Today on The Doc On The Run Podcast, we’re talking about the top three road hazards for runners.
What are road hazard? Well, road hazards are something that cause trouble. This is true for drivers of automobiles and it’s true for runners as well. Today we’re going to talk about the top three road hazards for runners.
On Saturday, a runner went on to our website and scheduled a consultation call because his foot was hurting. It turns out his foot was not just starting to hurt, it had been hurting for a few months, But at the start of a race this morning it started really bothering him again.
He scheduled a consultation call. We got on the phone, we talked about it. We figured out what happened. We came up with a plan.
What happened to him was that he got a stress fracture in one of his metatarsal bones in his foot. A metatarsal stress fracture is one of the most common problems that affects runners and keeps them out of training and out of racing. He had an interesting story and it really highlights how stress fractures happen in runners.
Back in October he was starting to have pain. He was starting to have trouble and it was odd to him because it wasn’t really a significant event that caused the beginning of the injury. He actually had run a 100-miler previously and he took some time off and rested. Then he was on what he thought was a relatively mundane return-to-training run.
On his way home at the end of that run, he was running downhill and when he came down hill and hit the sidewalk and turned right, he felt this sudden sharp pain in his foot. That was the same kind of pain he was having over three months later when he started to run and take off uphill during a trail race.
Here’s what happened. We talked about this at length and figured out that he actually developed a stress fracture, that the inciting event was really that one relatively easy training run on a trail that was a few weeks after the long race. He probably really beat up his foot in that long ultra-marathon and then he was predisposed to getting the stress fracture. The bone was still weak, it was still kind of hammered, but the stress fracture just hadn’t shown up during the ultramarathon. The stress fracture finally appeared a little bit later on this relatively easy run.
After we talked about it, we figured out exactly how it happened and realized that he hit one of these road hazards. He did something with his foot specifically in the way it hit the pavement that caused too much stress to load that bone and resulted in a stress fracture in his foot.
I thought it might be worth talking about the three things that I talk to runners about and hear causing problems. These are what I call “road hazards.” They’re things that you can really mess yourself up with, if you don’t avoid them.
Now, I have another friend who is actually a podiatrist and a longtime runner. She’s an elite runner as well, and she actually got a fracture in her foot when she stepped in a pothole during a race. Now, during a marathon, it’s pretty easy to step in a pothole because at the beginning of the race, you are so bunched up you can’t even see your feet because you are two inches from every runner in front and to the side, behind you, everywhere else and everybody’s running as a group. You really don’t have any room to even pay attention. In her case, she was running along and she basically stepped right into a pothole.
Potholes: The Classic Road Hazard
A pothole is a classic road hazard. It is an obstacle in the road that can cause trouble. If you are going fast and you hit a huge pothole, it can actually blow out your tire, and in her case, it blew out her foot and broke it. That is just one type of road hazard, so we’re not going to talk about potholes.
Obviously when running, you should not step in potholes. What I’m talking about here is not potholes. I’m not talking about obvious things like things that have been dropped in the roadway. Obviously you shouldn’t step on things when you are running, but there are things that are commonly found on our path in running that can lead to serious trouble, and so we’re going to talk about those three things.
The first thing is actually the gutter. The gutter is at the edge of the road, and usually it’s sloped significantly because the water is pouring off of the roadway running down into the gutter. Rain water is also running off of the sidewalk, which is sloped in the opposite direction, pouring toward the gutter.
The gutter is rarely flat. It’s usually sloped significantly, and because we often run in the road and don’t want to get hit by a car, we’ll run in the road facing the traffic so that we can see the cars coming at us and look the driver in the eye and see, are they texting their friends? Are they actually paying attention? Do they see us there? Are they going to run us over? Or is it safe to keep running and not get out of the roadway so we don’t get run over?
The problem is if you go run 20 miles and you are running in the gutter, you are running on a slope the entire way and your foot is sloping in the same way. It’s loading your right foot very differently that it’s loading your left foot because one foot is pronating and the other is supinating.
That difference in position puts a lot of differing stresses on each of your two feet. If you vary it and you switch sides of the road, that improves things significantly, but depending upon where you live, you may not be willing to do that.
You have to make a choice about whether or not you are going to run on a flat surface or one that is sloped if you are running in the road. If you run in the gutter and it’s sloping let’s say toward the left, but the sidewalk slopes toward the right, you can switch periodically between the gutter and the sidewalk quite easily to reduce your risk of getting an overtraining injury just because of the slope of the road that really afflicts the gutters.
That is the first point: stay out of the gutter. If you really want to avoid an overtraining injury, this and one of the simplest precautions. Either switch sides of the road periodically or stay out of the gutter altogether and find surfaces that are flatter when you are running.
Reflectors on the Road
Now, the second road hazard is reflectors. You know what I’m talking about. These are reflectors that are glued down on the road, that are glued down in the middle of the road on the painted dividing line.
Unless you are running in a marathon you are probably not going to hit one of those because it’s in the middle of the road. You are not going to run on the line in the middle of the road on most training runs.
These reflectors are often also positioned at the side of the road. Depending upon where you live, in many places there are blue reflectors on the side of the road where there’s a fire hydrant so that the fire department can find the fire hydrants easier.
There are also many of these reflectors at intersections. All of these road reflectors are fairly elevated. They’re an inch to a couple of inches tall. I don’t know exactly how tall they are, but they’re thick!
If you are running along and you hit one of those reflectors and it lands under your forefoot, it jams your foot upward. That forcibly dorsiflexes or pushes your foot up away from the ground and it can actually lead to something like a metatarsal stress fracture, or an Achilles Tendon issue, or a number of other injuries.
It sounds simple, but you do not want to run and land on one of those. It’s really a lot of force under your forefoot if you hit one of those reflectors, and it can cause a serious problems. You want to stay off of the reflectors. That is an obvious one. It’s no better for you to land on a reflector with your foot jamming upward than it is to land in a pothole, so stay off the reflectors.
Now, the last road hazard is the driveway cut-outs. What I mean is that if you look at a driveway, the driveway slopes down toward the street and then it kind of levels out when it hits the sidewalk. But at the edge of the sidewalk it slopes abruptly toward the gutter.
At each edge of it, there are very steep sort of 45 degree triangle-shaped sections where it bevels off up toward the sidewalk. If you are running and you hit one of those driveway cut-outs, the driveway cut-out is really steep and it’s an abrupt angle. In the same way that gutter can pronate or supinate your foot in one direction, so can the driveway cut-out.
Now, in the story I was telling you at the beginning of this, that is exactly what happened to the runner who had the stress fracture. When he was coming downhill he actually changed direction and he hit one of the driveway cut-outs.
I basically started explaining to him how it was possible that a stress fracture could be caused by a relatively short run after you’ve done an ultramarathon and your body is still actually recovering from all of that tissue damage. I told him, I just said, “Look, if you are coming downhill and you come off of the trail, you come down toward where the sidewalk is, you turn right and you plant your right foot. Even worse, if you plant it on the driveway cut-out, basically your foot is severely pronated because you are rotating over your foot, changing direction.”
He exclaimed, “That’s exactly what happened!”
When you hit that cutout, and turn right your big toe side of your foot, the medial side of your foot, is dropping downward on the driveway cut-out. The fourth and fifth metatarsals are then basically planted firmly and they basically work as independent suspension to the first, second, third metatarsals.
You have basically the three medial metatarsals lining up with the talus bone on the top of your foot. The fourth and fifth metatarsals line up with the heel bone underneath the talus, and when you pronate, the tow groups of metatarsals change direction independently. When he basically rolled in that direction, it cranked over, shifted all the forces to the middle of his foot which overloaded the third and fourth metatarsals and he consequently got a metatarsal stress fracture on this third metatarsal bone.
The unfortunate reality is that if he had not landed on that driveway cut-out, if he’d actually been on the road or even just on the sidewalk when he changed direction, he probably wouldn’t have gotten a stress fracture. That one event, when he was sort of weak, sort of beaten up from the prior ultramarathon was enough to overload the foot and lead to this metatarsal stress fracture. The driveway cut-outs are extremely dangerous.
I was running yesterday. I did a 10-mile run and I basically was running up the sidewalk in one section and there was a couple of times people were coming toward me. One time it was three people walking together talking. Another time it was an elderly woman with a walker. Another time it was a couple walking a dog. In those situations, rather than stay on the right side of the sidewalk and run through the driveway cut-outs, I just moved to the street.
I do not run across driveway cut-outs anytime if it’s avoidable because they are very, very high risk, so of all the road hazards that I think actually screw runners up that they don’t really think about, it’s probably the driveway cut-outs. It’s a huge, steep slope that you hit when you run over those driveway cut-outs.
Do your best to stay off of the driveway cut-outs whenever you are running because they are really high risk and it can forcibly change direction of your foot anytime you hit one of those slopes and it really can lead to an overtraining injury.
Do your best to avoid all these road hazards. Stay out of the gutter, stay off the reflectors, and stay away from the driveway cut-outs because those are extremely high moments of stress when you land on them.
Remember, a stress fracture is caused not by too much running, it’s caused by too much stress, so stay off of the stressful road hazard. If you do that, you can keep running with a much lower risk of an overtraining injury.
If you have a question that you would like answered as a future edition of the Doc On The Run Podcast, send it to me. And then make sure you join me in the next edition of the Doc On The Run Podcast.