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Female athlete with foot pain on running track

Why Does My Foot Hurt When I Run?

Your feet are exceptionally complex anatomical structures. They’re made of no fewer than twenty-six bones, with over one hundred muscles, tendons, and ligaments controlling their movement. They have a huge brace of responsibility in your gross body movement. Balance, stability, arch support, and forward propulsion are just a few of the foot’s daily tasks as we walk and run around in day-to-day life.

We should walk a minimum (yep, a minimum) of ten thousand steps a day – roughly five miles a day before we start adding in our running training. That’s a pretty heavy workload for a relatively small collection of bones in our body.

With that in mind, I can’t stress enough that runners’ feet won’t just benefit from but positively require a great deal of care and attention.

Anatomy of the Foot

There are three critical areas we look at when assessing the health of our feet: the intrinsic and extrinsic muscles, and our core or torso.

The intrinsic muscles control more refined movements like individual toe moving and arch support in the foot. The extrinsic muscles start in the legs and end at the feet, controlling our foot as we direct it in, out, up, and down.

Where does the core come in? The foot is like all of our major limbs. The core is the central operator of all of our locomotion. A strong core means strong feet.

These are the three critical muscle areas we’re going to look at closely and troubleshoot today. Let’s start with the intrinsic muscles.

The Intrinsic Muscles

The intrinsic muscles have a deceptively heavy workload, as we have not one, but three arches to support within the foot: the medial (inside) arch, the lateral (outside) arch, and the anterior transverse (front and across) arch.

What Can Go Wrong

The intrinsic muscles support all of these arches, and if we neglect them a plethora of problems arise. These are the examples I frequently see as a physio. Click the links for a self-management video for the selected area.

How to Prevent Intrinsic Muscle Weakness

Check out our self-management videos for full guidance on self-treating flat feet, bunions, and plantar fasciitis. A few minutes a day of each can go a long way towards strengthening your intrinsic foot muscles.

The Extrinsic Muscles

There are six extrinsic muscles that work to move your foot in all its various directions. If you try and draw the alphabet with your toes, you’ll see these muscles at work, and the many directions your foot can move.

What Can Go Wrong

There are a lot – a LOT- of things can go wrong in the extrinsic muscles. These are the examples I frequently see as a physio. Click the links for a self-management video for the selected area.

Calf Injuries: The most commonly known extrinsic muscles are your calf muscles (the gastrocnemius and the soleus), responsible for pointing your toes down into plantar flexion.

Tibialis anterior: If this muscle is tight or weak in runners, it most often presents as painful shin splints and lateral (outer) knee pain. Here’s an in-depth guide on how to treat and prevent tibialis anterior injuries.

Ankle sprains: Ankle sprains, as you might guess, always occur after a sudden and jarring impact, landing, or twisting of the ankle. You might hear or feel a “pop” followed by a sharp pain. You’ll often have throbbing or aching pain in your ankle even when you’re not putting weight on it, and you’ll have a sharp pain if you passively rotate your ankle into inversion or eversion.

Achilles tendonitis: Achilles tendonitis typically starts off as a dull stiffness in the tendon, which gradually goes away as the area gets warmed up. It may get worse with faster running, uphill running, or when wearing spikes and other low-heeled running shoes.

How to Prevent Extrinsic Muscle Weakness

BALANCE. BALANCE EVERYWHERE. Balance is the best way to strengthen your extrinsic muscles.

Try balancing with your feet together, staggered, with your eyes open or closed, on one leg, on one leg with eyes closed, on uneven surfaces (like walking around in both directions on the edge of a rug), balancing on your heels or toes, balancing whilst moving your arms and legs in different directions,  or whilst throwing or catching a ball.

The Core Muscles

As we’ve said, there’s a lot of pain felt in a runner’s feet that has very little to do with the feet themselves. It’s usually due to the runner in question having a weak core.

In addition to strength, if we have a stable core, we can be stable at the joints next to the torso. If those are stable, we can be stable at the joints in the hips. If the hips are stable, so too will the knees. And if the knees are, so are the ankles.

Conversely, if we have a weak core, the problem cascades down through the hips, knees, and ankles, and our feet will always be working harder than they need to to counteract the weaknesses above them.

This is why as physios we sometimes treat foot pain with hip stability exercises.  We’re not crazy, and did listen to what you said – we’re merely addressing the cause of the problem up the movement chain.

We’ll say it again: an inherently weak core causes a storm of issues down the movement chain. Foot pain almost always points to core weakness. Get a strong core with plenty of Pilates (we give regular free classes over on our Facebook page). Your body and your running will thank you for it.

Foot Pain Is Rarely Caused Within the Foot Itself

In runners, there’s a lot of issues that arise in the feet that have very little to do with the feet themselves. If you’re unsure where to start, or where your foot pain is originating from, start with working your core.

We are designed to be weight bearing, free running creatures. Unfortunately, our modern sedentarism doesn’t keep our core in good enough shape to run the way that we are supposed to. If you want to reclaim your running birthright, begin regularly exercising your core, and watch the health and strength of your feet follow.

This article was originally posted on RunnersConnect.

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