by Stephen Kominsky, DPM, FACFAS of Mid-Atlantic Podiatry Associates
Specialty in Sports Medicine and Reconstructive Foot Surgery

Summer is the season to be extra careful when training. Aside from the obvious issues of heat and hydration, summertime is when many people begin to ramp up their training for fall events. Fall brings cooler temperatures, and as a result, many of the “elite” activities take place during that season. Therefore, one must be vigilant in their monitoring of equipment (in this case the shoe gear) as well as training techniques.

Let us start with shoe gear. It is essential that the footwear be appropriate for the activity that is planned. Although it seems obvious to most, there are always people that I see that are wearing the wrong shoes. For example, it would be illogical, and contraindicated to wear a basketball sneaker for a 10K run. The biomechanics of each of these events are different, and therefore have different needs from the shoe gear. The area that I want to focus on in this piece is the concept of support; some refer to this as motion control.

Pronation is a term that many people are familiar with, but don’t really understand. From a biomechanical perspective, the foot is capable of doing two things. Pronate, or flatten the arch, or supinate which means to raise the arch. Normal gait requires the foot to have some of each motion with each step that we take. Problems arise however when one has too much of one or the other, or even worse, the complete absence of one or the other. Fortunately, the latter is very rare. A foot that supinates too much, is a high arched, rigid foot that does not absorb shock well. The typical symptoms associated with this foot type (but certainly not exclusive to this foot type) are painful callouses on the bottom of the foot, jarring knee pain usually around the knee cap, and joint pain in the hind-foot joints. Approximately 15-20% of the running population has this mechanical foot type. The remainder of the running population has either a neutral foot or an overly pronated foot (60%).

As a sports medicine podiatrist, the symptoms that I see most often associated with the pronated foot type are heel pain, arch pain, outside (lateral) knee pain and shin splints. Heel and arch pain are most often diagnosed as plantar fasciitis. This condition is an inflammation of the origin of the plantar fascia which is a thick broad band on the bottom of the foot that runs from the heel to the forefoot. This condition, which is very common, is often treated successfully with a combination of things both to relieve the symptoms and control the mechanics (pronation). This is where having the proper shoe becomes so important. There are many shoes on the market today that are designed to provide mechanical control. There are shoes for supinators, and there are shoes for over-pronators. A thorough biomechanical evaluation by a trained sports medicine professional should provide the basis for determining the foot type, and ultimately the style of shoe best suited. That should be followed by a visit to a sports shoe shop like the Georgetown Running Company that has professionally trained staff with the ability to recommend, fit and answer questions as well as provide training tips.

The other aggravating factor relative to training injuries is training technique. Very often, I am confronted with patients in the office that come in with a whole group of injuries that fall under the heading of “over-use”. This group of maladies is the result of inadequate preparation of the body for the level of stress that is occurring. For example a person that has been running 3 miles at a moderate pace three days a week for several months suddenly runs 15 miles one day. That event alone will cause a significant increased stress load on the entire body, but in particular the lower extremities. It has been determined that the average runner experiences 3-4 times their body weight in stress load on the lower extremities when running. That means that for the average 150 pound person, 600 pounds per square inch of force is going through the hips knees, and foot joints with every stride. No material known to man can withstand that force forever. In the case of our 3 mile to 15 mile example, there would be a breakdown of tissue at some level almost assuredly. Symptoms of over-use injury typically include pain, sometimes at a joint, often on the top of the foot, swelling and elevated skin temperatures. This last finding is the generalized response to inflammation.