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Runners Nightmare

Sun, 14 Dec 2025 21:11:34 GMT

Runners Nightmare

Understanding the biomechanics of running is something that takes years of training, although it is still a developing field with advancements in sensor and monitoring technology propelling the science forward. However, in basic terms, there are five phases of running gait. The five phases are:

1. Stance - When your foot first strikes the ground.

2. Loading - From when your heel hits the ground to the moment your forefoot touches down.

3. Mid-stance - The point at which your heel starts to lift and the forefoot flexes.

4. Toe-off - When your foot leaves the ground.

5. Swing - The time between your foot leaving the ground and touching it again.

The gastrocnemius muscle has one of the greatest influences on the foot during running gait as its pliability directly correlates with what part of your foot first hits the ground, when the heel hits the ground and how early the heel lifts off the

ground during each stride. The gastrocnemius is unique in the lower leg as it spans both the knee and the ankle, and therefore affects the foot position more when the knee is straight. Therefore, if the gastrocnemius is tight, as the body weight shifts forward causing the knee to straighten, the front of the foot is more likely to strike the ground first (given rise to metatarsalgia ,

forefoot pain) and the heel will hit the ground earlier and lift earlier in the gait cycle (given rise to plantar fasciitis and Achilles tendinopathy ).

In people who are belly/side sleepers the foot or feet are forced into a “pointing downward” (i.e. equinus) position (as above). Over time, this inevitably causes stiffness, especially in the calf muscles. Although most muscles in the lower leg are affected by this abnormal position of the foot at night, the Gastrocnemius muscle is particularly susceptible. Early morning running (when the stiffness is at its greatest), will further predispose to injury. Although stretching clearly helps, long periods of abnormal position of the foot at night is very difficult to overcome.

Since the COVID-19 pandemic, there has been an explosion in people taking up running. Unsurprisingly, I have also seen a massive increase in patients seeking medical advice with heel pain associated with running. As stated above, stretching and changing the foot position at night significantly improves plantar fascia/Achilles pain. The use of a night splint pillow (like the Foot-zz ) or hanging the foot over the bed can significantly improve the pain and stiffness allowing running.

The Ageing Tendon - Heel Pain

Sun, 14 Dec 2025 21:07:05 GMT

The Ageing Tendon

Although none of us want to admit it, age doesn’t come alone. Flexibility in tendons is considerably greater when your young. For example, gymnastics (which requires the greatest level of flexibility in sport) has the lowest average age of any Olympic sport. This is because as the athletes age, their decreasing flexibility means they are unable to compete. Bearing this in mind, when even elite athletes are susceptible to significant stiffening of their tendons and joints, in the average person the stiffening is considerably greater.

In my medical practice, I see tendon stiffness causing the most problems in plantar fasciitis and Achilles tendinopathy. In people who belly sleep (i.e. prone) or on their side, the foot or feet are forced into a ‘pointing downward’ (i.e. equinus) position. With this there is an inevitability of calf stiffness (especially the Gastrocnemius muscle). As people hit their thirties, this becomes a major problem, especially if compounded by weight gain. Studies back in the late 1990’s showed that with increasing age, the number of positional changes at night reduces. Therefore, if you are a belly/side sleeper and your positional changes at night decrease,

this will result in longer periods of the foot/feet being forced into a downward position.

If you are a belly/side sleeper it is really important to look at altering your foot sleep position and to stretch where ever possible. Exercises like Yoga and Pilates can be very beneficial. As you people hit their 50's, heel pain becomes much less of a problem as back sleeping is much preferred due to breathing capacity declining.

Weekend Warrior - Heel Pain

Sun, 14 Dec 2025 21:01:44 GMT

The Weekend Warrior Effect

"over-weight individual, lacking pliability in their muscles, to go for a run when their calf muscles are at their tightest"

The term ‘weekend warrior’ has been used to define people who only do sporting activity in their spare time. In my experience, this tends to happen when people hit their thirties. It certainly did for me and my close friendship group, when increasing hectic lifestyles, work commitments and parenting shifted sporting activities to a lower echelon of importance. This results in catching any kind of physical activity in whatever spare moment you can muster. With my physician hat on, I can assure you this is not great for the body. The ‘weekend warrior’ tends to be stiff, over-weight, lacking muscle memory and with worse general fitness. Couple this with thoughts of grandeur to their ‘glory days’, and it is a recipe for disaster. It should be no surprise then, that the rate of injury in this group is considerably higher than in those who take regular exercise. Achilles’ tendon ruptures are particularly common in the ‘weekend warrior’.

In regards to heel pain, I see in my practice a recurring theme every year. I always get a significant increase in referrals in March-April, after failed conservative treatment of heel pain that started in January-February. The characteristics of the people this refers to is very predictable. They tend to be male ‘weekend warriors’, who had a period of inactivity over the winter, who over indulged at Christmas and decided to go on a ‘get fit’ drive for their new years resolution. On their ‘get fit’ drive, they start doing early morning runs. If they are belly/side sleepers, where their feet are in a ‘pointing down’ (equinus) position all

night, we have a ‘perfect storm’ situation.

Breaking this down logically, this situation causes an over-weight individual, lacking pliability in their muscles, to go for a run when the calf muscles are at their greatest level of stiffness due to their problematic foot position at night. Bearing in mind that 4-8x your body weight goes through your heel (plantar fascia and Achilles) when you run, there is no wonder why the heel starts hurting. I see in equal measure Plantar fasciitis and Achilles tendinopathy turning up to my clinic as the result.

The Battle Between Night and Day - Heel Pain

Sun, 14 Dec 2025 20:54:55 GMT

The Battle Between Night and Day - Heel Pain

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Ankle Arthritis Information Updated

Sun, 14 Dec 2025 20:45:21 GMT

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�� Updating our Ankle Arthritis Treatment Leaflet | Liverpool Foot & Ankle Clinic

We’ve updated our ankle arthritis treatment information leaflet to reflect the findings of the recently published Oxford population study examining the long-term outcomes of total ankle replacement (TAR) versus ankle fusion (AF) in over 41,000 patients across England with up to 25 years of follow-up https://pubmed.ncbi.nlm.nih.gov/41355435/ @aofas1

This high-quality national data provides important reassurance for patients and clinicians alike:
• ✅ Both ankle replacement and ankle fusion are safe, effective definitive treatments for end-stage ankle arthritis
• �� Ankle fusion showed lower long-term revision rates compared with ankle replacement
• �� Importantly, ankle fusion did not increase the long-term risk of adjacent hindfoot fusion, a common concern
• �� The study reinforces that treatment choice should be individualised, based on patient age, activity, expectations, anatomy and comorbidities — not myths or assumptions

At Liverpool Foot & Ankle Clinic, we are committed to evidence-based, transparent shared decision-making. Updating our patient information ensures consultations are grounded in the best available long-term data, helping patients fully understand the benefits and trade-offs of each option.

�� The revised leaflet is now used routinely in clinic to support informed discussions about ankle arthritis care.

#AnkleArthritis #EvidenceBasedMedicine #SharedDecisionMaking #AnkleFusion #AnkleReplacement FootAndAnkle LiverpoolFootAndAnkle Orthopaedics PatientInformation @drlyndonmason @bone_and_joint_centre