The plantar heel fat pad is a really vital, but little acknowledged, structure of the human foot which protects the plantar calcaneus from injury when running. The heel fat pad has a special structure that permits it to cushion and also successfully soak up the impact energy of heel contact when running to reduce the effect forces on the plantar calcaneus, and its soft tissue and also osseous structures, in order to help avoid injury.
The heel fat pad is composed of specialized adipose tissue had within shut compartments called microchambers and macrochambers. Microchambers lie close to the plantar skin, as well as the larger, well-formed system of macrochambers are loaded with fairly low-density fat. The walls of these microchambers and also macrochambers are composed of septa, which are both fibrous as well as elastic in nature. These septa aid hold the fat in place plantar to the heel during weightbearing tasks and help the fat pad to displace and afterwards return to its unloaded form with heel dumping.
During loading of the plantar heel during heel contact during strolling and running, the fat of the macrochambers displace medially, side to side as well as par excellence, absorbing some of the effect power of heel strike. This motion of the private fat-filled macrochambers during heel influence helps shield the plantar calcaneus from injury.
Heel fat pads are thicker in males than ladies. In addition, research has shown that as the individual ages, the heel fat pad loses some capability to absorb influence energy which appears to be because of a gradual degeneration of the septal walls of the macrochambers and displacement of this fat out of the confines of the macrochambers.
This fat pad can atrophy and not absorb shock like it should. If this happens, then extra cushioning is needed inside the running shoes or a more shock absorbing running shoe will be needed.
In runners if there is pain on the outside of the ankle joint and there is no history of trauma, then the most likely problem is what is known as peroneal tendonitis. The peroneal muscles are on the outside of the leg and there tendons go around the outside of the ankle joint to then go to the outside and the bottom of the foot. The primary function of these muscles are to stabilize and support the foot.
If a tendonitis develops in the tendons of these peroneal muscles in runners, then the cause is most likely overuse. That is doing too much too soon and the tendons are not given a chance to adapt to the increasing loads that are placed on them from that too rapid increase in the distances and speeds being run. It is important that after hard longer runs that the body is given adequate rest before the next load is applied. if a load is applied too soon before the tissues have had time to recover, then there is an increased risk for an injury.
The pain of peroneal tendonitis usually just starts of as a minor ache, either just above or below the ankle bone on the outside of the ankle. Initially there is no swelling, but that will tend to develop later as the pain increases if the problem is not addressed.
To deal with peroneal tendonitis, the runners needs to cut back the running to tolerable levels to allow the tendons to heal. Podiatrists often use a lateral wedge to treat peroneal tendonitis in the short term as this decreases the activity of the peroneal muscles, so there is less load on the tendons. This goes under the heel in the running shoes. After the pain in the tendons starts to settle down, then a gradual and slow increase is needed in the distances run to allow the tendon to adapt to those loads are needed. A strengthening program is also very helpful.
You would think that overpronation is akin to a death sentence for runners if you read some of the running websites and social media commentary. You would think that it could be responsible for all the injuries that runners get and why they need the special motion control running shoes or foot orthotics to fix it. It really does get talked about in some circles that it is something quite evil and that it needs to be dealt with.
Pronation is a normal motion of the foot in which the ankle rolls inwards and the arch of the foot flattens. Overpronation is when there is too much of that normal motion. There is no clear definition of what overpronation actually is and what could be considered normal and abnormal. This problem is claimed to cause an inefficient running gait, so more energy is needed to run. It is also claimed that that a foot that overpronates can cause all sorts of problems from bunions to plantar fasciitis to knee injuries. Due to this, runners who do overpronate are strongly advised to use foot orthotics to support the foot and use the supportive types of running shoes.
Despite this, there are plenty of anecdotes of runners who can have quite a severe form of this type who never get problems and can run fast. This has led to claims that the whole concept around overpronation is a myth and is not really a problem. They claim it is invented by those who make money from foot orthotics and running shoes.
However, if you look at the actual research evidence, then yes overpronation (however you want to define it) is a problem in running. The meta-analyses and systematic review of all the data show that is a small risk factor for overuse injury in runners, but that risk is still statistically significant. This means that overpronation is a problem is runners but its probably not as big a problem that it was considered in the past.
Metatarsalgia is a bad term for a common problem in runners. It is a term that unfortunately gets used a lot but is quite a meaningless term and diagnosis. The term is like, for example, saying you have a sore knee. That sore knee could be due to any one of multiple different things. Metatarsalgia means pain in the metatarsals or forefoot, so it can be due to multiple different things. That is why the term is so meaningless.
The cause of the symptoms could be a callus of the skin under the ball of the foot; it could be a pinched nerve that causes shooting type pains; it could be a fat pad atrophy that causes problems with weight bearing; or it could be arthritis type symptoms inside the joints in the ball of the foot. Each of these potential reasons for metatarsalgia are very different to each other with different symptoms and different causes which just serves to illustrate just what a poor term it is to use.
Probably the most common cause for pain in the ball of the foot is a condition called a plantar plate tear. This is a strain of the ligament under the joints in the ball of the foot that can progress to a small tear. The pain is typically over the joint on the bottom of the foot and just distal to the joint. Usually it is the second metatarsophalangeal joint, but it can affect all or any of the joints. It is more common in those who exercise more. It starts as a mild ache that is often ignored, but it will progress unless there is a treatment started as it does not heal on its own.
Typically the treatment of a plantar plate tear is to use strapping to hold the toe in a plantarflexed or downward position to prevent it from bending up so the strain is given a rest. A rocker sole shoe or a shoe that is stiffer can also help do this. If this helps, it does tend to take a long time and patience is needed. If it does not help, then some plantar plate tears need a surgical treatment.
The growing bones in children are susceptible to injury if too much load gets applied to them too soon and the bones are not given time to adapt to loads. Generally at the ends of each bone are cartilage growth areas that growth occurs at. It is this softer cartilage area that is prone to damage. Problems with these growth plates tend to be more common in those who are more active or are heavier. All of these problems come right on there own when growth in the bone is completed and the cartilage growth area merges with the rest of the bone.
This is the growth injury at the front and top of the tibia bone just below the knee cap. It occurs where the tendon from the knee cap insert into the tibia bone. The insertion area can become swollen, tender and a small hard lump can appear. It is usually very painful on activity and especially when climbing stairs. The treatment of Osgood-Schlatter Disease is usually with a reduction of activity to within pain levels and the use of ice after activity to help with the pain. Stretching and strengthening exercises are also often used.
This is an injury to a growth area at the back of the heel bone that is more appropriately named calcaneal apophysitis. The symptoms of Sever’s is pain at the back and sides of the heel bone, especially if you squeeze the bone from the sides. It is usually more painful after activity. The best way to deal with Severs disease is to reduce activity levels to tolerable levels, use ice after activity.
The is a damage to the growing navicular bone in the foot with the pain being typically felt on the top of the foot, just in front of the ankle joint. It commonly affects younger children. A typical sign of Kohler’s Disease is that on x-ray the bone is very thin. This is more serious than the other types of growth injuries and can have long term consequences, so these are typically placed in a walking cast to immobilize the foot.
Heel pain is the most common musculoskeletal problem seen by podiatrists in runners. The most common cause of that heel pain is a condition known as plantar fasciitis. The problem with it being so common is that everyone is an expert on it and everyone has there own magic cure for it that they thing everyone should use. There is no shortage of advice for runners on how they should treat plantar fasciitis in social media, in eBooks, on YouTube and on forums. Every time you see a runner ask how to get rid of plantar fasciitis you get plenty of advice of what worked for them, therefore you should try it. However, for each recommendation of a particular treatment that gets given, there is another runner says that it did not work for them. Many of the treatments that you see recommended can not possibly work, but those runners swear by it.
So what exactly is plantar fasciitis? The plantar fascia is a very strong ligament that runs across the bottom of the foot connecting the heel bone to the ball of the foot. From the location of this ligament it should be obvious that its role or function is to support the arch of the foot. This means that anything that puts too much pressure on the arch of the foot is going to predispose the plantar fascia to injury. The factors that increase that load include the amount of running you do, your body weight and how tight the calf muscles are. They all put pressure on the arch of the foot and put increased strain on the plantar fascia.
The classic symptoms of plantar fasciitis is pain under the heel and first few steps pain when getting up from rest, especially out of bed in the morning. If you have that, then there is a pretty good chance that you have plantar fasciitis. Other conditions can cause similar symptoms, but are much less common.
How should plantar fasciitis be treated? The best way to reduce the load in the plantar fascia. You do that by reducing your running volume down to a level that can be tolerated. You stretch the calf muscles to reduce there impact on stressing the arch of the foot. And you use foot supports to hold up the arch so that the ligament does not have to work so hard. That’s it. Once it starts to improve, you then gradually and slowly increase the running distances and intensity.
There are many other treatments advocated for plantar fasciitis. A lot of them do help, but they help by reducing the pain and inflammation, which can be important. However, the key is to reduce the load by the methods mentioned above.