Forget The Pain, Running Injuries Can Be Depressing!!

Earlier this year I treated a patient who ran the Houston Marathon and jumped right into training for the upcoming triathlon season the following week, against my advice, while nursing a painful case of posterior tibial tendon tendonitits. Unfortunately this approach eventually sidelined him and forced him to scrap the entire triathlon season in order to undergo surgery and recover from his injury. This eventually led to a major case of depression which far outlasted his recovery from injury and almost kept him out indefinitely.

By nature, athletes have an extremely high tolerance for pain and at times tend to view their injuries as a normal part of their training regimen often to the point of ignoring serious symptoms. Posterior tibial tendonitis is a common injury in runners usually resulting from chronic overpronation and overuse caused by the repetitive force and trauma asociated with overtraining. Symptoms usually begin as soreness along the inside of the ankle and/or arch when pushing off and can eventually lead to weakness and severe pain. Left untreated, it can progress to a tear which usually requires lengthy immobilization or surgical intervention causing a major delay in any training regimen. However, if the injury is caught early and treated aggressively, it can be done without any interruption or possibly a slight, brief alteration in the training schedule while avoiding a lengthy delay which can spoil any runner's plans.

In this particular case, my patient underwent approximately 8 weeks of physical therapy, anti inflammatories and forced rest. During this time he became discouraged, angry and unmotivated, even though I recommended cross training to maintain at least some level of fitness so that his return to running would not be so traumatic. He resisted the entire time and even admitted to feeling "worthless" at one point. Once he was pain free, he was still afraid to resume running for fear he would reinjure his foot and it would sideine him again.

About 3 months after stopping running completely to rehabilitate from his injury, he began cycling, swimming and using the elliptical machine gradually. More recently, he resumed running starting at a much reduced distance than where he left off, and he is starting to regain confidence and a sense of self worth.

He now realizes what caused his depression and I have no doubt that he will return stronger than ever. More importantly, I think the lesson he learned and one that all athletes should learn, particularly runners, is not to ignore any injury. No matter how small or insignificant you may think the injury is, it can become significant if it is not addressed early and aggressively. The resulting depression from the mental trauma of having something so meaningful and enjoyable taken away can lead to an even more prolonged layoff from which you may never fully recover, long after the injury has healed.

Playing Sports Does Not Have to Mean Getting Hurt!

Sports Injuries of the Foot and Ankle

Sports injuries of the foot and ankle generally fall into one of two categories: (1) Acute/Traumatic Injuries which occur due to a sudden force, or impact, on the foot or ankle, and (2) Overuse Injuries which result from overuse, lack of proper rest, lack of proper warm-ups, or poor conditioning.

But playing sports does not have to mean getting hurt. Warming up adequately, training effectively, using proper equipment for your sport, and recognizing and addressing the early warning signs of injury can reduce your risk of aches and pains.


The following is a list of some of the most common sports-related injuries of the foot and ankle:

Baseball—blisters, ankle sprains, muscle strains, stress fractures

Basketball—ankle sprains, Achilles tendonitis

Bicycling—Achilles tendonitis, plantar fasciitis, blisters

Dance—ankle sprains, dancer's fracture, sesamoiditis, plantar fasciitis, metatarsalgia, Achilles tendonitis, trigger toe

Football—shin splints, ankle sprains, Achilles tendonitis, turf toe, blisters

Golf—plantar fasciitis, stress fractures, blisters

Running—ankle sprains, Achilles tendonitis, blisters, plantar fasciitis, IT band syndrome, patellofemoral pain syndrome, piriformis syndrome, shin splints, stress fractures, muscle cramps

Skiing/Snowboarding—frostbite, muscle strains, ankle sprains

Soccer—ankle sprains, Achilles tendonitis, IT band syndrome, muscle cramps, blisters, patellofemoral pain syndrome, plantar fasciitis, shin splints, stress fractures

Tennis—Achilles tendonitis, ankle sprains, IT band syndrome, Achilles tendon rupture, stress fractures

Volleyball—Achilles tendonitis, Achilles tendon rupture, ankle sprains

While it is impossible to prevent every injury, research suggests that injury rates could be reduced by 25% if athletes took appropriate preventative action, including the following: be in proper physical condition to play a sport, play by the rules of the sport, wear appropriate protective gear, rest, warm-up, and avoid playing when in pain or when tired.


Just a few extra words about running:


Running is one of the easiest ways for athletes to get injured. Running injuries are common and often affect the ankles and feet. The impact and stress of running is sometimes hard on the muscles and joints, especially if the early warning signs of an injury are ignored. The best way to avoid running injuries is to prevent them using tips such as these:
· Stretch, stretch, stretch!
· Wear Proper Footwear
· Replace Shoes as Needed
· Warm Up Properly
· Cross Train
· Avoid Overtraining
· Follow the Ten Percent Rule



A podiatrist can recommend the proper running shoe for your foot type. If you're not sure which shoe is right for you, consult your podiatrist.

Dancing With the Stars: Another Foot Injury?

What doe this have to do with running? A lot, if the training before a race or before a dance performance is not done properly.

Donny Osmond is the latest in a series of injuries from the reality show "Dancing with the Stars." He was dancing this week with a broken toe. A fractured toe can be quite painful, depending on the location, angle, and severity of the break in the bone(s). I speak from personal experience on this injury. I fractured one of my toes while I was a surgical resident and had no choice but to work, walk on it, wear closed toe shoes, and stand on it for prolonged periods of time. However, I did not continue to run or dance or engage in other sports for the weeks that was required for it to heal.

But...there seems to be a trend on this show with injuries and the stars continuing to dance and perform while injured. We saw this in the past few weeks with Tom DeLay who continued to dance on stress fractures in both feet until it got to the point where he had to quit the show...eventually. Other previous foot & ankle injuries included Misty-May Treanor with a ruptured Achilles tendon, Lance Bass with a toe fracture, and Kristi Yamaguchi with an ankle injury.

This is similar to what us physicians see with "weekend athletes" or runners to try to do too much, too soon. Proper sports training is just that--training. If an athlete is a beginner, such as these celebrities, with respect to a particular sport, then a gradual and incremental training process in necessary to prevent injury. If this does not occur, injury is more than likely to happen. So it is not surprising to me and many of my colleagues that these stars are getting injured at such a high rate. Perhaps the medical professionals associated with the show could point this out to the show executives and try to do something about it...or perhaps we will continue to see another series of injuries in upcoming episodes.

What do you think? Feel free to comment below on this possibly controversial subject. In my professional, medical opinion, it is quite obvious what will occur if changes are not made in the show's training schedule.