Keys To Treating Common Triathlon Injuries

Marybeth Crane, DPM, MS, FACFAS

The combination of a diehard mindset and the stresses triathletes must endure can lead to repetitive injuries. Accordingly, this author provides a treatment guide for common triathlon injuries such as stress fractures, blisters and Achilles tendonitis.

Participation in triathlons has grown at an enormous rate in the last 15 years worldwide. USA Triathlon publishes a demographic study each year and cites over 500,000 participants in races in the United States in 2012 with almost double-digit growth each year since 2000.1

   In discussing triathlon-related injuries, the best approach is to start with a window into the unique world of triathletes. It is necessary to have an understanding of the sport and the stubbornness that is ubiquitous to triathletes to be able to treat this group of athletes successfully in your practice.

   Let us start with the basics. A common perception of what the average triathlete looks like is what people see on TV watching the Ironman World Championships. Namely, people tend to envision an extremely fit, 30- to 45-year-old male with six-pack abs and less than 10 percent body fat. This is simply not the case. There is no “average” triathlete. In my practice, the youngest competitive triathlete is a 9-year-old girl and the oldest is a 78-year-old man. They come in all ages, sizes, shapes and socioeconomic as well as ethnic backgrounds.

   This was extremely apparent when I competed in my first Ironman event. The diversity of the field was amazing to me but the one thing triathletes all have in common is an underlying stubbornness that equates quitting with personal failure. Triathletes quit when their bodies (or equipment) can no longer function. In fact, Chris McCormack (a.k.a. Macca, a multiple Ironman world champion) coined a mantra that pretty much explains the attitude of most triathletes. The mantra is “embrace the suck,” which means that in a race, you look your inner weakness in the eye and embrace the suffering to make it to the finish line. Quitting is not an option.

   This is a tough group to treat because of this underlying stubborn nature. It is important to understand this psyche to be able to speak athletes’ language, and have the ability to educate them and validate your comprehensive treatment plan. No, not all triathletes are sadomasochists but a degree of determination and ability to withstand pain is an inherent part of most endurance sports.

   This being said, not all triathletes are competing in the Ironman distance. In fact, currently the most popular distance is the “sprint triathlon.” This is a 300- to 500-meter swim, a 12- to 17-mile bike and usually a 5K run. This takes most people one to two hours or so to complete, and requires minimal training (a few hours a week) to make it to the finish line in one piece. The other most common distances are the “Olympic triathlon” (1,500-meter swim, 40K bike ride and 10K run), the “Half-Ironman” (1.2-mile swim, 56-mile bike and 13.1-mile run), and the full “Ironman” (2.4-mile swim, 112-mile bike ride and a 26.2-mile run).

   It is important to understand the distances so you can characterize your patients better. A sprint triathlete is training just a few hours each week in each discipline whereas an athlete training for an Ironman event may be spending 20-plus hours per week swimming, biking and running.


Allow sufficient "float of the shoe cleat" check on the pedaling down stroke, not too much "dropping the heel."

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