Returning to Running From Foot and Tendon Injuries

Return to Running From a Tendon Injury

This blog is specifically discussing tendon type injuries. That includes tendonitis, tendinosis and plantar fasciitis. In podiatric medicine, we treat plantar fasciitis as a tendon injury. 

Let say you go for a hard workout, sometimes you do not feel the injury during or after the run. Then all the sudden, you wake up and feel pain. This is sometimes how tendon injuries present. 


Managing An acute injury 

An acute injury is when most of the pain and swelling occurs and usually lasts 1 week long. This must be treated with rest, ice, compression and elevation. This phase is important to ween back. What can be done for exercises in this stage is gentle range of motion and very light isometric exercises that does not irritate the tissues/ cause more pain. Anti-inflammatories can also help in this phase. You only want to completely rest the foot for a short amount of time . Too much rest can be detrimental to the tendon health, unless there is a tear or rupture , which brings us to the importance of loading the tissue in the next phase. Remember, exercise is the best form of medicine.

The Subacute Phase 

This is after an acute injury . There still may be swelling and throbbing in this phase. This is where strength must be initiated to help load the tendon to become stronger. However, it must be catered to the individual pathology and not too difficult. If it is too difficult it can relapse to the acute phase. Here it is not suggested to run yet. 

Exercises that may be done in this phase are again, range of motion but more specifically isometric exercises. This allows the tendon / injury to be loaded but in a manner that does not provoke pain. Certain movement that may provoke pain are fast movements or up and down. It is important to strengthen the injury in a movement specific order as particular movements will aggravate the area more. Isometrics can be done each day for 4 sets .

After a week of isometric movement, slow heavy eccentric movements are suggested. That can be done every other day with the isometric movements in between them.

As pain diminishes it is good to start implementing the spring like capabilities of a tendon. Tendons have this ability to allow us to jump and release and store energy. So this needs to be trained especially before running. This can be done by doing 2 footed hops say 5 x 1 min with 1 min rest. Wait 24 hours. If there is pain , or increases stiffness in the morning or next day, then that was too much load. What can be done is cutting the load in half by then trying to do 3 x 1 min the next time. These movements can be done every 2 times so there is plenty of recovery time  in between.


Once double leg hops is achieved then one moves on to single leg hops with the same protocol. If that is fine, then one can move onto a return to running program. 

Here is an example of the layout.



During the time of return to run, one may not want to forget the importance of strengthening the tendon and loading it properly. Hopefully one can remember the importance of strengthening so one does not succumb to injuries that can sideline them.


Managing Injuries 

Managing Injuries

As a foot specialist and runner, an important factor about injuries is nipping them prior to them becoming a bigger issue. Some people are afraid to rehabilitate in the early stages, however proper rehabilitation in the early stages can speed up recovery. Where doing too much too soon can also interfere with the healing process.

What happens in an injury

Acute phase means a recent time period from when the injury occurred. Inflammation usually happens in the initial time period of an injury and it can be painful.
Inflammation is meant to help heal the tissue by replacing damaged and injured tissue to restore function. Acute phase usually lasts 4-6 days . Here it is important to try reduce pain, reduce inflammation, wearing supportive footwear / braces or taping. Within this time period, most of the emphasis should be placed on rest and reducing pain.

Rest, Ice, Compression and Elevation should be done to help to mitigate pain. Rest is key! Icing the area is helpful in trying to reduce swelling. Compression can be done with wraps, but more easily, compression socks or sleeve are easy to apply and help reduce swelling. Elevation helps with lymphatic drainage, which helps to move inflammation away from the injury site away to be metabolized. This phase is mostly just resting and icing

If no medical contraindications, prescription anti-inflammatories help to reduce the amount of inflammation and pain. It is very important to reduce the overall load on the injured tissue. That includes wearing Birkenstocks, or supportive sandals or shoes in the house, braces or in severe cases, an aircast to reduce the load on the injury. When throbbing reduces, then you know it is okay to carefully start doing rehabilitation exercises. Rehabilitation exercises should be provided by a licensed health care provider, physiotherapist, chiropodist, massage therapist or chiropractor.

Subacute – Intermediate phase 4-21 days

This phase is where rehabilitation exercises are started. Here exercises should be done in a pain free manner. In this phase the healing tissue is immature and fragile. Exercise should be gentle and cause no harm. The tissue may revert back to acute phase if stressed too soon. If that occurs, revert back to PRICE (protection, rest, ice, compression and elevation).  In the beginning low resistance exercises and high reps should be done to help strengthen the site and surrounding muscles. Gentle stretches can also be done in this phase.

The final stage is to prep the body to handle sport specific exercises to handle their activity . It is important to monitor along the way and anything that makes pain again, may have to revert back to earlier stages. That may include resting, icing, compression, protection and easier exercises.

Chronic phase

This is typically when an injury is longer than 3 months. Sometimes, we cannot totally rest out feet. Some occupations require us to constantly be on the move and that may not provide the rest needed to allow an injury to heal. Emphasis should still be focused on reducing the amount of load on the tissue, when possible. To allow it to rest and also do rehabilitation exercises in a manner that does not flare up the tissues or aggravate the tissue. This phase can also respond well with treatment such as shockwave therapy. Orthotics also help in this phase to help reduce the overall strain and load on the tissues.

The main point is to see someone as soon as possible when in an acute phase of a foot injury. Conditions of the feet can be very stubborn, as we cannot completely let the feet rest. Plantar Fasciitis, is one of the more difficult conditions to treat once it has turned chronic. Signs of chronic plantar are first morning step pain and stiffness.

Injuries can be stressful and impact our quality of life. Hopefully these few tips can help you manage a foot injury you may encounter.