My advice for ‘top of foot pain’

Top of foot pain is becoming a more common running injury with the trend to barefoot and minimalist running. The cause of the problem is due to the constant load on the forefoot dorsiflexing the forefoot on the rearfoot and trying to lower the arch. This results in a jamming of the joints and bones on the top of the arch causing the top of foot pain. Technically, this is referred to as dorsal midfoot interosseous compression syndrome.


My Advice if you have top of foot pain:

  • Restrict your activity levels to within tolerance (substitute some other activity like cycling or swimming)
  • Get back to heel strike running to reduce the load (you can worry about transitioning back to the forefoot later when it is all healed)
  • Use a heel raise (this helps lower the forefoot); also do even more stretching for the calf muscles as this contributes to the problem if they are tight.
  • Foot orthotics with the right design features are very effective at treating this problem. The foot orthotics has to be designed in such a way that they allow the forefoot to plantarflex relative to the rearfoot or they will not help


Long term:

You can transition back to forefoot striking and away from foot orthotics very gradually and very slowly and very carefully so the tissues can adapt to the loads. However, in some runners the loads causing the top of foot pain are so high the tissues cannot adapt to the load. In that case, the heel striking and the foot orthotics need to be seen as long term options.

For more information:
‘Top of foot pain’ Management in barefoot Runners

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My Advice if you Overpronate

Overpronation is a term used to describe a foot that has rolled inwards at the ankle joint and is usually accompanied with a lowering of the arch of the foot. It is a term that is often overused and abused, especially in the running community. Feet that overpronate are not necessarily a problem. They are only a problem if the forces that are driving the overpronation is high. Many people have feet that overpronate and never have problems.

My advice if you overpronate:

  1. Do not assume that it is a cause of the running injury you have.
  2. Don’t listen to all the gurus who tell you to strengthen the muscles (weak muscles are a very uncommon cause of overpronation). That does not mean you should not do exercises, as they are probably beneficial.
  3. Get proper advice re the most appropriate running shoe.
  4. If overpronation is the problem, then foot orthotics are always the best short term solution. They will lower the force (is they are prescribed correctly) and allow you to get over the injury.  As to if you need them longer term, then that will depend on the exact causes of the problem and just how much the overpronation contributed to the injury. Only an expert can determine than
  5. Don’t listen to the online gurus with a blog and no qualifications and no experience in treating running injuries. Read about the ovepronation myths.

For more see:
Overpronation in runners
Risk of Injury From ‘Pronation’

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My Advice for Nail Laser Treatment

Fungal infections of the toenails in runners are common. The fungus thrives in the wet and damp environment of the shoe, and this is especially true in runners as they subject the toenails to so much trauma. The treatment for this is prolonged with the use of either oral or topical medications. The chance of the infection happening again after (or during!) treatment is high doe to that environment inside the shoe. Recently there has been a lot of hype surrounding the use of nail laser treatment. This is a one off treatment.

My advice for nail laser treatment:

  1. The FDA has approved it as being safe (that does not mean it works)
  2. There are no independent clinical trials comparing it to a placebo or the current treatments
  3. There are only the results from small uncontrolled outcome studies that have not been published for peer review done by the companies selling the laser device
  4. The treatment is expensive and as it is still considered experimental, the insurance companies in the US are not covering it

None of this means that it does not work. All this means is we do not know. All we have are the current unsupported claims by those with a vested financial interest.

My advice: You need to make your own mind up on this one.

For more, see:
Nail Laser Treatment

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My Advice for Sinus Tarsi Syndrome

Sinus tarsi syndrome is a problem that occurs between two bones in the rearfoot (talus and calcaneus) and the pain is usually felt on the outside of the ankle joint. It can be a chronic problem following an ankle sprain or it can be from a very flat pronated foot.

If the sinus tarsi syndrome follows and ankle sprain, then my advice is:
1.       Make sure that the rehabilitation from the original ankle sprain is adequate
2.       Get some physical therapy done to mobilize the rearfoot.
3.       Get some advice on exercises to carry out at home
4.       If that does not work, consider a steroid injection

If the sinus tarsi syndrome is due to a very pronated foot, then my advice is:
1.       You need foot orthotics that are designed to move the subtalar joint (the joint across the sinus tarsi) away from its end range of motion. Just supporting the arch is not enough
2.       A good motion controlling running shoe is really important
3.       If that does not work, then consider a steroid injection

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My Advice for Plantar Fasciitis

There is plenty of information on the web about plantar fasciitis, so there is no point repeating it here, except to give my advice on what you should be doing for it.

Put simply, plantar fasciitis is due to too much load in the plantar fascia for the tissue to handle. The only way to really fix and prevent it happening again in the long term is to lower that load.

Here is my advice if you have plantar fasciitis:
1.       Reduce the level of activity that is causing the symptoms. Substitute another activity (such deep water running, cycling, swimming) to maintain fitness levels
2.       Use ICE and other methods after a run
3.       Stretch the calf muscles (the research has shown that this is a major risk factor for plantar fasciitis)
4.       Strapping has been shown to be a great way to reduce the load, but this is a short term method and is great if you have a competition coming up.
5.       Get to a health professional who really knows about foot orthotics. Foot orthotics are the best way to reduce load in the plantar fascia (the research shows that). However, not all types of foot orthotics and all type of designs of orthotics do actually reduce that load, which is why foot orthotic can often get criticised. The right orthotic will work in most cases.
6.       Gradually return to full running mileage

Those steps will probably take care of most cases of plantar fasciitis in runners. There are many other treatments for plantar fasciitis and there is no secret sauce for plantar fasciitis. Most of the other treatments you come across for plantar fasciitis are all aimed reducing the symptoms or helping the tissues heal and there is nothing wrong with that. In the long term, these other approaches are less likely to be successful without a reduction in the loads in the plantar fascia

There is a non-mechanical form of plantar fasciitis, so if you have an ongoing problem, that may need to be investigated.

Use Foot Orthotics Long Term?
Every guru has an answer for this; however it will vary from case to case. If the forces in the tissues are high, then it is likely that you will need to use foot orthotic long term. If the forces in the tissues are not so high, then there is good chance the use of foot orthotics will be short term. In this case you can start wearing the foot orthotic less and less and allow the tissue to adapt to the load. If they can not adapt, then you need to keep wearing them. Do not listen to the guru’s, listen to what your body is telling you.

If you want to know more about your particular case, then ask about it at the Foot Health Forum or look up plantar fasciitis at Running Research Junkie. Most importantly, stay away from all the snake oil.

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My Advice Severs Disease

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Severs disease

Severs disease

Severs dissease treatment

Severs disease heel cups

Severs disease

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My Advice for Barefoot Running Injury

There is a lot of hype and rhetoric going around about the benefits of barefoot running in reducing the risk of getting a running injury. Nothing could be further from the truth. See these links:

The Barefoot Running Injury Epidemic
Vibram FiveFingers Cause Metatarsal Stress Fractures?
“Top of Foot Pain” from Barefoot Running
Why are barefoot runners getting so many injuries?

There is no doubt that you can read anecdotes from barefoot runners who are getting less injuries now compared to what they got before they started barefoot running. But there is also the anecdotes from those who have experienced the opposite. Barefoot running is not all that it is claimed to be. If it was what was claimed, then why are there so many getting hurt by it?

If you want to give it a go, then it can be done like the purists in barefoot or with a barefoot running shoe (which sounds a bit odd). The key thing is to transition extremely slowly from shod running to barefoot. It is probably advisable to spend a lot of time barefoot around the home, then progress to short then longer walks barefoot; then a few short runs over a period of weeks and gradually progress from there.

Any sign of injury needs to be treated with cutting back on the barefoot running and then using strategies like ice therapy until it settles, before commencing a gradual build up in the barefoot running.

As always, the advice of a health professional is always recommended.

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