Burning and aching feet while running is a common complaint that drives people into my office. It can start to burn only after a few miles, but then over time start to be annoying all day, even when not running. Patients ask, “What’s going on? My feet burn. Then, on top of this annoying burning pain, my hips and back are now hurting. I feel like I’m running all jacked up! Help!”

Help is on the way….

Let’s examine the symptoms. Burning pain while running, mostly in the ball of the foot and shooting pains into your toes from time to time.

Could be a neuroma, dorsal neuritis, metatarsalgia, or a stress fracture. Rarely, a pinched nerve in your back, called lumbar radiculopathy, can cause referred pain to your foot.

The hip and back pain is usually from running off balanced and compensating for your pain. Stop it! Let’s get the symptoms under control and then return to running hard instead of causing anther compensation injury. Relative rest is in order for today! If you find your back pain worsening, then a trip to the chiropractor is warranted to rule out a primary back problem.

Back to your foot tune up:

  • Step 1 - First, a visit to the podiatry office for an x-ray is indicated. This will rule out a metatarsal stress fracture. No fracture? Now we know it is probably a nerve compression problem.
  • Step 2 - Let’s look at your shoes. Running shoes should be purchased a full size larger than your regular street shoes, which ensures that your feet aren’t constrained. You can also check by seeing if there’s a thumb width of space between the front of your big toe and the front of your shoe, or by wiggling your toes when your shoe is tied; you should be able to have the room to “play the piano with your toes” inside your shoe. If not, then your shoes can be squishing your toes together and compressing your nerves. Remember, the number is just a number! A 9 in one brand can be a 10.5 in another.
  • Step 3 - Check to see if you tie your shoes too tight. Often triathletes will use elastic laces or speed laces to get their shoes on and off quickly in transition. These same laces used every day can compress the nerve on the top of your foot giving pain and tingling. Tie your running shoes snugly to achieve the ideal fit, but not super tight. Running shoes generally have a well-padded tongue, enabling you to tighten the laces just enough so the shoe gently hugs your foot but loose enough not to pinch. If you have a high arched foot, tie them even looser since the nerve is more exposed on the top of your foot than average.
  • Step 4 - Let’s inspect your shoes, looking for signs of wear and tear or abnormal wear in the forefoot. If your gait pattern has worn the forefoot down in a circle, you probably twist while running and it could be a sign you need new shoes or an orthotic to control your wayward gait. Shoes wears out after you run between 300 and 500 miles, so if your shoes are near the end of their lifespan, chances are they are not protecting you from the road in the way they did when you purchased them.
  • Step 5 - Experiment with sock fabric and features. Different runners prefer different types of socks and different sizes. Yes, running socks come in sizes and a sock that is too small can compress your toes and pinch the nerves as well. Other runners swear by socks that have individual toes, like gloves for your feet, because they can eliminate the burning sensation caused by the friction of your toes rubbing against each other.
  • Step 6 - Experiment with different shoes and inserts. If you're wearing minimalist shoes and you consistently experience burning feet when you run, switch to a shoe that provides more cushioning and/or stability between you and the road. Minimalist or lighter shoes can help you strengthen muscles in your feet and legs, they might not be ideal if you are a heavier runner or have abnormal biomechanics. Remember that these shoes are not meant for every day or everyone!
  • Experiment with a prefabricated insert from Healthy Steps or custom orthotics for those with significant biomechanical issues. Try with and without a metatarsal pad. Your podiatrist can guide you on choices of orthotic devices. You would be surprised how much fixing abnormal biomechanics can really help eliminate your symptoms.
  • Step 7 - Time for some intervention. Your shoes are good. Your socks fit. You’ve tried a metatarsal pad and a prefabricated arch support and still your feet burn! You probably have neuritis (a really irritated nerve) or a neuroma (scar tissue wrapped around a nerve). Your best option is injection therapy with a corticosteroid or other anti-inflammatory along and around the nerve. Often this will calm down the nerve and as long as you have followed the first 6 steps, may take care of the problem. If not, most other options are surgical and will take you out of commission for 6-8 weeks. Some physicians swear by cryosurgery to the nerve. Others like to try sclerosis.  If nothing helps and you are unable to run, surgical decompression or excision of the wayward nerve is the definitive option.

Burning pain in your feet while running is a bummer and can really slow you down. Try these steps to alleviate the burn!