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Thursday, September 01, 2011

'Top of Foot Pain' Management in Barefoot Runners 

Despite all the propaganda that barefoot or minimalist running is better due to less injuries occurring, it is now becoming increasingly clear that it is not the way to get less running overuse injuries. Just check any barefoot/minimalist website and look at all those looking for advice on their injuries! Just ask any of the health professionals who treat a lot of running injuries. Most will tell you of the barefoot running injury epidemic that they are seeing. There is no doubt that there are some who have successfully transitioned to barefoot or minimalist running who now claim to get less injuries, but there are also those who are getting more!

One of the more common injuries being seen is what has become known as ‘top of foot pain’, which probably is dorsal midfoot interosseous compression syndrome (DICS). The pain of this is usually over the dorsal midfoot area. The cause of this is when the dorsiflexion moments of the forefoot on the rearfoot are higher than the plantarflexion moments, resulting in the dorsal jamming. Forefoot striking has greater forefoot dorsiflexion moments of the forefoot on the rearfoot than does heel striking. I have been involved in the management of a lot of ‘top of foot pain’ now in forefoot strikers or minimalist runners and here is my approach to it:

1. Firstly you really need to understand the runners views on barefoot/minimalist running and just what they are prepared to do. By this I mean how acceptable of different interventions are they to be; are they training for a specific event (to get an indication of the ‘urgency’ to get over the problem); what sort of time frame they have; etc

2. Of course we use the RICE principle with this injury like any others in the short term and make modification to the training regime to manage it.

3. The best way to manage ‘top of foot pain’ in the short term and long term is to decrease that dorsiflexion moment. How can you do that?
4. However, depending on some of the answers to the discussion in (1) above, as too how acceptable some of these interventions are, for example:
Just why are the joint moments causing this problem so high? I think the most likely reason is the variations that occur in joint exes positions and the lever arms the bones and tendons have to that joint axis.

‘Top of foot pain’ is common in forefoot strikers (barefoot/minimalist runners). Understanding the role that the higher joint moments play in it guides the short and long term management, as well as the attitudes to forefoot vs rearfoot striking and the role of foot orthoses as a short or long term option and the issue of the magnitude of the moments and if the tissues can adapt to those moments or not.

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