Why runners need to put their feet first

The human foot is a feat of engineering. But it’s not something even us runners think a lot about. Orthopaedic surgeon Dr. Patrick Vienne, a foot and ankle specialist, explains why our feet deserve special attention.
It seems quite obvious that strong, healthy feet are the anatomical foundation for injury-free running. But as we hide them in our shoes, even we runners can forget that feet came first.


Every foot is unique. Finding the right shoe for your foot, and keeping that foot strong, are the fundamentals of running healthy. 


To better understand what we should be thinking about if we embrace a ‘feet-first’ approach, we spoke to Dr. Patrick Vienne, currently medical director at La Clinique du Pied in Lausanne. Dr. Vienne was chief of the foot & ankle department at the Balgrist University Hospital in Zurich, Switzerland from 1999 to 2008. 


An orthopaedic surgeon specializing in the foot and ankle for over 20 years, Dr. Vienne knows the remarkably complex structure inside out. But it wasn’t just the challenge of the anatomy that led Dr. Vienne to this specialism. His appreciation of what our bodies are capable of comes from firsthand experience as a mountain runner. And a serious one at that.

Dr. Vienne, pictured above, twice finished in third place at the prestigious Sierre-Zinal Alpine race and was also on the podium at the Swiss Mountain Championships in 1995. He represented Switzerland at the Mountain Race World Championships in Scotland that same year and has a half marathon best of 1:04:30. While today Dr. Vienne focuses on his work at the clinic, his love of running never left him. He still runs around 50 kilometers per week but “more for fun and to stay healthy.”


So, when it comes to helping us keep our feet in top form, Dr. Vienne is perfectly placed to advise, and it starts with understanding the incredibly intricate structure that we absent-mindedly put our socks into every single day. 


Different types of feet


What type of feet do you have? Not maybe the best conversation starter outside of the On Lab. But the first information Dr. Vienne surprised us with is that there are three main types of feet, or to be more specific, three main ways our toes are aligned. 


Most common is the Egyptian type, where the big toe lives up to its name and is longer than all other toes. This is the case for around half of human feet. But around 40% of us have what’s known as the Greek type, where the second toe is longer than all other toes. More rare, being found in only 10% of people, is the Roman type. This is where the big toe, second toe and third toe are all the same length. 


This actually doesn’t have a big impact on how we run. There are however, said to be some character types associated with each foot type, according to folklore:


“Interestingly, people with the Egyptian foot are said to be open minded, sociable and particularly good in business. People with the Greek foot type are thought to be great leaders, creative and intelligent. And people with the Roman foot are said to be not only rather calm and thoughtful, but also reliable and pragmatic."


Well, if the shoe fits… But Dr. Vienne soon gets more specific – and scientific. 


“The foot and ankle have a very complex anatomy,” Dr. Vienne explains. “In each there are between 29 and 34 bones, more than 100 ligaments, 30 joints, more than 30 muscles, 5 major nerves and 3 arteries.


“All these structures work together to allow motion in all directions on varying surfaces. The impact on these anatomical structures every step is huge. Running or jumping can result in forces four or five times our body weight. 


“The attachment of the Achilles tendon at the rear of the foot can stand forces up to 800 kg/cm2. It is a real phenomenon of nature but also represents a potential point of injury particularly from overload.”

And that’s the thing, just as the anatomy of the foot is more complex than you many realize, the demands we put on our feet are bigger than you might think. The role of the foot in running is not to be underestimated.


“Our feet and ankles are responsible for extraordinary biomechanics. From the moment of contact with the ground until the push-off phase there are subtle interactions between the forefoot, the midfoot and the hindfoot to adapt to different surfaces and allow many types of movements. This is called proprioception and works through automatic mechanisms involving tactile and sensomotoric nerve cells acting directly on the many muscles of the foot and ankle.”


Ok, so we have a new-found respect for the anatomy of the foot. But how can we use this information to help prevent injuries? Dr. Vienne groups injuries into two types: traumatic injuries and overload injuries. 


“Traumatic injuries [like slips, twists and falls] are usually not related to a mistake by the athlete,” Dr. Vienne says. “They can sometimes be associated with high-risk taking or wearing inadequate shoes."


“The role of the athlete is much more important in overload injuries. These injuries usually occur after a rapid increase in volume and intensity, particularly among beginners."


“We see the same problems in professional athletes, most of the time after a recovery period following an injury. Inappropriate shoes and technical mistakes can also lead to overload. The tendon insertions in the foot and ankle are the structures most often affected by overload. This can lead to chronic inflammation of these structures, which can be difficult to treat and in most of the cases are followed by a long period of rest or alternative activities.”


Of course, that sounds like something we want to avoid however possible. And, like so much in running, preventing overload is about pacing yourself. But there are a few additional steps you can take as well. 


“A progressive, structured increase of your training load is the best way to prevent an overload injury. On top of that, good technique and the right shoe can also help to reduce the risk of foot and ankle injuries.


“I also recommend that athletes compliment their endurance training by regularly doing some specific strengthening exercises and ending each training session with some stretching exercises, particularly stretching out the gastrocnemius muscle in your calf.  


“Finally, making sure you have enough time for recovery and balanced nutrition are important contributions to reduce the risk of injuries.”


To help build the right physical foundation for running and to build up your training gradually? Check out our runner’s health check, with exercises for helping the body handle the rigors of running. You might also like our half marathon and full marathon training plans. Looking for the On shoe that’s right for you? Our Shoe Finder tool is a great starting point. 





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