Professor Nicola Maffulli: Tied up too tight

I’m 24 and run five miles three times a week. Recently, when running, my right foot hurts for the first two miles or so; specifically, the bones on the top of my foot, just underneath the laces of my shoes. What do you think is the problem? I have been told before that I am rather asymmetrical and that my desk-bound job is doing me no favours. Could this be the cause?
Louise Werner, Chester

What you describe is not uncommon. Most likely, you use only one pair of running shoes, and most probably you lace them fairly tightly. We all are “rather asymmetrical”: one side of our body is not quite the mirror image of the other, and one foot is normally a bit bigger than the other. It is therefore relatively likely that shoes will be just right on one foot and a bit tight on the other. When the shoes are laced up, pressure is applied to the foot, and the tendons which pull the toes up (technically, the long toe extensors) may be compressed between the upper surface of the shoe and the underlying bones. At the start of your run, when the laces are still tight, the tendons are more compressed, and they rub against the bones and the shoe, causing pain. As the run progresses, the lace “give” a bit, and the pain improves. If you persist despite these signals, frank tendinopathy may develop, and then you will be in real trouble.

Another possibility, unlikely at your age, is that you have early degenerative joint disease (arthritis) of the mid foot. If this is the case – and I must say that I doubt it unless you had foot problems as a child or you have a congenital abnormality of the foot – then you should at least consider having a shoe with a stiff(ish) sole to prevent excessive movement of the mid foot. However, this will make your foot less able to absorb impacts and may cause problems higher up in the lower limb.

In general, you should consider having at least two different pairs of training shoes, and you should alternate them regularly: in this way, as no two types of shoe are exactly the same, your foot will be stimulated in a different fashion every time you run and will be less likely to experience problems. Also, remember that even good trainers are only good for some 800 miles.

· Professor Maffulli is a consultant orthopaedic and sports injury surgeon at Keele University medical school. If you have a question for him, email [email protected]

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