Why the big toe is to blame when the shin hurts

Stitches, runner's knee, torn ligaments, irritated tendons, knee pain or hip problems - almost every runner will experience pain in at least one part of their body at some point during their running career. The fact that a runner puts his foot on the ground around 1,000 times per kilometer is an enormous strain on the body. Sports physicians assume that the injury rate among runners is around 30 percent. In total, experts know of 28 injuries associated with running.

What is striking, however, is that the five most widespread "common ailments" in the running world affect parts of the body below the knee. According to scientific studies, pain at the inner or outer edges of the shins occurs most frequently (shin splints syndrome), followed by irritation of the Achilles tendon (Achilles tendonitis), pain at the tendon plate of the sole of the foot (plantar fasciitis), pain at the kneecap and front knee (patellar tendinopathy), and sprains of the ankle. And although the running shoe industry has been researching and innovating for 40 years, injury rates among runners are higher than ever.

Mother Nature's handiwork

Mother Nature has actually created a true masterpiece of engineering in the human foot, which does not need any external support. You have to imagine the foot as a kind of twisted, spring-like plate to which the toes are attached at the front to anchor the plate to the ground. When the foot touches the ground, the plate untwists and elongates to absorb the impact, causing the plantar fascia to pull the toes into the ground (reverse windlass mechanism), anchoring the foot and providing a stable base. As the runner's weight begins to move over the foot, the heel lifts off the ground, using the toe joints as pivot points (the windlass mechanism). Now it's the toes' turn to pull on the plantar fascia, lifting the arch and twisting and shortening the foot to become a tighter, stiffer spring in preparation for the all-important push-off phase of running. Put simply, the forefoot optimizes propulsion, the midfoot provides mobility, and the heel cushions impact.

An old proverb says: Use it or lose it

The shoe industry is now intervening in this masterpiece of Mother Nature and preventing the foot from performing its function as a mobile shock absorber and stable propulsion lever. With the intention of preventing injuries, it is developing innovations that allow injuries to occur in the first place. For example, renowned Harvard professor Daniel E. Liebermann and colleagues have analyzed how toe-bouncing disables toe muscles, increasing the risk of injury. This effect can be seen every day on sneaker owners on the street: Because runners can no longer roll over the big toe, they avoid this torque, which should actually go over the big toe, by turning their foot outward and significantly overpronating. The latest trend among running shoe manufacturers to install carbon plates in the midsole to improve performance is also almost paradoxical.
Renowned biomechanists have also been able to prove in several scientific studies and expert opinions that the position of the big toe has a relevant effect on the pronation of the rear foot during the stance phase of running. The more deformed and shoelike the big toe is, i.e. the more pronated a so-called hallux valgus is, the more pronated the runner will be. But it is precisely this hallux valgus that the shoe industry provokes by sticking to its classic asymmetrical last, which squeezes the toes tightly together in the forefoot.

Running shoe design must be rethought

Instead of trying to control pronation through the rear of the shoe, biomechanical studies suggest that running shoe design needs to be completely rethought to allow more space for the toes in the forefoot. This immediately guarantees runners more stability in the forefoot and prevents running injuries below the knee in the long term.The good news here is that even if the knee or Achilles tendon hurts - the body can be regenerated. Those who start walking and running with anatomically correct, foot-friendly shoes can restore the structure and function of the foot - and thus practice their favorite sport permanently without pain or injury.

The most frequent running injuries

Tibial tendon syndrome: incidence 13.6 - 20 percent / prevalence: 9.5 percent)
Achilles tendinopathy: incidence: 9.1 - 10.9 percent / prevalence: 6.2 - 9.5 percent) 
Plantar fasciitis: incidence: 4.5 to 10.0 percent / prevelence. 5.2 and 17.5 percent 
Patellar tendinitis: incidence: 5.5 - 22.7 / prevalence: 12.5 
Ankle sprain: incidence: 10.9 - 15 / prevalence: 9.5

Author: Lee Saxby

Lee Saxby, one of the best known running technique coaches internationally. His knowledge and expertise in biomechanics and foot function have helped injured runners, both recreational and elite, around the world. Lee works closely with Sebastian Baer to bring the principles of natural foot function to the general public and finally put the focus on our most neglected body part: our feet!