When Treadmill Running Causes Foot Pain

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When Treadmill Running Causes Foot Pain
Clinical Editor: Nicholas Sol, DPM, CPed

Q: How do you treat conditions associated with treadmill use?
For plantar fasciitis, Dr. Borovoy emphasizes stretching of the gastro-soleus and maintains biomechanical control with orthotics. He uses ice and NSAIDs to combat inflammation. He also discusses proper training techniques with the patient and the importance of decreasing inclines when using a treadmill.
When it comes to hip pain, Dr. Borovoy usually notes a tight iliotibial (IT) band and pain with palpation of the superior attachment. His treatment for this is the same as for plantar fasciitis and he recommends specific stretching for stretching the IT band.
Since most knee pain is secondary to a shortened stride with treadmill use and pronatory forces, Dr. Borovoy recommends counseling the patient on appropriate training, decreasing the use of inclines and adjusting one’s speed appropriately in addition to orthotic control.
In all cases, Dr. Beekman advises his patients to lower the incline of the treadmill. For the plantar fasciitis, he tapes the affected feet and fabricates orthotics if the taping does not lead to permanent relief.
If equinus is an aggravating factor, depending on the situation, Dr. Beekman emphasizes stretching after pre-fatiguing with electrical stimulation, heel lifts and/or night splints.
When treating Achilles tendonitis, Dr. Beekman institutes treatment in three phases: rest, transition and rehabilitation. The transition stage consists of Achilles taping, stretching after pre-fatiguing with electrical stimulation, ultrasound and heel lifts. The rehabilitation stage entails stretching after pre-fatiguing with electrical stimulation, ultrasound, heel lifts and night splints.
Dr. Beekman adjusts his treatment depending on the severity of the patient’s condition, starting treatment at the appropriate phase. His more severe patients start at the rest phase while the least severe patients will start at the rehabilitation phase. He adds that he will use a CAM walker during the rest phase in severe cases.
In Dr. Sol’s experience, orthotic management alone is often insufficient to treat treadmill related plantar fasciitis and intermetatarsal neuroma. In addition to custom orthotic management, he often uses steroid infiltration. He combines this with a prescription for new athletic shoes and emphasizes changing the exercise routine by decreasing exercise time and incline, and increasing rest.
As for intermetatarsal neuromas, Dr. Sol has discovered, like many of his colleagues, that sclerosing injections are a “very useful therapy.”

Dr. Beekman is a Diplomate of the American Board of Podiatric Surgery and the American Board of Podiatric Orthopedics and Primary Podiatric Medicine. He is also a Fellow of the American Academy of Podiatric Sports Medicine.
Dr. Borovoy practices in Novi, Mich. and is Chief of Podiatric Surgery at Providence Hospital in Southfield, Mich.

Dr. Sol (shown here) founded the Walking Clinic, PC and practices in Colorado Springs, Colo. He is a consultant to Tekscan.

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