Whilst running, the foot repeatedly absorbs the forces associated with ground contact, shock absorption and push-off. This involves the bones, joints, muscles, tendons and ligaments. If the training load increases faster than the tissues are able to adapt to it, overuse injuries may occur. Previous injuries, recovery, muscle strength, individual foot structure and the fit of your footwear also play a role. However, it is a mistake to assume that all problems stem from incorrect running technique or a specific foot type. Flat feet or high arches may affect load distribution, but do not in themselves determine whether an injury will occur. Therefore, in the case of recurring pain, it is more important to identify which structure is causing the discomfort than to assess the shape of the foot yourself.
Blisters are among the most common problems associated with skin friction during physical activity. They are caused by repeated shear forces acting between the skin’s surface and the underlying tissues. The risk is increased by, amongst other things, ill-fitting shoes, damp socks and prolonged pressure on the same areas. Typical locations include the heels, toes and the midfoot area. It can help to wear well-fitting footwear, socks that minimise moisture build-up, and to protect areas particularly prone to chafing. A small, intact blister usually does not need to be pricked. However, if there is increasing redness, swelling, pus or severe pain, medical assessment is necessary, as an infection may have developed.
Black toenail after running
Dark discolouration of the toenail may be caused by a subungual haematoma, which develops following an injury or repeated pressure. In runners, this is exacerbated, amongst other things, by the foot sliding forwards inside the shoe, particularly when running downhill. The toenail may become painful and, in some cases, may partially or completely detach from the nail bed after a while. To prevent this, it is important to ensure there is sufficient space for the toes and that your shoes fit properly, so that your foot does not slide around excessively whilst running. If you experience severe, throbbing pain under the toenail, you should consult a doctor promptly. You should not pierce the toenail yourself. It is also important to remember that not every dark discolouration is caused by running; therefore, any change of unclear origin – particularly one that persists or worsens – requires a dermatological assessment.
Heel pain in the morning and after running. Is it plantar fasciitis?
Characteristic pain under the heel, particularly during the first few steps after getting out of bed, may indicate a problem with the plantar fascia. This is a strong band of connective tissue running along the sole of the foot, which helps maintain the arch and bear weight. The symptoms often worsen after a long period of rest or following intense exercise.
This condition is sometimes referred to as plantar fasciitis, but in many people the chronic changes are due to overuse and degeneration, rather than being purely inflammatory. For this reason, the term "plantar fasciopathy" is increasingly used. Management may involve temporarily adjusting activity levels, appropriately selected stretching and strengthening exercises, and a change of footwear. Not everyone needs insoles, and simply massaging the heel is not always sufficient to resolve the problem.
![foot pain whilst running]()
Pain in the front part of the sole of the foot, in the area of the metatarsal heads, is often referred to as metatarsalgia. However, this is not a single specific condition, but rather a term for a range of symptoms that may have various causes. In runners, the problem may be linked to increased pressure on the forefoot, changes in training loads, restricted mobility in certain joints, or ill-fitting footwear.
Similar symptoms may occur with irritation of the interdigital nerve, known as Morton’s neuroma. Despite its name, this is not a typical nerve tumour, but a condition associated with chronic irritation of the nerve and thickening of the surrounding tissues. Characteristic symptoms include a burning sensation, tingling or pain radiating towards the toes, often between the third and fourth toes. Tight footwear can exacerbate the symptoms. If the symptoms persist, it is important to distinguish between these conditions, as they require different treatments.
A stiff and painful big toe
The big toe plays an important role when pushing off the ground. If the joint at its base gradually loses mobility and becomes painful, one possible cause is hallux rigidus, i.e. stiffness of the big toe most commonly associated with degenerative changes in the metatarsophalangeal joint. Pain may occur whilst running, walking briskly or standing on tiptoes. It is sometimes accompanied by swelling or a palpable thickening around the joint. However, one cannot assume that running is the sole cause of this condition. Previous injuries, the structure and biomechanics of the joint, and individual predispositions may all play a role. Treatment depends on the severity of the condition and may include changes to footwear, adjusting the load placed on the foot, and other methods recommended by a specialist.
One of the more serious problems faced by runners is stress-related bone damage, which can lead to stress fractures. These occur when repeated stress exceeds the bone’s capacity for remodelling and regeneration. They often affect the metatarsal bones, but can also occur in other parts of the foot, including the navicular bone. The risk may increase with a sudden rise in training intensity, insufficient recovery and a lack of the energy required for the body to function properly.
Unlike the diffuse discomfort felt after exercise, pain associated with stress fractures is often clearly localised to a single spot. Initially, it may only occur whilst running, but later it may also occur whilst walking. Occasionally, swelling and tenderness on palpation may be present. If you suspect a stress fracture, you should stop running and see a doctor. Early changes may not be visible on a standard X-ray, so in some cases an MRI scan is required.
Pain in the tendons and around the ankle
![pain in the heel whilst running]()
Not all foot problems originate in the bones or joints. Pain can also result from overuse of the tendons responsible for the movement and stabilisation of the foot. Examples include conditions affecting the posterior tibial tendon, which runs along the inside of the ankle, or the peroneal tendons on the outside. Symptoms may worsen whilst running, walking on uneven ground and performing certain foot movements. Treatment depends on the diagnosis, but appropriately tailored rehabilitation and a gradual adjustment of the workload often play an important role. There is no single set of exercises suitable for all tendon injuries. Exercises can help with recovery, but they should be tailored to the location of the problem, the severity of the pain and the stage of return to activity.
The basis of prevention is sensibly matching the workload to your body’s current capabilities. A sudden increase in distance, frequency or intensity of running can lead to overuse injuries, particularly after a long break. Recovery, adequate sleep and a diet that provides the body with sufficient energy and the nutrients needed for tissue repair are also important.
It is worth ensuring you have shoes that fit well, do not pinch the toes and are comfortable whilst running. However, there is no strong evidence to suggest that any one specific type of footwear or insoles prevents all injuries. Orthopaedic insoles may be helpful for certain problems, but they are not necessary for every runner. Similarly, it has not been proven that simply running on soft surfaces or stretching before every training session effectively prevents all foot injuries. Before running, you can do a short, gradual warm-up and include strength exercises tailored to your abilities in your training plan. The most important thing, however, is to respond to any worrying symptoms. If the pain alters the way you walk or run, gets worse with each training session, or persists despite rest, it is not worth trying to wait it out.
A visit is recommended if the pain recurs, gets worse, causes you to limp or makes everyday walking difficult. Persistent swelling, numbness in the toes and pain clearly localised over a bone also require medical consultation. People who are unable to put weight on their foot following an injury, notice a deformity or have symptoms of infection require urgent assessment. There is no single timeframe for returning to running that applies to all injuries. A minor graze may heal relatively quickly, whilst overuse injuries to the bone often require several weeks of reduced weight-bearing. A safe return to activity should depend on the type of injury, the resolution of symptoms and a specialist’s assessment, rather than solely on the passage of a specific number of days.
Why do my feet hurt after running?
The causes may include overuse, ill-fitting footwear, soft tissue irritation or bone injuries. It is important to note the exact location of the pain, when it occurs and whether it worsens when weight is placed on the foot.
What does heel pain mean when I get out of bed in the morning?
Pain during the first few steps after rest is characteristic of plantar fasciitis. However, this is not sufficient for a self-diagnosis, as heel pain can also have other causes.
Can you go for a run if your foot hurts?
It depends on the cause, but you shouldn’t ignore pain that is getting worse. If the pain affects the way you move, persists whilst walking, or if you suspect a bone injury, you should stop running and consult a specialist.
Why do the soles of your feet hurt after running?
This may be due to overuse of the plantar fascia, increased pressure on the forefoot, or irritation of other structures in the foot. The location and nature of the discomfort help to narrow down the possible causes.
What does a burning sensation in the midfoot mean whilst running?
A burning sensation under the toes may occur with metatarsalgia or nerve irritation, including Morton’s neuroma. If it is accompanied by tingling or numbness in the toes, it is advisable to seek a consultation.
Why do toenails turn black after running?
The most common cause related to running is repeated trauma and the formation of a haematoma under the nail. If the discolouration is not clearly linked to an injury or does not move as the nail grows, it requires medical assessment.
How can you recognise a stress fracture of the foot?
Pain localised to a single spot, which worsens under weight-bearing and is sometimes also felt whilst walking, may raise suspicion. Diagnosis requires a medical assessment and, in some cases, imaging tests.
Do flat feet increase the risk of injury whilst running?
The structure of the foot can affect how weight is distributed, but having flat feet alone does not mean that a person will sustain an injury. Training, muscle strength, previous injuries and other factors also play a role.
Do orthopaedic insoles help with foot pain?
They can be helpful for certain conditions, but they are not a one-size-fits-all solution. They should be selected based on a diagnosis and individual needs, rather than solely on the appearance of the foot.
What running shoes should you choose to avoid foot pain?
First and foremost, they should be comfortable, a good fit and provide enough space for your toes. There is no single model of running shoe that effectively prevents all running injuries.
Does running on tarmac damage your feet?
There isn’t sufficient evidence to suggest that tarmac alone is the direct cause of all overuse injuries. The risk of injury is influenced by factors including the extent and rate of increase in training load, recovery, and individual tolerance to exercise.
How long does it take for a foot to recover from a running injury?
The time taken to return to full fitness depends on the type and severity of the injury. Abrasions may heal quickly, whilst stress fractures and certain tendon injuries require much longer treatment and rehabilitation.
Sources:
- Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review https://pubmed.ncbi.nlm.nih.gov/17473005/
- Heel pain-plantar fasciitis: revision 2014 https://pubmed.ncbi.nlm.nih.gov/25361863/
- Management and prevention of bone stress injuries in long-distance runners https://pubmed.ncbi.nlm.nih.gov/25103133/