Running Injuries

Running is tough business! Every time your foot strikes the ground (800 – 2000 times a mile), the force taken up by the body is almost 3 times your body weight. If you add this up, 400,000 pounds goes through your feet for each mile of running. Is there any wonder why running injuries happen?

What’s on our side that reduces the prevalence of running injuries? Evolution! The body has evolved over millions of years so that we can walk and run for long distances. The leg, foot, and ankle are designed for a mechanical advantage to effectively take up the force going through our bodies when we run. Add to this the newest technology in running shoes and training regimens, and most runners are able to avoid serious physical setbacks.

How to prevent running injuries

Most running injuries are a result of errors in training. These errors can include inadequate stretching and sudden increases in running distance. Careful training and stretching may help to prevent running injuries. Books, magazines and other websites are available that can educate you about training regimens and stretching exercises.

Athletic shoes

Proper running shoes for your feet and running style can enhance performance and prevent injuries. Here are some helpful hints to follow when you are purchasing a new pair of athletic shoes:

  • Try on athletic shoes after a run or at the end of the day, when your feet will be at their largest.
  • Wear your normal running socks.
  • The shoes should be comfortable as soon as you try them on.
  • There should be a firm grip of the shoe to your heel. Your heel should not slip as you walk or run.

Initial treatment for running injuries:

  • Change the surface you are running on (dirt or soft track instead of hard pavement)
  • Change your running shoes
  • Change your workout regimen. This includes decreasing your mileage, slowing down your pace, and decreasing your running your duration.

Common running injuries

Shin splints

Shin splints are a very common cause of leg pain in runners. The symptoms are exercise-related pain on the inner side of the middle or lower part of the shin bone (tibia). Shin splints are caused by inflammation of the lining of the bone where certain of the leg muscles attach.

What are some of the causes of shin splints?

Running on hard surfaces, long hilly runs, or suddenly increasing your mileage can cause the pain. Runners who pronate, or those who are knock-kneed are at higher risk for developing shin splints.

Treatment of shin splints should start with icing after your run, and stretching before and after you run. Try using a commercial arch support in your shoes, and if this helps, consider purchasing a custom-made one. Changing your running regimen is necessary if the above modalities don’t help. This includes decreasing your running distance, limiting hills, and changing to a softer running surface.

Achilles tendonitis

Achilles tendonitis is characterized by pain along the Achilles tendon, especially when you are starting to run, and when you are running uphill. The symptoms usually decrease after several minutes of running. The pain may also occur when you first wake up in the morning. In addition to pain, you may have swelling along the Achilles. For more information about Achilles tendonitis, see the section on Tendonitis of the Foot and Ankle.

Plantar fasciitis

The plantar fascia is the thick ligament that makes up the arch of the foot. This structure commonly gets inflamed from overuse, especially running. Symptoms include pain under the heel, or along the arch. The pain typically occurs when you are starting on a run, then goes away after warming up, but may recur after stopping. Plantar fascia pain is also typical first thing in the morning, or after sitting for a while.

Treatment for plantar fasciitis includes aggressive stretching exercises, taking anti-inflammatory agents, and the common initial treatments for running injuries. If these modalities do not relieve your symptoms, you should seek help from an orthopedic surgeon. They may recommend:

  • A splint to wear at night
  • Ultrasound treatments to the arch (done by physical therapist)
  • A cortisone injection
  • Custom-made orthotics

Stress Fracture

Stress fractures are caused by excessive stress on the bones of the foot, usually one of the metatarsal bones. When this occurs in a runner, it is due to too much running. Most commonly this is from a change in your training regimen, such as an increase in your running distance, or running on a harder surface.

The symptoms of a stress fracture are localized pain and swelling, often quite severe in nature. The pain is better with rest and worse with activity, especially running. The diagnosis is made with an x-ray.

Treatment of a stress fracture is rest, and immobilization, either in a cast or in a stiff-soled shoe, for 6 weeks, or until the pain and swelling subside, and the x-ray shows healing of the fracture.

Ankle sprains

Ankle sprains are an extremely common injury in all athletic endeavors, and running is no different. An ankle sprain results from a twisting injury to the ankle, such as when missing a step, or running on uneven ground or pavement. The treatment of an ankle sprain depends on its severity. For a full discussion on ankle sprains, see the separate section devoted  to Ankle Sprains.


Orthotics are used to support and align the foot, and also as shock absorbers for the foot. They can provide support in cases of a flatfoot deformity, or overpronation (inward collapsing of the arch). However, the vast majority of runners do not require custom-made orthotics. If you are having pain along your arch when you run, it is worth purchasing a pair of over-the-counter shoe inserts. If these help, wear them for 1-2 months, and then try and remove them from your shoes. If the pain returns, then we will recommend a custom semi-flexible orthotic.


Updated: June 2017