This is not medical advice. If you’ve recently had an accident, go see a doctor.
The only long term solution to stay healthy and continue running as you age is to learn about your body to keep your body strong and mobile. The solution comes from YOU and YOUR HABITS!
The Common Sense Solution
If you go to the doctor and tell them that it hurts when you run, most likely they're going to recommend you stop running. While this might help in the short term, a better recommendation is to run better.
If running is the primary cause for your pain, consider running for shorter time or go slower and take faster and shorter steps to avoid the pain. If walking for more than one hour causes you pain, stop at 45 minutes! The dose makes the poison.
The body is one unit
“He who treats the site of pain is often lost” - Dr. Karel Lewit
Before jumping into specifics about the foot and ankle,it would be foolish to only focus on that area of the body because everything is connected.
There are myofascial (muscle) lines from your head to your feet, so although the issue is happening at the lower limb, often the primary cause of pain is away from that area, most commonly in the hips.
Muscle imbalance at the hips are a primary source of pain, so it's important to balance and strengthen the lumbopelvic hip complex to remain healthy. I'll explain how in Step 3.
Step 1: Change your Shoes
I've helped a few dozen people overcome chronic lower limb pain, and one of the easiest and fastest solutions is to change the shoes you wear.
Modern shoes put excess strain on the bottom of our feet, the plantar fascia, by raising the heels and toes, which stretches this area excessively and reduces the ability of our feet to absorb force as designed.
Modern shoes also squish our feet, which causes the big toe to become weak and useless.
Shoes physically change the bone structure of our feet! When we're born our toes are wide, but shoes cause them to get squished together, which reduces our ability to absorb force.
Tight shoes are the only cause for bunions.
Visiting a podiatrist to get a pair of shoe orthotics can help to prevent further damage in the short term by reinforcing the foot arch.
However, instead of trying to “fix” the foot with orthotics, first let’s try to get your body to work better on its own by building the foot arch that God has given you! Perform the short foot exercise to build the muscles of your feet.
Being barefoot or wearing flat shoes as often as possible will build strength and resilience in your feet and ankles. Here is a YouTube video where I review of common barefoot shoes:
Step 2: Improve Posture & Technique
If you have pain while running, it's very likely your technique can be improved.
If you have muscle or joint pain, you're likely overstressing these tissues. Here are some things to consider:
Do the bottoms of your shoes wear evenly or is there a difference?
Take a picture of your ankles from behind and notice if your foot is excessively pronated or supinated.
This will show up in how your shoes wear over time.
When walking or running, think about striking the ground with the outer part of your foot, then push off through the big toe. At no point should the inner part of your foot touch the ground.
Take a picture of yourself while standing.
Do your feet point forward, inward, or outward? Is there any rotation that occurs in your feet or lower limbs? Are your steps symmetrical and even or do you favor one side?
When you push off while walking, go directly over the toes and don't allow your foot to turn out. If your foot turns out while walking, it's a sign of calf tightness and you'd want to stretch that area (Step 3 below).
Record a video of yourself from the side while walking or running.
Are you leaning forward?
Are you leaning back?
Do your legs and arms extend behind you the same distance they go in front or is there little movement?
The leg should travel the same distance behind as it travels in front while walking and running.
If you use primarily the "wrong" muscles when walking or running, over time you're likely to experience chronic pain. If you're walking and running by using primarily the calves or hip flexors, these muscles are not meant for that, so eventually you're going to experience joint damage and disfunction.
The primary muscles that should be working when walking or running are the glutes (your butt!).
Your butt muscles work to extend your hips, which is how human locomotion should be powered. Slow down when walking and running to focus on using your butt muscles. By focusing on the hips and areas closer to your center, you take stress off the more distal areas like your feet and ankles.
Awareness of how you walk and run will help you to better understand your body so you can adjust and improve your technique over time. If you feel overwhelmed by this information, consider working with a qualified physical therapist or personal trainer with experience helping people with your issue.
Step 3: Strengthen Your Body
Strength is never a weakness and weakness is never a strength. Here I'm going to provide you with a training program that will help to strengthen your entire body so you experience less chronic pain over time.
Add Variety
If you only walk forwards, it's easy to build up imbalances. Instead, add variety to your movement. For each hour you walk forwards, walk 10 minutes backwards to train different muscles.
Practice walking sideways.
Practice crossing your legs as you walk.
Greater variety in your movement will help to avoid chronic overuse injuries that are common. Before, during, or after your running exercise, consider adding in some variety to your movement by changing how you're moving.
Foot & Lower Limb Strength & Mobility
Foam roll the bottom of your feet with a lacrosse ball. This should not be overwhelmingly painful, but if it is, make it a regular part of your routine. 2 minutes daily will give you better results than 2-3 times per week. This is one of the best ways to improve plantar fasciitis and foot arch pain.
Identify if your calves are tight by performing the 5-inch ankle dorsiflexion mobility test. Place your toe 5 inches away from the wall (approximately a fist and thumb distance), keep your heel down, and press your knee directly over the middle toes. If you're unable to touch your knee to the wall it means you have opportunity to improve ankle mobility.
The slant board calf stretch is the most effective method I've found for improving ankle mobility. Simply stand on a slanted surface for 2 minutes in the morning and night to get fantastic results in a short time.
Sit on your heels to improve ankle mobility. This should not be particularly painful, but if it is it means you have opportunity!
A common cause of shin pain is muscle imbalance between the calf and tibialis anterior muscle. The Tibialis raise is the #1 exercise that will reduce shin pain.
Strengthen your calves by performing full range of motion standing calf raise on an elevated surface.
The primary muscles that are strengthened are the calf muscles.
Making your feet face towards one another at the top of the calf raise will help strengthen many of the deep calf muscles.
Hip Strength & Mobility
Stand on one leg and hug the other knee into your chest, then let go and attempt to hold it in position for 10 seconds above your hip level. If your leg drops immediately or you’re unable to hold it then you lack hip flexor strength.
To improve hip flexor strength, practice the hip flexor march. You can increase the difficulty by holding a weight in one hand.
Lie on your stomach and keep your hips grounded as you lift one leg of the ground to see if you have at least 10 degrees of hip extension on each side. When you lift your leg, if you feel your hamstrings working more than your glutes it means your hamstrings are dominant.
Perform a glute bridge by lying on your back with feet hip width and lift your hips and hold for 10 seconds. If you don’t feel your glutes working, it’s a sign your glutes are dormant. If you notice this, then focusing all your attention on building your glutes is going to help tremendously!!
If you have access to equipment, place a weight on your hips to perform the hip thrust and further strengthen your glutes and hip extension.
To loosen tight muscles of the hips, perform the couch stretch.
Once you've mastered the couch stretch, begin practicing the ATG split squat to build strength with lengthened hip flexors and improve ankle mobility. This is one of the best movements a runner can do.
If your hip flexors are very tight, consider the postures you hold each day. Most people spend excess time on their butts and backs, which tightens these muscles. Instead, try to spend some time each day lying on your stomach to stretch your hip flexors and core musculature.
Sit on a table and ground your hips, then rotate the lower leg away from the midline to assess internal rotation and towards the midline to assess external rotation. Perform the same movement on both legs and look for differences.
The 90-90 stretch will help to balance hip rotation. Lean forward to test external rotation on your front leg, lean backwards to test internal rotation on your back leg.
If you feel your back in the 90-90, the pigeon stretch allows you to stretch the outer thighs.
While the frog stretch allows you to stretch the inner thighs.
The hip airplane exercise is a functional way to quickly improve hip rotation while standing.
Perform the single leg standing test and notice if the hip of the raised leg is level or above the standing leg hip or not. If you lack hip control, this puts additional stress on other areas of your body.
One of the best exercises to build hip control is a slow box stepdown. Perform the stepdown by standing on one leg and hinging at the waist until you’ve pushed your hips back as far as you can. Then bend your knee to lower your body down until your back foot touches the ground. Is balance good and do you feel your glutes working?
Another exercise that can help you test hip strength and control is the single leg glute bridge. Perform the single leg glute bridge by raising your hips with one leg and holding for 10 seconds. Make a note if you feel something other than your glute working.
Record a video of yourself doing a reverse lunge from the front and review what you see.
Are your feet stable or do they turn out? Are they flat or excessively arched?
Does your front knee cave-in or does it track just outside of your big toe?
Is each side symmetrical? Do your hips stay facing forward or rotate?
A challenging exercise to improve hip and core balance and control is the contralateral loaded rear foot elevated split squat. Hold a weight in the opposite hand from the front leg, place your back leg on an elevated surface, keep most of your weight on the front leg and start the movement with the hips.
Another exercise that is very helpful for people is the RNT split squat. This involves using a band to pull your knee in the WRONG direction so that your muscles have to work harder to externally rotate the front leg towards the right direction.
Core
A stronger core will make you more resilient in everything you do.
Perform the Deadbug by bracing your core and reaching towards the sky as you lower one leg at a time, hovering over the ground for a second, before returning and repeating on the other side.
Perform the plank w/ leg raise to improve core stability by holding a strong plank position and then lifting one leg at a time.
If this is too challenging, perform the bird-dog by extending your opposite arm and leg and hold for 10 seconds. Complete 5 reps per side. If you’re unable to perform a bird dog due to knee pain, perform a standing bird dog while holding onto a chair or table.
Perform the Side Plank by rotating to one side and supporting your body with your elbow and feet. Go to the knees or use a wall instead of the ground if this is too challenging.
The suitcase carry will help you train core bracing and stability while walking.
The number of exercises you can perform are endless. What I've done with this article is introduce you to some of the most effective exercises to strengthen your body for walking and running.
DDD Program Summary | Perform 3 rounds of the mobility circuit. |
A - Couch Stretch - 60 seconds per side | B - Hip airplane - 5 reps per side w/ 3 second hold at each end range |
C - Slant Board Calf Stretch - 60 seconds | D - Heel sitting - 60 seconds |
Core Stability | Perform 3 rounds of the core stability circuit. Rest as needed between sets. |
1A - Deadbug - 30 seconds | 1B - Suitcase carry - 45 seconds per side |
1C -Plank with leg raise - 30 seconds | 1D - Glute bridge - 20 reps. |
Strength | Perform 3 rounds of each superset. Rest as needed between sets. |
2A - ATG Split Squat - 6 reps with a 5 second hold at the bottom on each side | 2B - Contralateral Loaded Split Squat - 12 reps per leg |
3A - Hip thrust - 12 reps | 3B - Box Stepdown - 10 reps per leg |
5A - Standing calf raise - 20 reps | 5B - Tibialis raise - 20 reps |
Conclusion
If you have pain while running, I recommend the book Anatomy for Runners to learn more about your body.
Get a pair of barefoot or wide toe box shoes or spend as much of your time as possible barefoot. Check out the Barefoot Shoe Review Video if you're unsure of what to get.
If you’re looking for a podiatrist, Dr. Emily Splichal is the best one I’ve found online who emphasizes the importance of the short foot exercise and strength training.
If you’d like to work with me to overcome your chronic foot/ankle pain, schedule a consultation. If you have questions, leave a comment below or send me a message.
Hope this helps! - Tom
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