How To Detect And Treat Running Injuries

By Brian Fullem, DPM

   Many runners will consult a podiatrist for their initial physician visit for lower extremity injuries. Diagnosing and treating the most common running injuries requires finding the cause of the injury and going beyond simply treating the symptoms. Injured runners will often show up in the office with a bag full of old running shoes, a training log and a self-diagnosis. In my practice, runners tend to be the most well-informed patients and simply advising these patients to refrain from running could lead to them seeing another doctor.    When seeing a runner for the first time in the office, one must gain the athlete’s trust by demonstrating a knowledge of training principles and running shoes, and have the patience to listen to the patient describe his or her injury and training history. Any changes in training, running shoe model or overuse prior to the injury may provide an important clue to making the proper diagnosis and determining the cause of the injury. One should also perform a static biomechanical examination as well as a gait examination with and without shoes. It is helpful to have staff advise runners to bring their running shoes and shorts to the initial visit so one can properly visualize the entire lower extremity during the exam.    Plantar heel pain is one of the most common complaints in any podiatry practice. Due to the frequency with which plantar fasciitis is diagnosed, physicians sometimes fall into the trap of predetermining this diagnosis before considering all the facts. The patient history is of utmost importance when it comes to narrowing one’s differential diagnoses. If the runner has seen other physicians, had prior treatments (including injections, physical therapy and orthotic devices) and has seen little improvement, plantar fasciitis should not be one’s only focus. Also keep in mind that patients can get plantar fasciitis even if they have orthoses.

Pertinent Pointers On Diagnosing Plantar Fasciitis

   Classic plantar fasciitis presents with increased symptoms with the first steps in the morning and more pain at the start of a run that can subside with activity. These patients will typically experience worse pain later in the day or the next morning after running.    These patients will usually have focal pain at the plantar medial or middle aspect of the calcaneus. Differential diagnosis should include tarsal tunnel syndrome, neuritis of the first branch of the lateral plantar nerve, flexor hallucis longus tendonitis and calcaneal stress fracture. If the pain is getting worse during activity and the patient’s first steps are no longer the most painful time of the condition, then plantar fasciitis may no longer be the primary diagnosis.    Applying a plantar (arch) strapping may be helpful in clarifying the diagnosis. Plantar fasciitis almost always feels better when the arch is taped and supported. One can instruct the patients to tape themselves. Patients may also continue running during treatment as long as symptoms improve during this period. If the taping is beneficial, this may guide future treatment and possibly indicate that a custom orthotic device should have a higher degree of success.

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