Hi, I have been having a sharp, needlie-like pain in my right heel. I have determined it's Plantars, however, is there a shoe you recommend to deal with this problem? I am planning to get the Strassburg sock to wear in bed to heal it, however, I do need to get new shoes. Please advise!
Reply - Janet
Without knowing your specific biomechanics, it's hard to say.  Many people with Plantar Fasciits benefit from a shoe with a bit more stability or control, but there are those with the condition who have fairly high and stiff arches and need a shoe with a bit more cushioning.  (the latter is rarer than the former)  The things I recommend for PF include
1.  Stop wearing high heeled shoes - migrate gradually down into flats as much as possible.
2.  Stretch your calves several times a day (gently and make sure your arch is locked when you do it.)
3. Back your training down a little - especially hill work and speedwork.
4. Use some form of nightsplint -- the sock is OK, but I prefer the more rigid nightsplints personally.  Try the sock out and see if it works for you.
5. Go to a technical running shoe store and have them assist you in selecting a shoe that's correct for your gait pattern. If you don't have a store nearby, you may want to consider a video based gait analysis - see the services page of this website for more details or send me an e-mail. Once I can see what's going on biomechanically I can be of better help in your selection of a shoe.
Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hi, I am a distance runner and recently completed my first 50-mile trail race (I have done many marathons and other ultras, but this is my furthest distance to date). I had no knee pain during training, and haven't had this problem before, but I developed fairly sharp knee pain a few days after the race. The pain is below the kneecap, slightly to the outside but radiating just below the kneecap across the width of the leg. It hurts when I walk after waking up or after sitting for a while, and it hurts worse and is stiff after icing. When I have tried to run a few times, first thing in the morning, the pain is almost excruciating at first, but then after walking 5 minutes, and then jogging for 5 more minutes, it goes away entirely for the rest of the run. It then returns later in the day. I first thought it was patellar tendonitis, but it is not worse when going up or down stairs - it is actually worse on just level ground. Can you provide any guidance on what the injury might be, and how I can treat and prevent it from recurring? Thank you!
Reply - Janet
It might be worthwhile to see your doc to rule out something nasty like a superior tibial stress fracture or some sort of bone edema.  The reason I'd say that is because you describe the pain as being sharp and not worse when going up/down stairs.  With the major mileage you run, it's worth it to rule out the really bad injuries.  A bone scan or MRI will be pretty revealing - an x-ray not so useful.
Once you've rule that stuff out - then the first thing I'd do is take a week totally off running and do something non-weight bearing like swim.  When you try running again you might try to lengthen your warm up. Instead of going out the door at a run, walk for a mile before running the first step. You may have just not allowed the tissue time to recover from your recent event? If you've not ramped back your mileage, you might take a period for recovery - drop mileage in half and do only easy paced running for a bit.  Make sure you're maintaining good flexibility in your calves and hamstrings, keep consistent with your hip strength exercises, check your shoes for excessive wear.  First things first though -- get it checked out. Sharp pain like that is worth a visit to the specialist.  Hope you're back on the trail soon, let me know if I can help.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hi, I've been training for a half marathon for 2 months now. Our long runs are almost 8 miles on the weekend. I recently had below ankle pain. I thought maybe I needed new shoes. I went to a runner's shoe store and the shoe fitter said I needed high arch shoes. I used my new mizuno wave shoes today and after a typical 4 mile run I felt like I sprained my ankle when I took the shoes off. Is it possible that the new shoes are compensating too much and I need a different shoe? My older Saucony shoes originally worked but they do not have any heel support....thanks for the answer!
Reply - Janet
It could be that the shoes are different enough that you're going to have to take a little time to get used to them.  It could also be that the ankle pain you felt in the new shoes was just a progression of the below ankle pain you felt prior to getting them.  Are you being consistent with your calf stretches?  Perhaps a couple of days of rest, and walking rather than running in the new shoes will help with the transition.  If the shoes are a lot more supportive and your calf muscles are not as flexible as they should be, these two things could combine to give you the pain you describe.  Take a few days off running, do your stretches and do some walking -- hopefully you'll be back on track in just a few days. Janet Hamilton - MA, RCEP, CSCS, RRCA-certified coach

I've been running for 6 months now. I was fitted for stability shoes about four months ago--Mizuno Alchemy---for overpronating with my right foot. I developed left knee soreness early on. No swelling, but pain behind the knee cap after and sometimes during runs. It's mild. Once I increased from 2 or 3 mile work outs to 4, 5, and 6 miles, I developed right ankle pain. The ankle bothers me more than the knee. It hurts on the interior side right around the bone. Pressing on my interior ankle bone hurts. I love running and don't want to give it up. What can I do?
Reply - janet
Perhaps it would help to do some flexibility and strength work?  Do you stretch daily?  Work on calf and hamstring stretches in particular. Don't be aggressive, but be gentle.  Also - do you do strength exercises for your hips? Your knee really depends on a strong set of hips to be happy. Also - what about pacing and terrain... do you perhaps run at a pace that's too close to race pace all the time? If you're always on hills, perhaps switching to flatter terrain would help.  I'd be happy to help with more detailed guidance - see the services page or send me an e-mail.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hi - I am a long distance runner, typically running between 40-50 miles in off season and 50+ during training season. Right now its down time for me, but i'm having some issues with my back and what I assume to be my psoas muscle. I'm having a lot of "pressure" in my lower back while doing ANY high impact activity. I havent ran in 8 weeks (thinking taking time off would let things heal). In those 8 weeks, i've been stretching like crazy. Stretching and doing yoga hours a day. I've been able to swim, so i've been doing that as well. Running is very painful. LOTS of "pressure" in lower back and pain running from lower back to groin area. Walking is not quite as bad, but still painful. Cycling I can do with no pain. Do you have any idea what is going on or any more advice? With taking 8 weeks off, i'm at my wits end and ready to RUN!!! Hard core training starts in 6 weeks and I need to get this under control. thanks!
Reply - Janet
Have you seen an orthopedist to rule out something nasty like a pelvic or sacral stress fracture?  Perhaps a visit to the doc is in order so you can identify exactly what you're dealing with.  You can't "stretch away" an injury - so though the stretching and Yoga are a good idea - they won't fix the problem.  The fact that you can do some form of exercise is good, but the way you describe your symptoms really indicates that some diagnostic imaging is in order.  X-rays probably won't show anything, but a bone scan or MRI would. Also keep in mind that if those come up clean, you're wise to push your doc to give you a referral to a good orthopedic PT who can help you with some exercises.  Once you know what you're dealing with injury-wise, it's a lot easier to plot your recovery path. When you get ready to return to running, be very gradual about it or you risk getting another injury by ramping up to your previous mileage too quickly.
Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I have a mild groin strain, and the doctor says I can run easily, but no sprinting. Can I use the eliptical bike to get sprint work in, or does that too work the groin?
Reply - Janet
it's not just the impact, but the intensity you need to worry about. Trying to do high intensity biking or elliptical work will impede the healing of your strain.  Take it easy and let things heal. Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hi Janet, I'm a regular runner. I run between 8 and 10 km 3 to 4 times a week. After 30 or 40 minutes of running, the bottom of both my feet go numb. My running shoes are bran new Nike running shoes. I have tried running with an old pair and the same thing happens. I even tried loosening them, and the numbness does not go away. Do you know what my problem could be? Thanks in advance Janet!
Reply - Janet
Nike makes good shoes but perhaps the model you're using isn't the right one for your gait pattern?  If it's not shoe related, some things to consider include tight calf muscles or perhaps issues related to your lower back.  Have you recently worked on speeding up or doing more hills? Just a few things to think about.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I have been running 40-50 miles/week for about a year now and I just completed my first marathon, my time was 4:03, I want to really work on speed, I want to make Boston either in the spring or fall and I want to increase my milage to 60-70 miles/week, How should I go about reaching my goals? I am ready to Train Hard!
Reply - Janet
There are a few pieces that have to fall into place.  Number one is you need an adequate endurance base to RACE a marathon, not just run it.  Two you need to work on specific speed elements.  Third - you need adequate strength and flexibility to tolerate the training needed to get the speed you want. It's a complex mix! If you add too much speedwork with inadequate base mileage, you'll increase your risk of injury.  If you run your base mileage at a too-fast pace, you risk injury.  If you don't get adequate rest/recovery ... you guessed it... you'll risk injury.  Build mileage slowly, and once your base is built you can do speedwork.  I'll be happy to help with more specifics - check out the services page of this website and let me know if you're interested.  I have room on my schedule for two new clients at the moment so you're in luck! Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hello Janet, I asked a bit ago about a stress fracture. I have been letting it heal for a long time now and i should be able to run in a little bit. But, i am just wondering what are the most common underlying causes for a stress fracture so i don't make that mistake again? Thanks!
Reply - Janet
I generally categorize them in four ways:
Lack of adequate flexibility - stretching doesn't prevent stress fractures, but it's possible that muscles that don't have adequate flexibility change the forces around an area and contribute to the problem.
Lack of adequate strength - generally functional strength exercises like lunges, squats, balance & reach, etc. will have a better carryover for running than exercises like knee extensions and curls.
Biomechanical factors - often it's things like pronation that's not occurring at the right time or to the right degree... usually excessive and prolonged pronation that's not being adequately supported by your shoe or shoe/orthotic combination.
Training errors - this is a HUGE category - including things like adding mileage too quickly, doing too many hills or too much speedwork, or simply going out the door too close to race pace on every run. 
Keep in mind how important your return to running after your stress fracture is. If you do it right, you're in good shape... do it wrong and you risk another injury.  I'd recommend you consider working for several weeks on a walking program then a transitional walk/jog and then finally back to running again.  If you want help with this - let me know... its' what I do!
Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I have been training for my first marathon since June and just ran it a couple of weeks ago. I had surgery on my ankle (reconstructive ATFL) in late 2004. A couple of months into running I noticed that the inside of my same foot would hurt when I ran long distances, though it was a pain I could run through. As the months went on, my pain progressed and came on earlier and earlier into the run- some days though it wouldn't hurt at all. I chalked it up to a weak ankle/foot from my surgery. However a few days after my marathon, I tried to run and the pain was unbearable. Since then I have taken a few days off of running (i've been cross training on the elliptical/bike/swimming/stairmaster- which I still feel it, but not bad)- as soon as I hop on the treadmill, the pain returns just like before. The pain is localized when I am working out (by my navicular bone and Posterior Tibial Tendon spot)- when I am through working out, the pain kind of creeps to other areas around that area- it used to go away after I finished working out, but now it sometimes takes awhile or even still hurts the next day when I go to start my workout! HELP! I do have an appt w/ a podiatrist this week, but was looking for any helpful information!
Reply - Janet
Since this was a first marathon, it's important to realize the need for adequate recovery afterwards. That doesn't mean you lay around for a month, but doing substantially reduced training for a month is definitely in order. Depending on the injury that caused the ATFL problems in the first place, I'd be concerned about articular cartilage damage.  If it was a fairly traumatic incident that lead to the initial ankle ligament injury then there's a real liklihood that you damaged your articular cartilage at the same time and the rapid ramp up to your first marathon (June to November is not a lot of time for a first marathon ramp up) may have put too much stress on that tissue.  Hopefully the physician can rule out severe injury - diagnostic testing should help with that.  In the mean time, back off a bit -- don't push the training.  Perhaps some non-weight bearning stuff like swimming or deep water running would be a good choice. Best of luck to you. Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I have very tight calfs and they feel like they are gorged with blood as I run. Today I shortened my run by half because I was winded from my tight calfs. They feel like they will not stretch at all. I could stretch now, and in one hour have to stretch all over again. I am eating enough bananas, vitamins, gatorade 2x a week. I am running only about 15 miles a week. Please help!
Reply - Janet
There are a few unknowns here that might play a role... how long have you been running? If you're new to running and you've ramped up your mileage quickly, perhaps backing the mileage down will help.  Do you run hills? If so, back off and run flatter terrain.  What is your pace? You should be running primarily easy, conversational paces.  A good rule of thumb is that this is a pace that is about 1.25 times your 5K race pace.  If you race a 5K at a 7:00 mile, you'd do easy pace running at 8:45 pace.  Are you in the right shoes for your gait pattern?  This one may be hard to determine if you haven't had a gait analysis done, but you can often find help at a technical running shoe store where they'll watch you run in several pairs of shoes and try to determine which provides the best combination of support and cushioning. Do you stretch regularly? If not, perhaps incorporating gentle calf stretches throughout the day will help.   The tight feeling in your calves may be due to chronic exertional compartment syndrome.  This usually presents as a tight, aching cramping sensation that comes on at a specific time in your run and goes away when you stop running. There's generally no pain at night, no tenderness to the touch.  This condition can sometimes be treated with conservative measures (frequent stretching, training changes, proper footwear) but sometimes requires surgery.  Hope this info helps.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hi! I hope you can help. I have high arches and narrow heels. I pronate some where when shoe stores see me they want to put me in adenelaines. I've been struggling with shoes for 5 years. I started out in NB 767s and developed peroneal tendonitis. I went to the Dr. and he said my big toe was locked up and that was mainly caused by my heel not being locked down and supported. He issued me orthotics saying my main issuie wasn't my arches but in supporting my heel so I don't put so much pressure on my toe and etc. Well I stayed in stability shoes for a couple of years nirvana, nb851, adren. but I always had an ache in my peroneal. I went somewhere else and told me I needed to be in motion control brooks ariel. He also recommended another shoe, a stable neutral Mizuno wave creation. He said I could even do some runs in it. I started switching these 2 shoes back and forth and the mizuno ones really felt better. I felt the ariels were too stiff and maybe pulled on my achilles a little. Well on a long run while wearing my ariels I developed a sharp pain in my achilles that I had to stop. Got tendonitis and went to PT. I stopped wearing the ariels and wore the mizunos and for about 2 months I was in heaven! Then I started developing an ache in my post tibial area. I went back to the pedorthist and he issued me another orthotic saying my other one didn't have a deep enough heel cup and didn't support my arches enough. And to try and wear these in the ariels. I still feel as if it might be messing with my achilles and it is hurting my big toe in the joint. When I put the orthotic in the mizuno wave creation it doesn't hurt my toe but it might cause my post tibial to get aggravated again. Sorry so long. I keep going to professionals and no one knows and I don't have the money to keep buying shoes and orthotics. Any ideas on what else I need to look at?
Reply - Janet
has anyone checked your calf flexibility?  I find it pretty common that the people who have a hard time tolerating the orthotic and shoe support that their pronation demands are those with lack of adequate calf flexibility.  Perhaps it's something to discuss with the PT who helped you?   Also I sometimes find that orthotics need to be adjusted -- sometimes a little tweaking of the posts or heat adjusting the arch contours (if they're plastic) works wonders... sometimes it takes more than one adjustment.  Hope this food for thought.