Looking around the barefoot running forums, a common problem that comes up is TOFP (top of foot pain). It appears to be a common injury that barefoot runners get and is probably more common in those making the transition to barefoot or minimalist running. There are a number of different things that can cause TOFP ranging from tendonitis to ganglions to stress fractures. What appears to be the most common causing is a jamming of the bones o the top of the foot that occurs more in forefoot striking versus rearfoot striking.  Interestingly, the suggested management of top of foot pain is to go back to shoes and rearfoot strike. After that, there needs to be a gradual return to barefoot to allow the bones to adapt to the load. I have also seen advice for TOFP that in some people the forces are so high that they may have to resort to orthotics, rearfoot striking and using running shoes. I guess that just means there is no standard advice for this and each runners top of foot pain needs to be evaluated on its own merits.

Severs disease poses an interesting one for the barefoot runner. It only happens in youngsters up until the age of 14-15 years, so is only an issue for that age group and their parents. Severs disease is an overuse type injury to the cartilage growth plate at the back of the heel bone. The growth plate merges with the bone around the mid-teen years, so is a self limiting problem.  It is more common in active kids who play a lot of sport on hard surfaces. So the hard surfaces play a role in Severs Disease. As barefoot running does not involve a heel contact and is more a midfoot and forefoot running pattern, theoretically barefoot may be beneficial for Severs Disease. However, another factor is that the Achilles tendon attaches to this back of the growth plate in the heel and will put a lot of strain through the area. Barefoot activity or changing to a midfoot or forefoot strike will increase the load through the Achilles tendon and the growth plate. This perhaps suggest that barefoot running or activity may not be a good idea for those kids with Severs disease. The standard treatment for Severs Disease is to reduce the volume of activity and use a heel raise to relieve the pull from the Achilles tendon and give some shock absorption.

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Sinus tarsi syndrome is a problem that causes pain on the outside of the ankle joint with tenderness felt just in front of the outside ankle bone (lateral malleolus). Traditionally, this is due to two reasons. One reason is that ligaments between the talus and calcaneus (two bone below the ankle joint) are strained as part of an ankle sprain. This is often best treated by a physical therapist and manipulation and sometimes an injection. The other cause of sinus tarsi syndrome is a pronated foot. This is when the foot rolls inwards below the ankle joint at the subtalar joint (the joint below the ankle joint). When this joint gets to its end range of motion, there is bone on bone contact that stops the pronating foot. If the forces pronating the foot are great, then this compression may become painful. The treatment of this in barefoot running is going to be problematic as the compressive forces have to be relived and the traditional way of doing that is with foot orthotics. Long term, muscle strengthening may do away with the need for orthotics if indeed it was a muscle weakness that led to the foot pronating in the first place.

For more, see these: Recurrent Ankle Sprain | Sinus Tarsi Syndrome | Sinus Tarsi Syndrome | Sinus Tarsi Syndrome

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