November 3

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Running Foot Pain with Iyad Salloum

By Wil Seto

November 3, 2023

foot pain

Mark: Hi, it's Mark Bossert. I'm here with Iyad Salloum of Insync Physio in North Burnaby, BC Canada, a physiotherapist of immense renown, and we're going to talk about running foot pain. Something you have a little bit of recent experience with, Iyad. 

Iyad: Yes, unfortunately. How are you, Mark? 

Mark: Good. So what's the deal with this pain in the foot thing? Can you just ignore it? 

Iyad: As I learned, absolutely not. So it could be anything. The unfortunate thing that we see with foot pain and running is that wherever the pain is in the foot, people will self diagnose it as plantar fascia pain or plantar fasciitis or plantar fasciopathy or anything that, you know, they could find online that kind of points to that.

Now, sure, that is one of the diagnoses that could happen, one of the conditions that could affect the foot, and usually it will start at the heel and into the arch, but that's only one of many other things that could happen. Recently we've been seeing a lot of like, especially with the nice weather that we've had late into the fall, people are still exercising and running, and it's been good. It's kind of gotten cooler, so the running distances maybe get a bit bigger.

You start to develop these aches, most of the time in the foot will get them in either the, let's call it on the way outer side of the foot. Like at the, if you think your pinky toe here, it would be at the metatarsal, which is kind of there. And that could be due just to running pattern, for example.

Where you're hitting on the outside of your foot first. Most people come in and tell me, Oh, I pronate. But pronating is the opposite where you go into the inside of your foot. I pronate too much when I run. And it could be that you're doing the opposite of that. So you're hitting on the outside and then your foot's kind of flopping down like that repeatedly.

And now doing this once or twice isn't going to do much for you. But if you're thinking about, you know, take about a 1000 steps per kilometre of running that adds up. Those repetitive small impacts could get up to quite a bit that your foot has to adapt from.

So that's a simple case where we could have the bones get sore and as part of that recovery then, we need to figure out where along this healing timeline that this thing is. If we catch it early, we could start different kind of training programs for example, that help maybe it's some issues with control of the hip or the thigh that's allowing them maybe they have to hit really hard to kind of compensate for that deficit in the chain. So we would kind of do some training there and then some day training. 

Unfortunately, we see people too late sometimes where they don't even know that they have an actual stress fracture going on in the foot. So then when we send them for the proper diagnostic testing, which most commonly will be the x ray 1st. And if you see it on an x ray, and that's probably like a later development, not an early development of that bone injury. But even if it's negative on the x ray, we will do more tests. Sometimes an MRI or CT scan are actually better to find this stuff. And usually we'll work with our family doctor colleagues for that diagnosis.

If it's still in the early phases that we can manage it by managing the volume of things. And modifying the activity and also training up on other areas where necessary. If it's in, unfortunately, in the fracture phase, then we have to work, like in a complete fracture. We'd have to work with our orthopedic surgery colleagues, try to figure out the best plan. 

And the unfortunate thing is it's a bit controversial, so there's no 1 size fits all to this. Some people are proponents of no weight bearing and some people are proponents of early weight bearing. So, I think this depends and I think we'd have to follow the medical advice and what the team decides based on that individual themselves.

Mark: So it's not something to ignore. You have to pay attention to it sooner than later. 

Iyad: Yes, and the most important thing is sometimes I find the most common reason we get this is when people will try to change their running style to fit something that they saw on a magazine, like a forefoot strike. If they're a heel striker or a midfoot striker, if they're a forefoot striker, that's a common reason.

The other reason is recent footwear change where they go from something that's very high in foam and then to a more stiff shoe without a proper transition. Or just simply running way too much, which was my case, for example. And I think yes, intervene early 'cause you could do a lot. And then you could also in many cases, if we know what it is early on, we can continue your training in a safe way instead of just getting you to stop completely to allow things to recover.

Mark: If you're having running foot pain, get in to see the physiotherapist at Insync Physio. You can book online at insyncphysio.com. Or you can call the Burnaby office at (604) 298-4878. Vancouver is (604) 566-9716 to book. You have to book ahead. They're always busy. Insync Physio. Thanks Iyad. 

Iyad: Thank you.

Wil Seto

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