Feet - Podiatrists and Running injuries
Running injuries are difficult. Anybody who tells you they aren’t maybe hasn’t appreciated the complexity of the runner and running injuries. What can cause injury in the runner?….here’s a few things to start with:
- General Training Error
- Previous Injury
- Running pattern
- Normal Daily Activity (Such as work ergonomics, driving position)
- Muscle Balance
- Disease process (such as diabetes)
- Systemic musculoskeletal issues (such as hypermobility)
- Increased BMI
- Foot Function
- Trainer choice
- Joint dysfunction (possibly multilevel)
- Leg length difference
So, where does the podiatrist come in?
Why have you been referred to one…or why am I writing this?
The skill in treating the runner comes from the assessment. Both in terms of a good history taking and then observing the patient run, this is essential in getting the best suitable treatment plan for the injured runner.
From the patient history (when we discuss your running and injury the start of the appointment) the experienced podiatrist would already have begun to formulate a diagnosis and treatment plan. Recognising the injury history is the initial step in an accurate diagnosis. From here the physical examination will be conducted to either confirm this diagnosis or / and to assess the possible multitude of factors which have caused it.
Assessment often begins statically. The podiatrist will take joint ranges of motions and test muscle strengths. They may look at you stand and walk. However, it is essential they watch you run for several reasons. Firstly, there are no static measurements which will reliably tell us how you run. If we want to know how a patient runs…we have to watch them! Secondly, if any treatment is aimed to change your running, then how can we tell if this has been achieved without watching you run before and after? That’s another good reason for the use of computerised gait assessment, not only does it allow you to be slowed down and angles calculated, but it means we can compare you before and after treatment. Be prepared at your assessment to run in front of several cameras.
What treatment can be required? Along with the long list of causes of running injury comes the long list of professions which may be involved in a successful return to running. For example, the podiatrist may refer you to:
- Physiotherapy. If the assessment finds an issues with muscle balance, core stability or referred pain from structures such as your back
- The Running coach. If your running pattern (such as an overstride or poor cadence) relates to your injury
- The Orthopaedic Consultant. If your assessment reveals an intrinsic problem with a joint or tendon or it requires further imaging
- The trainer store. Often runners with foot problems (such as bunions and gross pronation) need close collaboration between the podiatrist and an experienced running store
But what might the Podiatrist supply for treatment? Along with possible referral the podiatrist may prescribe you orthotics. Orthotics are simply in-shoe appliances designed to reduce your pronation (or supination in some rare cases). So, if your injury relates to too much pronation (or supination), they may be advised. These are often custom made, simply because for runners these are comfortable, lower bulk and offer the possibility of increased support. However, other treatments to decrease pronation (such as referral to physiotherapy for core strength or advising suitable trainers) may be advised before orthotics are prescribed.
Reading the above it becomes apparent that the roll of the podiatrist is often to correctly assess and diagnose both the cause and nature of the running injury. Sometimes the Podiatrist alone is required, in some cases all the other professions above can become involved at some level! This requires the Podiatrist to have a good working relationship with many different agencies. Accepting this is important, as there is no one profession able to supply everything the injured runner may need.
Finally, when selecting a Podiatrist, do find one with a good track record in treating runners. Further qualifications in sports injuries are a good sign. Ask questions as to how many orthotics they have prescribed in their career and how long they have been qualified. Look past meaningless titles such as “running Podiatrist” or “sports podiatrist”. These are not recognised by the college of podiatry. If in doubt call local running experts such as Dave. Call and speak to the Podiatrist and ask them how many runners they have treated that month with the same pain as you. Running is very important to a lot of people for many different reason, don’t let it slip away to the frustration of inexperienced care and recurrent injury.
Paul Harradine is a Podiatrist with more than 25 years experience in treating all levels of sporting participants and teams. His practice (The Podiatry Centre) supplies podiatry services for 2 premiership football teams and county cricket teams, as well as working with elite sports including sailing, athletics and triathlon. He has a master’s degree in Sports injury and therapy and has prescribed more than 10,000 pairs of custom foot orthotics in his career (more than 8,000 of these he has made in his own lab). Paul works in Cosham but has sports experiences associates also working in Southampton, Guildford and Chichester For further information please see www.thepodiatrycentre.co.uk or www.thepodiatrycentre.co.uk/portsmouth/podiatrist-paul-harradine.html