Five Common Foot Overuse Injuries

Running, hiking, basketball, soccer, dancing, tennis. There are many athletic activities that involve your feet taking repeated pounding over many years.

Over time this can lead to repetitive injuries to the bones, joints, and soft tissues of the foot, which are exacerbated when mileage is suddenly increased, proper recovery isn’t allowed, training errors are made, or poorly supportive footwear is used.

As you continue working toward your physical activity goals, you may begin to notice mild discomfort in your feet. Although the symptoms of overuse injuries can develop slowly, ignoring these early warning signs can lead to debilitating conditions that make it difficult – if not impossible – to stay active.

Today we’re breaking down five of the most common overuse injuries of the foot. Understanding these conditions will allow you to catch small problems early and avoid larger issues in the future.

Understanding Overuse Injuries

Before we get into common overuse injuries of the foot, let’s review how they happen in the first place. Unlike acute injuries, which are usually the result of some type of traumatic incident, overuse injuries occur when repetitive microtrauma overwhelms the body’s ability to adapt and recover.

When tendons, bones, fascia and other tissues are placed under load repeatedly over a long period of time, they will remodel themselves to help better handle that load in the future.

However, when load is too quickly increased, insufficient rest is given, or training errors are made, the breakdown of tissues will outweigh the body’s ability to repair itself.

This eventually leads to painful symptoms and often structural injury. Most athletes know that increasing mileage by more than about 10 percent per week is asking for trouble, but there are many other common situations where injury risk is increased.

Training errors like suddenly adding hills or speed work can also increase risk as can running on different surfaces frequently or continuing to run in worn-out shoes. Biological risk factors also play a role and can include age-related degeneration, foot structure, bone density, and even body weight.

Common Overuse Injuries of the Foot

Plantar Fasciitis

Probably the most common reason people visit Treasure Valley Foot & Ankle for heel pain, plantar fasciitis results from repetitive overload at the plantar fascia’s origin on the heel bone.

Patients will often describe sharp pain in the heel with their first steps in the morning or after prolonged sitting, as well as tenderness to palpation near the inside of the heel. Pain will typically also worsen with prolonged standing or after running.

Treatment is usually straightforward and begins with reducing load while improving flexibility. Stretching of the calf muscles and plantar fascia, night splints, supportive shoes, and orthotics are all recommended.

Most people will notice improvement in their symptoms after several weeks of treatment, although patients with chronic conditions may require additional therapies such as shockwave therapy or image-guided injections.

Achilles Tendinopathy

Achilles tendinopathy is another common problem that presents with pain and stiffness along the tendon. This can occur in either the midportion of the tendon (a few centimeters above the heel) or at its insertion at the heel.

Patients will frequently complain of stiffness in the tendon when taking their first steps in the morning, pain with push-off when walking or running, and mild tenderness to palpation with resisted plantarflexion of the ankle.

As with plantar fasciitis, runners and other active adults between 30-50 years old are most commonly affected, with common inciting factors including sudden increases in running mileage, hill workouts, or exercises that load the calf muscle like squatting and lunges.

Treatment again focuses on modifying load while gradually strengthening the tendon over time with a specific emphasis on eccentric or heavy slow resistance calf exercises for 8-12 weeks. Heel lifts or booties may help if the pain is located at the insertion. Unlike plantar fasciitis, corticosteroid injections are best avoided as they appear to weaken the tendon and increase risk of rupture.

Stress Fractures

When repetitive pounding causes injury to bone faster than it can be repaired, a stress reaction or fracture can occur. The metatarsals, navicular, and calcaneus (heel bone) are the most common sites for stress fractures in the foot.

Symptoms typically include localized pain that gradually worsens with activity, but is often relieved with rest in the early stages of the injury. Swelling and focal tenderness are also very common. X-rays are often normal early on and an MRI is frequently needed to confirm the diagnosis.

Treatment depends on the location of the stress fracture. Some stress fractures are considered low risk for failure and can heal with activity modification and the use of shoe inserts or a walking boot. Other stress fractures do not heal as well with conservative management and may require surgical intervention. Healing usually takes 6-12 weeks.

Metatarsalgia

Metatarsalgia is a general term used to describe pain under the ball of the foot. It usually occurs directly under the second or third metatarsal head and is most commonly due to overuse of the forefoot from high-impact activity, abnormal foot mechanics, or thinning of the fat pad that normally protects this area.

Patients with metatarsalgia typically present with aching or burning pain in the forefoot that is worse with activities like walking or running, as well as with wearing tight-fitting shoes. You may also notice a callus forming under the metatarsal heads as the bone attempts to redistribute pressure away from the painful fat pad.

Treatment usually involves simple modifications to footwear along with the addition of metatarsal pads, rocker soles, or orthotics. Since metatarsalgia is often associated with tight calf muscles and weak foot muscles, rehabilitation should also focus on improving flexibility and strength in these areas. Symptoms usually improve within a few weeks once proper loading is restored.

Posterior Tibial Tendinopathy

Posterior tibial tendon dysfunction is caused by overuse of the posterior tibial tendon, which connects muscles in the back of your calf to the bones on the inside of your foot. When this tendon becomes irritated or damaged, patients typically develop pain along the inside of the ankle and arch that may lead to flatfoot deformity if not properly treated.

Although it can happen at any age, posterior tibial tendon dysfunction is more common in middle-aged and older adults. Patients will often complain of pain along the inside of the ankle or arch that is worse with activity and may make it difficult to perform a single-leg heel rise.

As mentioned above, supportive footwear, orthotics, activity modification, and strengthening of the posterior tibial tendon are important to help prevent progression to adult-acquired flatfoot.

Symptoms and Diagnosis

All overuse injuries of the foot will generally cause pain with activity that improves with rest. Other symptoms that indicate overload include stiffness after sitting or sleeping, focal tenderness along the affected bone or soft tissue, and pain that slowly worsens over weeks to months rather than abruptly after an injury.

Foot pain that changes the way you walk, decreases your activity level, or makes it difficult to stand or walk for work or daily activities needs medical evaluation. Many people start experiencing symptoms weeks or months before they visit our clinic, so trying to “run through it” may only cause further injury.

Overuse injuries are typically diagnosed based on a thorough history and physical exam. We will often order weight-bearing X-rays to evaluate your bones and joints, although ultrasound or MRI may be required if tendon pathology or early stress reactions are suspected.

Evidence-Based Management

While you should always see your doctor to confirm a diagnosis, there are several things you can do at home to start managing your overuse injury. Initially, we recommend modifying your activity level, taking anti-inflammatories as needed, and temporarily reducing your training volume.

Complete rest is not required for most conditions, although activities that impact the injured area (such as running with stress fractures) should be stopped until further notice. Low-impact cross-training activities such as swimming or biking can be used in place of your regular workouts.

Your physical therapist will focus on gradually loading the affected area while improving flexibility, strengthening your calf and foot muscles, and addressing any biomechanical issues that may have contributed to your injury.

Return-to-play decisions should be based on objective criteria such as pain levels, symmetry strength testing, and functional movement assessments. If your symptoms are not improving after several weeks of treatment or are getting worse, come see us.

Prevention

Injury prevention is always better than treatment, so take steps to avoid developing overuse injuries of the foot by starting any new activity slowly. A good rule of thumb is not to increase your weekly mileage by more than 10%.

Replace worn-out shoes before they no longer provide adequate shock absorption, and make sure you’re wearing the right type of shoe for your foot type and activities you participate in.

Strengthening your calf muscles and feet, as well as balance exercises, can also help.

Listen to your body and take small aches and pains seriously. It’s easier to address a problem in the beginning stages than to fully recover from a chronic injury.

Frequently Asked Questions

Q1: What are the most common overuse injuries of the foot?

A: Plantar fasciitis is the most common overuse injury of the foot and is one we see frequently at Treasure Valley Foot & Ankle. Achilles tendinopathy, stress fractures, metatarsalgia, and posterior tibial tendon dysfunction are also very common.

Q2: How do you know if foot pain is overuse or stress fracture?

A: If your pain comes on gradually and improves with rest, it’s more likely due to overuse. Sharp pain that is localized to one spot and hurts more when you are active (and doesn’t improve with rest) may be a stress fracture.

Q3: Should I rest if I have an overuse injury?

A: Not necessarily. For most injuries, complete rest is not required. Modify your activity levels and cross-train until you can return to sport without symptoms.

Q4: How long do overuse injuries of the foot take to heal?

A: This depends on the specific injury, but most injuries improve within 4-12 weeks if properly treated. Chronic problems will take longer to fully recover.

Q5: When should I make an appointment to see a foot doctor?

A: Come in to see us if the pain is severe, doesn’t improve after a few weeks of self-care, interferes with your normal activities, or is causing other symptoms like swelling or bruising.