Keys To Treating Common Triathlon Injuries

Marybeth Crane, DPM, MS, FACFAS

   Newbie triathletes are the most commonly injured. They are also the ones starving for more information and most likely to get their medical information from Dr. Google. Many people move from just running or cycling to triathlons because of the perception that adding variety to their exercise regimen will reduce overuse injuries. The theory is that the variety of the muscle use in the three sports will ideally minimize the strain on any single muscle set. For runners in particular, adding biking and swimming to their routine means less pounding on the pavement.

   It is a great theory but in practical terms, it almost never works. The very nature of a triathlon and an underlying competitive nature lead to training harder and longer. Therefore, these athletes wind up adding more stress to workouts without necessarily subtracting anything. Accordingly, the idea that people can reduce their chance of injury by competing in triathlons is usually a misconception.

An Overview Of Traumatic And Repetitive Stress Injuries

Now that you understand a little more about the nature of the sport and its participants, let us talk about these injuries. Triathlon injuries fall into two main categories: traumatic and repetitive stress.

   Traumatic injuries for triathletes include sprains, tendon ruptures and fractures, abrasions from falling off a bike, and even puncture wounds from running from the beach to the bike in transition. These injuries are not unique to triathlons and are commonplace in most podiatry practices.

   The most common triathlon-related injuries are caused by repetitive stress. These are the “too much, too soon, too fast” injuries. One study of training patterns and injury rates showed that for non-elite triathletes, the likelihood of sustaining an injury is lowest when training for a total of eight to 10 hours per week, specifically cycling for five to six hours and running for three to four hours weekly.2 Time spent on swimming training does not appear to affect injury risk. Less training or more training increased injury risk. A common training tip is that it is better to be 15 percent under-trained than 1 percent over-trained. The literature supports this common sense approach as well.

   One might think swimming is relatively free from podiatric injuries but keep in mind that many triathletes will train with flippers on their feet and can actually aggravate a foot or ankle injury with these training aids. Flip turns can also be quite traumatic to an already injured foot or ankle. Do not forget to caution an injured athlete to be less zealous with turns.

   Cycling-related injuries are often due to poor bike fit and shoe gear. If the saddle of the bike is too high or too low, and/or the cleat of the bike shoe is too far forward on the pedal or too loose, Achilles tendonitis, patellar tendonitis and iliotibial band syndrome can occur. If the cycling shoes are too tight or not wide enough, Morton’s neuroma and metatarsalgia are not uncommon. Get a professional bike fitting or a Retül (Retül Studios) computerized fitting of your bike to prevent and/or treat these injuries.

   I urge every podiatrist who is interested in treating triathletes to spend some time at a good cycling store to learn the basics of troubleshooting a bike fit or at least find a local resource to analyze your athletes’ bike fit. Fit is everything, especially when a long course triathlete can easily spend seven hours in the saddle.


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

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