Why do my toes tingle?

Article by: Margot Manning podiatrist and running coach

Why do my toes tingle?

5 causes of tingling in the toes

Tingling toes are a common sensation experienced by some when running as well when wearing day to day shoes. The main reason for tingling to occur is from pressure on a nerve.  Running can cause continual pressure on nerves from long term repetitive motion and the resultant swelling of feet. Tingling occurs if either shoes are too small, or there is an underlying injury. Don’t think it is your shoes – what do you need to look out for?

Five common tingling toes injuries

  1. Neuritis: Inflammation of the nerves that run between the

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    bones at the ball of the feet. This is usually resolved by changing footwear and lacing.

  2. Neuroma: Thickening of the nerve at the ball of the foot where it fills up the available space and hurts even when not active. Both footwear, podiatry and sometimes surgery are necessary depending on the progression of the symptoms.
  3. Bursitis: Fluid filled sacs become enlarged due to pressure between the heads of the metatarsals (long bone of the feet). These fill the space between the bones and put added pressure on the nerves. Footwear, podiatry and if no resolution, a visit to a sports doctor for cortisone injections may be needed.
  4. Synovitis or joint capsulitis: Inflammation of the fluid within the toe joint, usually from trauma (e.g. landing badly on a rock) or when the head of the metatarsals are driven into the ground. The latter is a biomechanical problem that needs to be addressed with podiatry care. Like bursitis, the increase in size of the joint can put pressure on the adjacent nerve creating tingling as a secondary symptom.
  5. Plantar plate tear: The plantar plate is a strong fibrous structure that sits beneath each of the joints at the ball of the foot. Its role is to withstand the high loads at these joints and to create stability. If the toes are over extended repetitively or with excessive force (e.g. running up hills), thickening or a small tear can develop in the plantar plate. Over time, the affected toe can drift apart from its adjacent toe, and develop both synovitis and a claw toe. These changes to the joint integrity can lead to subtle tingling of the toes.

Tightshoes_TinglingtoesOf the five injuries, plantar plate tears are the least common, but the most misdiagnosed. This is because there can be a combination of symptoms from the other four injuries above.  This can lead to unsuccessful treatment plans and ongoing frustration for the runner.

Don’t ignore tingling toes. Whilst it is often a footwear isolated issue that can be relieved by; wearing thinner socks, specific lacing techniques or changing the shoe itself. If your tingling toes are not relieved by these adjustments there may be an underlying injury that is the cause. Book in to see one of our podiatrists at intraining Running Injury Clinic for accurate diagnosis and treatment.

Our podiatry team are all runners and understand how frustrating an injury can be. We know you want to get back out and run injury free as quickly as possible.

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Stronger Achilles for faster running

From the Sole

How to make a stronger Achilles for better performance.

Article by: Steve Manning – Podiatrist and coach at intraining Running Injury Clinic
Article by: Steve Manning – Podiatrist and coach at intraining Running Injury Clinic

One of the best ways to run faster with less effort is plyometric drills.  These drills exaggerate a part of the running action while having a forced dynamic stretch component before springing back.  They include mainly jumping, skipping and bounding.

Research has shown that these drills have the greatest effect on running performance in the least amount of training time.  The downside is that they have an increased injury risk while doing them.

The reason that these drills are so effective is that they work on the elastic component of the muscle.  That is the part of the muscle that stores the energy from landing and then returns that energy like a spring as you push off.  This elastic component is critical to distance running efficiency.

The Achilles and deep fascia connective tissue that surrounds the calf muscle are the most important elastic tissues for runners.  The thicker and stiffer the Achilles the better it is able to store the energy from landing.  Plyometric drills are able to increase the strength of the Achilles by changing the size and strength of each fibre in the Achilles as well as its overall width and resistance to stretching.

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Bounding – Plyometric drill for strength

Three ways to incorporate plyometric drills into your training

  1. Initially only do the drills for 10 to 20 minutes once or twice a week and for a training block of 6 weeks.  This will reduce injury risk.  After that you only need to incorporate a few minutes of drills with each speed session.
  2. These drills need to be dynamic but controlled.  Do not strain or reach while doing the drills.  Focus on staying on your forefoot and having as short ground time as possible.
  3. Warmup properly before doing the drills with a run of at least 10 minutes.  Doing some coordination drills like high knees and bum kicks can also help warm up the Achilles for the harder plyometric drills.

Plyometric drills can be a very effective way to faster running through a stronger Achilles.  Our podiatrists at the intraining Running Injury Clinic can instruct you on how to use the best technique to do the drills for the best result with the least injury risk.

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600x600-workshops-logoKeen to take it a step further? The intraining Running Injury Clinic conduct running form workshops on a regular basis.

If you are interested in improving your running technique, reducing risk of running injury or keen to learn more about running form, find out more about the Running Form Workshops available.

For more From the Sole injury articles click here.

Is your gait causing shin pain?

Article by Doug James (intraining physiotherapist and podiatrist)
Article by Doug James (intraining physiotherapist and podiatrist)

Gait related shin pain

Running injuries are common. In a given year, runners have a 70-80% likelihood of developing an injury that will prevent them from running pain free for at least a week. While there are many different types of injuries that can occur, some people may be more prone to a particular injury while seemingly resistant to others. There are a lot of different factors that can account for this including age, sex, training history, biomechanics (and more) however of these, running technique is one of the few factors that can be changed.

It needs to be mentioned that no particular running technique can guarantee that you will be injury free. Different, and sometimes worse injuries can develop when people attempt to change their running style. The aim of this article is understand the types of shin injuries that can develop from running, and the factors influencing them.

Shin injuries are commonly lumped under the umbrella term of ‘shin splints’ by some medical professionals. This rather obtuse term neglects the specific location, onset and severity of the injury – all factors required for correct diagnosis and subsequent treatment.

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Running can cause injuries to muscle and bone in the shin
Running can cause injuries to muscle and bone in the shin

 Antero-lateral shin pain

Pain on the outside part of the front of your shin is usually related to the Tibialis Anterior muscle. This long muscle is responsible for lifting your foot upwards at the ankle joint. The muscle can become overworked if subjected to more exercise than it is used to and tends to become sore after the run, with pain disappearing a few days later. This injury is frequently seen in those that are new to running, or returning after time off from the sport. People that tend to heel strike (i.e. land heel first) are far more likely to be affected by this injury, and athletes are also more at risk if running in incorrect footwear – particularly if the shoe is too stiff (resulting in foot slapping), or lacks adequate pronation support.

Heel striking occurs when the runner’s heel lands on the ground first – usually in front of their centre of mass – and the further in front, the more of a problem this poses. In this position the Tibialis Anterior muscle is working to have the toes lifted higher than the heel to prevent tripping. The forefoot then rapidly lowers putting further strain on the Tibialis Anterior as it is responsible for the controlled descent of the foot. Once the foot is flat on the ground, the Tibialis Anterior may be subject to further strain if the foot heavily and/or rapidly pronates (rolls inwards).

The Tibialis Anterior can be put under even greater levels of strain when running downhill as this tends to amplify the slapping movement of the heel-to-toe progression.

Key points you should know

  • Your running technique can predict the type of injuries you get
  • “Shin Splints” is a commonly used term but utterly innaccurate
  • A running assessment can help identify faults leading to shin injuries

Postero-medial shin pain

Pain felt on the inside part of the shin along the edge of the tibia (shin bone) is often diagnosed as Medial Tibial Stress Syndrome (MTSS), or more recently known as Medial Tibial Traction Perisostitis (MTTP). Irrespective of the nomenclature, the injury usually begins as a broad area of discomfort along the inside part of the shin. This usually starts as a mild discomfort at the start of the run, but resolves after a few minutes. The pain is usually a response to an increase in loading along the edge of the tibia causing swelling around the periosteum (outer lining of the bone) initially, which can progress to bone damage thereafter. The increased loading is usually from higher running volume or intensity (or both) than is usual. Conjecture exists as to whether damage is due to force generated at foot strike, associated muscle tension from the Posterior Tibialis muscle, or some combination of both.

Training load plays a large role in the development of this injury, however there are certain gait factors that may increase the likelihood of developing it. Over-pronating can play a part in increasing the tension in the Posterior Tibialis muscle, which in turn exerts a traction force on the tibia. Overstriding (landing too far in front of the centre of mass) increases the initial impact forces transferred through the lower limb and shin that can also damage the tibia. Additionally, running in shoes that offer insufficient cushioning (i.e. are worn out, or offer less support than the athlete is accustomed to), and under-pronating can increase shock that also affects the tibia and lower limb.

Worse still…

Overstriding and heel striking are two common factors in shin pain
Overstriding and heel striking are two common factors in shin pain

With both of the injury areas mentioned above, after a sufficient reduction in training (and in some cases complete rest) for a suitable period, the injury will recover and heal. There are two notable exceptions to this however – shin injuries where pain becomes worse with running need to be investigated immediately. Sharp localised pain (on the front or side of the tibia or fibula) can be the sign of a stress fracture and should never be run on as this will steeply increase the injury severity and healing time required. Management usually involves rest (the amount of which can be calculated somewhat more precisely with the aid of an MRI scan), a fracture boot (in some cases), and a considered return to exercise plan.

The other critical shin injury not to miss is compartment syndrome. This is a dangerous injury where pressure builds up in the muscle sheath persisting for hours after exercise and can lead to permanent damage to the muscle and nerves in the leg and foot. This often requires surgery. If you suspect you have a stress fracture or compartment syndrome this should be investigated immediately.

For the injuries mentioned earlier, specific changes in running gait, footwear, and training can help to reduce the severity and reoccurrence of these injuries and possibly lead to better performance as well. If you’ve been dealing with running related shin problems, contact the intraining Running Injury Clinic for an appointment.

600x600-workshops-logoIf you are training more without realising the benefits of increased performance, it may be a simple modification to your running form that will result in the benefits you are looking to achieve. The intraining Running Injury Clinic conduct running form workshops on a regular basis.

If you are interested in improving your running form or reducing your risk of injury, sign up for the Running Form Workshop on 8 October or 3 December 2017.

For more From the Sole injury articles click here.

Stay injury free

Want to stay injury free?

Here are three things you should know.

You may have just run your first major goal race. While this is an exciting running period, it is the time when you are most vulnerable to developing an injury. To help you stay on the road, here are three reminders to keep you running happily running towards your next goal race.

1.Long runs vs racing

If you have multiple races planned such as the Gold Coast Marathon, Brisbane Marathon Festival and Twilight Bay Run, you should be changing your long run focus in your training plan. This phase of training is called the competitive phase so the emphasis is more on the racing. Long runs will still occur but less frequently to allow maximum benefit from each of the races you have done.

2.Pace control

Successful races and improvements in training times are amazing motivators. But it is now that you need to exert even more control in managing your speed sessions and weekend races so not to let your enthusiasm override your goal training pace. Planning your speed work and long run paces in advance can help to avoid overtraining. It can be useful to sit with a coach and plan these paces for each session to help keep you on track. Our podiatry team are also coaches and can help you write an individual program with personal pace targets.

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3.Refresh your footwear

It is 7 months now since you may have set your 2017 goals and purchased your training shoes. If your legs are feeling a little more tired or the shoes are feeling soft, now is definitely the time to replace them or add the new shoe into the mix. Don’t let a dying or worn out shoes be the cause of an injury that will interfere with the rest of your year’s racing. If you aren’t sure, or think you may need new shoes come into the intraining Running Centre at either Milton or Indooroopilly locations and have our footwear experts assist in providing you with advice on selecting the right type of shoe to suit your running needs.

Article by: Margot Manning podiatrist and running coach
Article by: Margot Manning podiatrist and running coach

Remember these three tips, and take action early if any niggles get worse. At intraining Running Centre, we love running and share your passion, and will work hard so you don’t miss a minute of it.

Have a question for our coaches? Click here to email us your question

Need help with an injury? Email our running injury specialists at intraining Running Injury Clinic.

Calf injuries and you

Calf injuries during race season

By: Doug James (intraining podiatrist and physiotherapist)
By: Doug James (intraining podiatrist and physiotherapist).

There are few things more frustrating than spending months training for a race, only for an injury to prevent you from being able to run it. Calf and lower leg injuries are responsible for a good number of these ‘DNS’ (Did Not Start) type injuries, but many of them are preventable.

Your calf muscles and lower legs are like barometers for how well you are handling your training load. Pain and muscle tightness are often signs of overuse and may signal an oncoming injury. The biggest cause of running injuries are errors in your training approach. At this point of the season errors may be due to not allowing sufficient recovery time between hard sessions, and failing to heed warnings that you are pushing too hard.

Optimal performance comes from finding a balance between a decent volume of training, while allowing enough time to recover. Your recovery can be aided through ice baths, and manual therapies such as massage, dry needling and foam rolling. When these things no longer relieve symptoms, a more serious injury may be presenting.

Common calf injuries include muscle tears, tibia stress injuries and Achilles tendinitis. Muscle tears can arise purely from bad luck (though over exertion is usually a factor), but as with the other two injuries, they may be a result of overuse and/or bad biomechanics. If you’ve trained for much of the year, you would likely have worn through at least one pair of running shoes by. Having a relatively new (but worn in) pair for your goal race is a sensible idea. Dramatically changing the type of shoe however, isn’t.

The heel pitch (height of the heel compared to the forefoot) can affect how much strain is placed on your calf and Achilles tendon. The average running shoe has a heel drop of about 10mm (meaning the heel sits 10mm higher than your forefoot). If you were to suddenly start running in a shoe with much lower heel drop – which a lot of racing shoes do – you may find yourself with a painful calf and/or Achilles.

Heel to toe drop example

Wearing a shoe that has too much, or too little pronation support can also be an issue. Pronation support is a feature in shoes that may help to reduce strain on parts of your foot and leg – assuming you need it. Wearing a shoe with an unnecessary amount of pronation support and stiffness can result in excessive force on your leg, Achilles tendon and calf muscle.

IRIC17_RehabLogoV2In cases where correct footwear prescription alone isn’t sufficient to remedy an injury, it may be necessary to consider a foot orthotic. A podiatrist can design a shoe insert to improve your foot biomechanics which may help lessen the impact on your leg and calf.

If you are having issues with your calf (or want to avoid them) contact the intraining Running Injury Clinic for an appointment. Our team of podiatrists are able to prescribe the ideal training or racing shoe for you (and custom made orthotics if necessary). Additionally, physiotherapy can be useful for pre-event massage and dry needling to get you running at your best.

Good luck with your winter running season!

Pain in the heel?

Pain in the heel becoming a pain in the butt?

Feetures_PFsockLet’s face it, having a pain in the heel is a huge pain in the butt. Plantar Fasciopathy and/or Fasciitis is a prevalent injury amongst runners and the general public alike. Plantar Fasciopathy causes significant and often debilitating pain that affects not only running, but everyday life. Most often pain is experienced in the heel, but it can also extend through the medial arch of the foot.

Enter the new Plantar Fascia compression sock from Feetures. This is the latest high-quality recovery focused foot garment to hit the shelves at intraining Running Centre. Whilst not the silver bullet in curing plantar fascia pain, they’re a great adjunct treatment for sufferers of Plantar Fasciopathy. The Feetures sock assists in relieving tension through the plantar fascia and providing lasting support and symptomatic relief.

Three key areas the Feetures PF sock can help

  1. Eases heel and arch pain
  2. Targeted compression lifts, stretches and stabilizes the plantar fascia and supports the Achilles tendon
  3. Easy to wear sock provides convenient relief

If you are looking for a compression sock that will assist in your recovery process and help reduce the pain in your heel, these are worth a try. Not only will they offer Plantar Fasciitis sufferers in managing pain, the socks provide fantastic comfort and can be worn both during and after running.

Article by Emily Donker. Podiatrist, coach and runner
Article by Emily Donker.
Podiatrist, coach and runner

The Plantar Fascia Compression Socks from Feetures have recently been launched worldwide. We are excited that intraining Running Centre is one of the first few locations you can get your hands on a pair … well, your feet in a pair!

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