Types of leg and foot pain when running
Anyone who has ever suffered from a niggling injury or leg pain when running will agree, it can be incredibly frustrating it is can make the simplest things – such as running – impossible.
So, let’s explore some of the culprits behind what is causing your leg pain when your run.
Pain in the shin when running
The common term people refer to describing this type of pain is shin splints. This is a ‘blanket term’ referring to more than one lower-limb ailment. When broken down, medical professionals within sport refer to these common injuries to identify shin pain when running;
- Muscle strain can occur from overuse of a muscle or from trauma such as a slip, trip or fall. In shin splints, it arises from the overuse of the Tibialis anterior and the Tibialis posterior. This happens when they are weak, too short or doing a job that they are not intended to do through altered foot mechanics. If you suddenly up your training intensity and duration without the adequate build-up the muscles will be weak, they will fatigue and ultimately start to break down. Altered foot mechanics occurs from ill-fitting footwear or compensating for an injury. You can read more here.
- Stress fractures: Tibial stress fracture is an overuse injury where tiny cracks appear in the bone due to an increased transfer of force. This happens when the muscles become fatigued and can no longer absorb the shock generated when the foot strikes the ground. Stress fractures can sometimes be misdiagnosed as muscular shin splints due to the location of the injury. However, shin splints ease when the muscle is warmed up whereas stress fractures worsen as you run. If you suspect a stress fracture you need to seek medical advice and have it confirmed with an X-ray. In most cases, they will heal with 4-6 weeks of rest.
- Medial tibial stress syndrome: Presents like a muscle strain but more localised to mid-portion of the shin. It is a stress-reactions of the tibia and surrounding musculature when the body is unable to heal properly in response to repetitive muscle contractions and tibial strain.
- Exertional Compartment Syndrome (ECS): The lower leg has four compartments that cover the whole area. ECS is less common than the conditions described above and is characterised by a tightening in the shin that worsens during exercise. Some runners often report that their legs feel so tight they might explode. Often the lower leg can feel firm to touch and be quite painful, it is important to have this checked out by a medical professional.
Pain in the calf when running
Calf strain’ is the common terminology used by runners when describing calf pain. Muscle strains are categorised into four classifications defined in the Munich consensus statement
- Grade 1 strain (mild) – Overexertion injury. The muscle will be a little painful but there will be no change to strength or the range of movement.
- Grade 2 strain (moderate) – There will be a few tears to muscle fibres. You will experience a sharp pain when it happens then over the next few hours it will remain painful, with some slight swelling and possibly redding of the skin or bruising. There will be a decrease in strength and range of movement.
- Grade 3 strain (severe) – This is a partial tear muscle. This will be very painful at the point of injury and the pain will remain after. There will be immediate swelling and reddening of the skin followed by bruising. This will also be accompanied by almost complete loss of strength and mobility, often linked to the levels of pain.
- Grade 4 strain (severe) – This is a Total tear of the muscle or a tendon avulsion, where the tendon comes away from the bone. Injuries such as this are normally linked to a traumatic event. You will experience immediate pain, swelling and bruising as well as total loss of strength and mobility. It is often reported that following a Gd 4 strain the pain subsides, this is due to the muscle/tendon being severed so the pain signals cannot travel up the nerves.
The British athletics association recently published further categorisation into muscle strains through a sub-classification. This is used to identify the specific structures involved.
- A – Myofascial
- B – Musculo-tendinous
- C – Intratendinous
Pain in the Calf when running
Gastrocnemius strains are relatively easy to identify as this is the large muscle that runs down the pack of the lower leg. You will feel pain and tightness within the muscle and it will normally be tender to touch. Doing a calf stretch or heel raises will bring on the pain.
Depending on the grade of the strain you may or may not experience pain when walking. You will experience pain when running and it is advised that you avoid this until the pain eases. Try something that is low impact such as the bike for CV fitness.
Use heat or ice to help manage the pain. Read more here
Pain in the lower calf when running
Soleus muscle strain.
The soleus lies under the gastrocnemius muscle and is a flat pancake-like muscle that runs from the Achilles tendon to the back of the knee. They help to point the toes (plantarflex) are mainly made up of slow-twitch fibres, so very important for long-distance running.
Most runners only become aware of their soleus muscle when they pick up an injury. The most common mechanism for the injury is from overuse of the muscle triggered by running more on the balls of their feet. Things like an increase in hill running or a change to a more minimalist footwear are common contributing factors. Pain in the soleus can also occur when compensating for a knee injury as you will try to reduce the shock on the knee avoiding a heel strike.
Pain in the arch of the foot when running
Foot arch pain when running can occur due to structural issues, overuse, physical stressors or neurological conditions. A common structural or mechanical issue would be flat feet or high arches.
conditions that can cause arch pain when running:
Plantar fasciitis is the most common cause of arch pain when running. It is caused by inflammation of the plantar fascia ligament that connects the front of your foot to your heel.
Runners will experience pain and stiffness in the heel or the arch of the foot. Typically, it will feel worse first thing in the morning and become more painful with walking, running or standing for prolonged periods of time.
Pain can be alleviated with some gentle stretches or by rolling your foot on a roller or golf ball.
Overpronation describes the mechanics of the foot when you walk or run and can be commonly labelled as ‘flat feet’. Medically this is not technically true. With over-pronation, the outer edge of the heel strikes the ground first. The foot then rolls inwards flattening the arch of the foot which can lead to arch pain when running due to the damage to the muscles, tendons and ligaments.
If you overpronate you may want to start wearing a more supportive running shoe or seek out supportive orthotics to wear in replacement of your current insoles.
In long-distance runners, you can normally identify if you pronate by looking at the sole of an old pair of trainers. If you have excessive wearing of the outside of the heel and the inside part of the midfoot and toe, then it is worth having a physio or podiatrist have a look.
High arches (Cavus foot)
High arches can be your inherited structural mechanics, or from a neurological condition. With either of these contributing factors, you will have had high arches all of your adult life.
With unsupported high arches, you may experience pain when running, walking or standing for long periods of time. Additionally, you may find you are more prone to ankle strain injuries.
You will need to seed advice from a medical professional such as a podiatrist to help find the best mechanical support for the feet. This can be achieved with the right orthotic insoles, often custom made to your mechanics.
Pain in the ball of the foot when running.
This type of pain is very common in runners and can occur from biomechanics or neural conditions.
Big toe joint pain (metatarsophalangeal joint)
This can present as a dull ache that is sore first thing in the morning, after a run or an in the evening. It will feel stiff and sore, in some cases, it may be warm to touch. This is because of arthritic changes to the joint making it inflamed and irritated.
If you overpronate then you will put excessive force through this joint and over time cause it to degenerate. You can alleviate these symptoms by wearing a more supporting running shoe or supportive orthotics. If the pain persists then it is best to seek a medical assessment of the foot.
Morton’s neuroma (plantar digital neuritis)
These occur in-between the toes and are a degenerative change to the plantar digital nerve. This is often accompanied by a bursitis, inflammation of the jelly-like bursae that act as a spacer between the bones and tissue of the foot. Runners will often experience pain when walking and running, a burning, tingling sensation in the toes as well as a small pea-sized lump in the foot.
You should seek an assessment from a medical professional if you suspect that you may have Morton’s neuroma.
This is a common overuse injury to the ball of the foot. The term refers to pain and inflammation of the foot and is often considered to be a symptom of other conditions, not a specific condition itself. You will experience pain when you run, walk or stand for too long, especially if you are barefoot. Runners often describe feeling like there is a pebble in their shoe. It will feel sharp, achy or burning in the ball of the foot and, in some cases, numbness or tingling in the toes.
Metatarsalgia responds well to ice as it will help to reduce pain and inflammation in the area. As well as that a period of rest and some cushioned insoles will alleviate the pressure to the foot.