick tendinous band of
tissue that runs from heel bone, or calcaneus, into the
forefoot. This tendinous tissue helps maintain that arch
of the foot. Plantar fasciitis refers to an inflammation
of this tissue. It is caused by microtears, repetitive
microtrauma and chronic inflammation in this tissue. Pain
may be in the heel or further down the arch. Patients
usually give a history of severe pain when first getting
up out of bed in the morning or after sitting for a period
of time during the day. Usually, the pain will get better
as they walk or as the tissue warms up. Runners usually
exacerbate these symptoms, especially with hill climbing
and sprinting. Often it is associated with poor flexibility
and tightness of the heel cords. Treatment for plantar
fasciitis involves an aggressive heel cord-stretching
program, anti-inflammatory medications, such as ibuprofen
or Naprosyn, and cushioned heel cups for the shoes. Expensive
or custom-made orthotics are not necessary in the majority
of patients with heel pain. Injections are sometimes necessary
if symptoms do not improve after six to eight weeks of
conservative treatment. Occasionally, persistent pain
may be alleviated by the use of night splints, keeping
the soft tissues stretched overnight. In the worst-case
scenario, a period of casting or immobilization may be
necessary. Surgery is rarely necessary for this problem
and most of the time it is self-limiting.
The third problem plaguing runners, Achilles tendonitis,
is an inflammation of the Achilles tendon. This tendon
is the largest tendon in the body and connects the calf
muscles to the heel bone. Many events may trigger an attack
of Achilles tendonitis. These may be rapidly increasing
running mileage or speed, adding hill running or stair
climbing to your routine, starting up too quickly after
a layoff, trauma caused by sudden contractures of the
calf muscles, or overuse secondary to lack of flexibility
of the calf muscles. Symptoms of Achilles tendonitis may
include mild pain after exercise or running that worsens,
a sense of sluggishness in your legs, episodes of diffuse
or localized pain along the tendon during or a few hours
after running, morning tenderness about 1-1/2 inches above
where the Achilles attaches to the heel bone, stiffness
in the Achilles or ankle that improves with exercise,
or mild swelling. Treatment usually involves rest, cross
training with other activities that do not stress the
Achilles, anti-inflammatory medications, heel pads to
shoe inserts such as a heel lift, bandages or braces to
restrict motion of the tendon, stretching, massage, ultrasound
and exercises to strengthen the muscles in the front of
the leg and ankle. Surgery is extremely rare for this
problem and is an option of last resort.
The American Orthopaedic Foot and Ankle Society suggests
six steps to reduce the risk of incurring a running injury:
