Top of foot pain is a condition that is being seen more frequently in athletes lately. It is more likely to occur in runners who use minimalist/barefoot footwear, but can occur in all types of running shoes and in non-athletes. The discomfort on the top of the foot is most likely due to a diagnosis, medically known as dorsal midfoot interosseous compression syndrome. This is a frequent cause of top of foot pain is due to higher loads trying to flex the forefoot on the rearfoot and there being some compression loading occurring at the top of the foot. The best way to manage this injury on the top of the foot, is an initial decrease in running levels; the use of taping to force down the foot to stop the compression; and the use of a rearfoot strike when running (you can go back to the forefoot striking gradually and slowly as the symptom get better). Foot orthoses with features that allow the forefoot to drop down are usually the better treatment over the long term if the tissues cannot adapt to the loads being placed on them when forefoot striking.

Sinus tarsi syndrome in runners can be one of two sorts of problems. Sinus tarsi syndrome can follow an ankle sprain as a chronic problem. The sinus tarsi is the gap between the talus and calcaneus bones in the rearfoot and the ligaments between them can get strained during an ankle sprain and not get initially noticed and only diagnosed at a later date as the initial injury settles down. This cause of sinus tarsi syndrome is best treated with physical therapy and exercise. The more common cause of sinus tarsi syndrome in runners is a foot that has flatted or pronated to end range of motion at the subtalar joint, so the structures in the sinus tarsi are compressed at end range of motion. This cause of sinus tarsi syndrome is best treated with foot orthotics and motion control running shoes to prevent the joint from going to its end range of motion. In both types of sinus tarsi syndrome, if they are not responsive to treatment can benefit from steroid injections into the area.

Severs disease is a common problem of the heel in youngster that exercise a lot, especially on hard surfaces and often also have tight calf muscles. It is almost the only problem that happens in the heel bone in youngsters. Severs disease is considered a strain or even a stress fracture of the growth plate at the back of the heel bone. The area that is hurt is the part of the heel that hits the ground first in heel strike running and is also the part of the heel that the Achilles tendon attaches to. For these reasons the growth plate at the back of the heel bone is put under considerable strain, especially in active children. The classic symptoms of Severs disease is pain at the back of the heel bone on activity and pain on squeezing the back of the heel bone on the sides. Severs disease treatment is generally straight forward and needs a reduction in activity that is causing the symptoms and also the use of a heel raise. A good pair of running shoes to cushion the heel is extremely important. Calf muscles stretches should also be used and often foot orthotics are help to improve any problems with the biomechanics of the foot. Around about the mid-teens, the growth plate merges with the rest of the heel bone and this can no longer be a problem.

There has been a lot of attention being given to the philiosophy of barefoot running vs. running in running shoes. Most of the interpretation by the media and barefoot running community has been very misleading and misinformed (see: Barefoot running and its interpretation by the media). The research has clearly shown that running barefoot is different to running in shoes. No research has actually shown that one is better than the other, yet that is how many have interpreted it.

Despite numerous claims made by the barefoot running community an anti-running barefoot website has raised many questions to balance the rhetoric that appears on barefoot running websites:
No research has shown that running shoes cause injuries.
No research has shown that here has been an increase in the amount of running injuries.
Running shoes do not cause osteoarthritis or plantar fasciitis.
There is not an epidemic of impact related running injuries.
Running shoes have not been shown to weaken muscles.
There is NO evidence that there is less injuries in those that run barefoot.

This does not mean that there is anything wrong with narefoot running. It just means that the claims made by the barefoot running community are being critically analysed and they do not stack up to scrutiny.

See: Barefoot Running Debate on Podiatry Arena for a discussion on these issues.

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