A Healthy Pace: Running Tips to Avoid Knee, Foot and Ankle Injuries – and Other Mishaps

If you’ve been training for months for your first marathon or half marathon, you know the challenges ahead, primarily staying well-hydrated, avoiding muscle strains, staying injury-free and keeping mentally sharp.

The most common injuries among runners involve the knees, feet or ankles, explains Cary B. Chapman, M.D., orthopedic surgeon at Baptist Health Orthopedic Care. Dr. Chapman specializes in minimally invasive surgical treatments for chronic and acute foot and ankle injuries, ankle arthritis, ankle replacements, bunions, and hammer toe deformities.

“A vast majority of running injuries involve the legs, with the knee being the most injured area,” explains Dr. Chapman. “Up to 50 percent of all running injuries involve the knee, including patella-femoral syndrome (pain in the front of the knee) and Ilio-tibial band syndrome (pain on the outer part of the knee).”

What about marathoners? “As an orthopedic foot & ankle specialist, the most common injuries I see related to marathon running are plantar fasciitis, Achilles tendinitis and stress fractures of the foot,” he adds.

While physical injuries are vital to avoid with proper training, the most important “potential injury” to be aware of during a long-distance event, such as the marathon or half-marathon is “heat related illness,” said Dr. Chapman. “Overexposure to heat can lead to muscle cramping and weakness, dizziness, nausea and vomiting, as well as confusion and disorientation,” he emphasizes. “Risks from heat-related illness can be reduced with an appropriate hydration with electrolytes (sports drink).”

The full marathon covers 26.2 miles, with frequent stations set up along the route offering water or sports drinks that replace electrolytes (including potassium, calcium, sodium) that are lost when you sweat.

Even the best trained runners can experience pain during a long-distance event.

“A vast majority of marathon runners experience pain during the event, especially in the thighs and calves, regardless of their training methods,” said Dr. Chapman. “The best advice for those experiencing pain during a marathon is to reduce your pace.”

Nonetheless, months of proper training – involving a progressive program of stretching, warm-ups and cool-downs, proper pacing, determining hydration needs and avoiding strains in muscles and joint – should precede a long-distance event to avoid pain and other mishaps. What’s the primary piece of advice that Dr. Chapman give to marathoners regarding injury prevention before the big event on Jan. 29?  

“The best way to prevent injury during a marathon occurs in the months leading up to the marathon,” he said. “That includes proper footwear and running form, appropriate running mileage management and time for recovery during training, as well as warming up and cooling down before and after the event.”

Even for the well-trained runner, a half-marathon or full marathon can have its challenges when it comes to staying well hydrated.

“An added danger in South Florida is its high humidity levels,” explains Michael Yurubi, D.O., a board-certified family medicine and sports medicine physician with Baptist Health Orthopedic Care, who specializes in the prevention, diagnosis and nonsurgical treatment muscular-skeletal system injuries. “When humidity is high, the body sweats less and it does not evaporate as easily from the skin. The body then struggles to cool down, making it prone to heat exhaustion and heat stroke.”

For most people, water is the best fluid to drink before, during and after exercise. But long-distance runners benefit even more from “sports drinks” that contain carbohydrates and electrolytes. There are several key physical components to training for a marathon, including establishing a routine for hydration and nutrition, including those "carbed-up" pre-packaged gels for the longest runs.

Runners who want to start training for a long-distance event should become fully aware of proper hydration needs early on. You can learn how to measure your “sweat rate,” which is based on the amount of liquid your body loses after an hour of exercise. By calculating your sweat rate, you can better evaluate what you should drink to replace lost fluid and help avoid injuries.