Michael Smith, MD
David Hesse, DPM, FACFAS





Women’s foot and ankle running injuries

David Hesse, DPM, FACFAS
Podiatric Medicine
Hesse Foot & Ankle Clinic
Eau Claire

The Q AngleWhen I attend or volunteer at marathons in our region of the country, I notice that the participants seem to include as many men as women. Why is it then that I see so many more women in my office with foot and ankle conditions as a result of training for running events? Why do we in the sports medicine world devote so much time to treating running injuries specifically for women? The answer can sometimes be elusive, but there is one particular musculoskeletal difference between women and men that provides some answers:
The Q Angle.

This angle is formed by joining lines between the hip joint, the knee cap and the femur bone (thigh bone). Women are inherently wider at the hip joint, which results in a slightly larger Q Angle. The biomechanical implications are increased stress at the hip, knee, ankle and arch. This simply puts women at a higher risk of injury to the foot and ankle complex than men during running. Let’s get down to the nitty gritty.

What are these foot and ankle injuries and what can you do about them?

Plantar Fasciitis
This is easily the most common foot complaint for any athlete. This is an inflammation of the largest ligament in the foot which happens to attach to the bottom of the heel. The primary cause is extra stress on the arch, coupled with increased activity.

Stress Fracture
The most common stress fractures in the body occur in the foot. The central metatarsals and the heel bone (calcaneus) are at greatest risk. Women tend to have bone that is less dense and at higher risk of exercise-induced fractures.

Shin Splints
Inflammation of the shin bone (tibia) and the fascial attachment sites of the lower leg muscles. “Tibial Stress Syndrome” presents as pain on the front of the lower leg during and after running.

Achilles Tendonitis
An inflammation of the large tendon in the back of the ankle that attaches your calf muscle to your heel. Again, increased stress on the arch and lack of flexibility can lead to injury.

Morton’s Neuroma
Irritation to the nerve that passes between the 3rd and 4th toes.
It is often described as a burning or tingling pain, but can also present as numbness. It is most often caused by tight shoes and inadequate cushion.

Now that we have identified all the usual suspects, how are they treated?

As always, the best treatment is prevention. Here are my three big suggestions: Stretch/Warm Up
This cannot be over-emphasized. Stretching before and after running may be the most important preventative measure a runner can take. There is now even evidence that walking or even light running “before” you stretch can be helpful. Either way, be warmed up and stretched out prior to your training run.

Good Support
When you are training, make sure you are using proper running shoes and arch support. Get educated on shoes that are most appropriate for your running style and biomechanics. Most of my marathoners wear prescription orthotics as well. The best way to determine your need for appropriate foot support is to sit down and discuss it with a qualified foot and ankle doctor. Over-the-counter arch supports can be helpful, but orthotics tend to be the gold standard for competitive runners.

Most runners are getting better at this. It has been suggested that athletes drink one full “squeeze bottle” of water for every pound of water weight lost. After a lengthy run, drink water throughout the day until your urine is clear or light yellow. The more hydrated your tendons and ligaments are, the less likely injury will occur.

“In the event of injury, you should present immediately to your doctor. The sooner you address the problem and begin an appropriate treatment course, the more quickly you will resume training and the less likely you will require surgical intervention.”

Dr. Hesse is a Board Certified Foot Surgeon and a Fellow of the American College of Foot and Ankle Surgeons.

Dr. David Hesse – Hesse Foot & Ankle Clinic
For information or to schedule an appointment:
715-514-4706 | 866-749-3668 | www.hessefootandankle.com
Dr. Hesse sees patients in Eau Claire, Chippewa Falls and Menomonie.