Take the Right Step Forward 

In Massachusetts, for decades, the start of the outdoor running season was prompted by the many runners of all levels preparing for the Boston Marathon. Many novice and seasoned runners are seen lining the streets and trails as they shake off the winter season. Some are just beginning to run while others are trying to increase mileage or pace to compete in their next race. This year we feel the absence of our hometown marathon, but we have also seen a spike in recreational runners.

Running injuries are common; various studies report between 30-75% of runners are injured each year. Running involves the whole body and therefore a good training routine should include flexibility, strength, and running specific exercises. There are several parts of the body to keep in mind when developing a training routine, but one area often overlooked is foot strength. Despite what type of a foot strike you have, the foot is the first part of the body to hit the ground, transmitting forces up the leg, and influencing how the rest of the body will respond to the impact.

The foot is supported through the deep muscles on the bottom known as the intrinsic muscles, as well as the plantar fascia which travels from the base of the toes to the heel. When the foot strikes the ground, it should land on the outside of the foot in a rigid position. This position is called supination and prepares the foot for striking the ground. As the body moves over the foot into the stance phase, the foot becomes more flexible to absorb the shock and adjusts to the terrain, also known as pronation. As a runner starts to push off the toes, the foot becomes more rigid again to help propel the body forward. The arch of the foot acts like a spring, stretching as it is loaded and recoil to push the body forward.

People have different foot types and may pronate or supinate more or less than someone else. Although certain foot types may increase your likelihood of an injury, it is important to know that supination and pronation are normal parts of the gait pattern. Pronation should happen, the issues lie in how much and when the foot does it. Over pronation doesn’t necessarily mean you need orthotics; you may need support in your footwear, but you also probably need to strengthen your foot! Strong, flexible feet and ankles are important for good running form.

To avoid running injuries, in addition to having a strong core and hip muscles, it is recommended to strengthen the deep intrinsic foot muscles. There are four layers that make up these intrinsic muscles that support the foot and body with walking and running. Often, people wear orthotics or big clunky shoes to “support” their feet and do not spend the time strengthening all of these muscles to enhance foot control. We do not like to wear a back brace without strengthening our core, why should we effectively brace our feet without strengthening them? Learning how to strengthen these muscles can only benefit your support system in your foot and decrease the load on the plantar fascia. 

Another group of muscles that help the foot stay strong are the lower leg muscles. These muscles are called the extrinsic muscles because they are on the outside of the foot but have tendons that connect onto the bottom of the foot, for leverage and support. If the foot and lower leg muscles are stronger, they will be able to support and disseminate the shock of striking your foot which is significant as runners achieve approximately 1,000 steps per mile.

The Spaulding Healthy Running Program is geared toward non-injured runners looking to improve their running pattern and efficiency.

A physical therapist can improve your exercise regime and correlate it to how you run via video analysis and musculoskeletal assessment. Runners are individually assessed for lower extremity flexibility and strength, balance, and motor control which are helpful for a running program. Strength doesn’t guarantee a successful runner but knowing how to control your body while running can.

Jennifer Green PT, DPT, CSCS and Nancy Sibley, PT, DPT, CSCS are Advanced Clinical Specialists at Spaulding Framingham with extensive training in evaluating and treating runners and are certified in the Healthy Runner Program.