Foot Anatomy

By: John Fiore, PT

As runners, our feet take a beating.  The human foot is designed with locomotion in mind. Healthy foot function hinges on a balance of mobility, strength, and support. When one of these three necessary components is compromised, injury risk increases. 

Foot Anatomy

Foot Anatomy

The foot is complex!

Understanding the foot and how to avoid a few common foot injuries will enable runners to run with confidence.  The human foot contains 26 bones and nearly 100 joint surfaces.  In addition, our feet absorb 2.5 to 5.0 times our body weight with each foot strike. The bones of the foot form three distinct structural and functional units.  The rear foot is made up of the large calcaneus and talus.  The rear foot is designed for weight bearing and articulates with the lower leg bones (tibia, fibula).  The mid foot is made up of the navicular, talus, and cuneiform bones.  The mid foot has a dual role.  It absorbs shock during weight bearing and forms the stability we rely on (the arch) when pushing off to initiate the next step.  The fore foot is made up of the five metatarsal bones and 14 bones in our toes (phalanges) and plays a role in terrain adaptation and balance. 

Foot Mobility

Foot mobility creates shock absorption and terrain adaptation. During the walking and running stride, foot function changes from one of shock absorption to one of propulsion which means the foot must stiffen to lift our body weight against gravity for the next step or stride. Foot stiffness during all phases walking or running greatly increases the impact through the joints of the foot. Mobilizing the foot by rolling over a small ball or self -massage is a simple way to insure foot mobility.

Foot Strength

Calf Strengthening

A calf strengthening program. Photo:

The bottom of our feet has four layers of muscles (called intrinsic foot muscles) which support the arch and provide dexterity to our toes. The lower leg muscles control the function and support of our ankle and feet collectively. 

The calf muscle group (gastric-soleus), for example, is crucial for propulsion and Achilles tendon health. 

A progressive calf loading program tailored to your abilities and goals is a great place to start. A 31% reduction in calf muscle strength naturally occurs between the ages of 20 and 60 (DeVita, et al 2016), making lower leg, Achilles, and foot injuries more prevalent in runners over the age of 40. Strengthening the medial and lateral ankle (tibialis posterior, fibularis musculature) is important as well to improve ankle stability. It is important to have a physical therapist evaluate your unique foot and ankle function (strength, range of motion, joint mobility, tissue tension) in order to create a strengthening-loading program which is right for you.

Foot Support

Strong, mobile feet equal healthy feet with adequate support for running. Many of us, however, have feet which are less than ideal either due to genetics (thanks for the bunions Grandma), prior injury, or surgery history.

In some cases, therefore, the use of an insole or custom orthotic may be needed to support the foot and ankle. A custom orthotic is a medical device with the goal of placing the foot and ankle in a neutral position. Activity goals, prior injury and medical history is factored into the design of each pair of custom orthotics. Sapphire Physical Therapy makes custom orthotics on-site using the Amfit system which allows for an accurate, custom fit. Orthotic materials (based on activity, medical history, foot type) range from soft to semi-rigid carbon fiber and everything in between. Watch for our October orthotic special (20% off all orthotics) or contact John Fiore ( or see our website to find out more about custom orthotic options or to discuss a foot-ankle strengthening program to keep you running strong. 


DeVita P, Fellin RE, Seay JF. The relationship between age and running biomechanics. Med & Sci Sports & Exerc. 2016; 48 (1): 98-196.

McKean KA, Manson NA, Stanish WD. Musculoskeletal injury in the masters runners. Clin J Sport Med. 2006; 16 (2): 149–54.

Location of shin splints pain

By: Evie Tate, PT, DPT

Shin splints, more formerly known as “medial tibial stress syndrome”, is a common overuse injury seen in runners. It is characterized by pain along the inside of the shin (tibia), typically in the area closer to your ankle, that can be present in one or both legs. Here are some ways you can directly address risk factors associated with shin splints.

Improve your calf muscle endurance (specifically plantarflexors)

Studies have shown that poor plantarflexor is associated with increased risk of developing shin splints.1 The plantarflexors are the muscles that you use doing a heel raise. Try doing heel raises to strengthen your plantarflexors and help keep shin splints at bay. Goal number: 25 single leg heel raises (1).

Evie demonstrating weighted single leg calf raises

Rest days

Shin splints are considered an over-use injury (2). When you are training, make sure you are utilizing rest days and/or low-impact cross training (swimming, biking) activities. When our training exceeds what our muscles and bones can tolerate, we develop overuse injuries. The best way to combat these injuries is by giving our body the rest it needs. If you are finding that you are not sleeping as much, have increased your activity levels dramatically and/or are feeling more fatigued during your runs than what is normal, don’t be afraid to take a rest day. One day of rest will sometimes far exceed the benefits of going for a run when fatigued! 


If you have shin splints, one thing you can try is using an orthotic.  While they don’t work for everyone, orthotics may help reduce your pain if you have developed shin splints (3). The best way to see if orthotics work for you is to simply try on a pair, walk around and if they feel good, they may help you! 

If you are battling shin pain, talk to your physical therapist to develop the strategy that will best suit you and your specific needs. 


1 Madeley LT, Munteanu SE, Bonanno DR. Endurance of the ankle joint plantar flexor muscles in athletes with medial tibial stress syndrome: A case-control study. Journal of Science and Medicine in Sport. 2007;10(6):356-362. doi:10.1016/j.jsams.2006.12.115 

2 KORTEBEIN, PATRICK M.; KAUFMAN, KENTON R.; BASFORD, JEFFREY R.; STUART, MICHAEL J. Medial tibial stress syndrome, Medicine & Science in Sports & Exercise: March 2000 – Volume 32 – Issue – p S27-S33

3 Moen, M.H., Tol, J.L., Weir, A. et al. Medial Tibial Stress Syndrome. Sports Med 39, 523–546 (2009).

If you have ever trained for a sport or participated in a regular exercise routine, you have likely heard of plyometrics. Plyometric training is a useful tool not only for athletes but also is an important component in physical therapy as way to help patients return to sport and activity. Though plyometrics are typically thought of as an exercise for more explosive sports, runners should be adding in this to their normal routine as well. 

What Are Plyometrics?

Plyometrics are a form of training that utilizes our body’s stretch-shortening cycle to produce powerful, explosive movements. Both speed(time) and strength(force) are functions of power and can be manipulated to achieve varying outcomes.  This stretch-shortening cycle in our muscles can be thought of as a spring being compressed and released (1).

Benefits of plyometrics

The primary goal when performing plyometric training is to increase our body’s power output to improve our performance during athletic maneuvers. For runners, this means increasing our running economy or improve the efficiency at which we run. Plyometrics have been shown to improve running economy as well as increase tendon stiffness and bone density (1, 2). This is especially important considering how prevalent tendon and bone injuries are in the sport of distance running.  

How to perform plyometrics

Plyometrics require an ‘explosive’ movement. Near maximal effort should be used when doing plyometrics to maximize the potential benefits, which is part of what makes plyometric training so great. Because of the level of demand placed on the body, individuals do not need to perform countless repetitions to achieve their goal. Depending on the amount of running you are doing, it is best to start with one set of ten repetitions for each type of jump, two to three times a week and then add additional sets from there.  

While plyometrics can be beneficial, we suggest consulting with your local physical therapist regarding any questions or concerns about your ability to implement plyometric training. 

Examples of Plyometrics for Runners:

  1. Double leg hop for distance
  2. Single leg hop for distance
  3. Counter movement jump (step off box and quickly follow with jump)

For more information on plyometrics, visit the Sapphire PT blog here:

By: Andrew Traver, Student of Physical Therapy/Sapphire Physical Therapy Clinical Intern


1 Voight, Michael L., and Steven R. Tippett. “Plyometric Exercise in Rehabilitation.” Musculoskeletal Interventions: Techniques for Therapeutic Exercise, Third Edition Eds. Barbara J. Hoogenboom, et al. McGraw Hill, 2013,

2 Davies, George et al. “CURRENT CONCEPTS OF PLYOMETRIC EXERCISE.” International journal of sports physical therapy vol. 10,6 (2015): 760-86.

By: Bailey Hewitt, PT, DPT

A hot (or rather cold) topic that is often posed within the Sapphire Clinic walls is when and how much to ice after an acute injury. This is a reasonable question as the protocols & principles have morphed quite drastically over the years.


In 1978 Dr. Gabe Mirkin created the first acute injury response acronym of REST, ICE, COMPRESSION, ELEVATION. This concept included ice a key stakeholder in the reduction of the inflammatory cascade to elicit an accelerated recovery.


Nearly a two decades later, the “P” was added to represent PROTECT by Kerr, Daley and Booth via ACPSM standards. Yet, this didn’t seem to quite cover it as there was no progressive re-introduction to building sport tolerance and REST discouraged movement.(3)


In order to addressed these limitations, the “OL” was added, which represented OPTIMAL LOADING. Current research continues to support the notion that OL “…aids in recovery through cell generation induced by light mechanical loading in the early stages.(4)” Translation: relative rest through light movement is key in telling our brain we still need that body part and need it quickly.

Example: Pumping (stepping on an imaginary pedal) the ankle after sprain.  This contraction creates a light muscle pump that naturally flushes excess inflammation from the body.

During this same time period, further contradictory evidence was emerging suggesting that the inflammatory cascade of an injury could be BENEFICIAL in recovery; Further, it indicated that the application of ice could hinder this response despite its ability to inhibit pain. In response, Dr. Mirkin officially retracted RICE in 2014 to draw attention to this new opposing evidence. (3,4)

Inflammatory cascade:

Say you roll your ankle, your body sends out macrophages which are inflammatory cells that deliver Growth Factor hormones to the injured area which kick starts the healing process by flushing out the damaged tissue. Where ice can impact this process is by blocking the body’s natural release of this hormone, thus delaying healing and increasing recovery time. (4)


Just when you thought the acronym couldn’t get any longer, PEACE & LOVE emerges in 2019 to address the limitations of POLICE. PEACE is designed to address subacute injury while LOVE is targeted toward the subsequent stages of tissue healing.

Science has proven that the inflammatory process can be beneficial but this is not applicable to all situations because science has also shown that long term inflammation can be equally detrimental. Chronic inflammation is often the cause of increased pain, muscular inhibition, reduced range of motion, etc.

With that being said, ice is an option to reduce pain and limit inflammation of minor acute injuries but should likely not be used to fully eliminate our natural healing process. On the other end of the spectrum, as in the case of a severe inflammatory event, one would want to interfere with the cascade to limit the detrimental effects of edema that can impact an individual’s recovery (i.e. post-op).


It is not a simple yes or no answer and like all good things in life, “it depends”. I hope this helps guide your thought process should you need to treat an acute injury in the future. If you are unsure how to respond appropriately, please seek out professional medical attention.


  • Glasgow P, Phillips N, Bleakley C. Optimal loading: key variables and mechanisms. British journal of sports medicine. 2015; 49(5):278-279.
  • Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999
  • Mirkin, G. & Hoffman, M. (1978). The sportsmedicine book. (1st ed.). Little Brown and Co.
  • Bleakley, C. M., Glasgow, P. & MacAuley, D. C. (2012). PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine. 46, 220–221.
  • Mirkin, G. (2014, March 16). Why Ice Delays Recovery.
  • Dubois, B. & Esculier, J-F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. 54, 72-73.
  • Vuurberg G ,Hoorntje A ,Wink LM , et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline.Br J Sports Med2018;52:956.doi:10.1136/bjsports-2017-098106
  • Singh DP , Barani Lonbani Z , Woodruff MA , et al. Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury.Front Physiol2017;8:93.doi:10.3389/fphys.2017.00093