While many endurance runners anticipate common complaints like blisters, chafing, and general exhaustion over the course of 26.2 miles, other problems remain concealed deep within tissue. A typical marathon requires 50,000 to 60,000 steps, placing immense pressure on the feet. Ahead of major events like the New York City Marathon, podiatrists emphasize that less obvious foot injuries can sideline even seasoned athletes.
Among the less common but notable concerns are sesamoid injuries. Named from the Greek word for sesame seed, the sesamoid bones are two pea-shaped structures located beneath each big toe that assist runners in pushing off the ground. Dr. Jeffrey Baker, a podiatrist with the Balance Health and Weil Foot & Ankle Institute in Chicago, notes that while these injuries are rare in the general population, they occur regularly among runners. Individuals with high arches face elevated risks because rigid feet fail to flatten sufficiently to absorb impact, concentrating weight on the heel and ball of the foot instead of distributing it evenly. Forefoot strikers and runners with tight calves also experience increased vulnerability. A stress fracture in this area typically mandates four to six weeks in a walking boot, whereas inflammation known as sesamoiditis is managed with ice, anti-inflammatory medication, avoiding barefoot walking, and temporary low-impact cross-training.
Another specific condition is cuboid syndrome, also referred to as cuboid subluxation. This occurs when the square-shaped cuboid bone on the outer edge of the foot, situated halfway between the heel and the pinky toe, becomes slightly dislodged. The resulting discomfort can be alleviated through a maneuver called the cuboid whip. During this procedure, the runner lies face down with the affected knee flexed at a 90-degree angle while the physician applies a forceful downward motion to the bottom of the cuboid to restore alignment, often bringing immediate relief.
More severe is the navicular stress fracture, affecting a kidney-shaped bone toward the back of the foot that possesses limited blood supply. Because circulation is poor, the bone struggles to repair micro-damage fast enough to match high-impact training loads, causing pain across the top, middle, and inner arch of the foot. Baker describes this complication as particularly challenging, noting that it often requires an extended recovery period and, in many cases, surgical intervention.
Distinguishing between standard post-race soreness and a serious injury can prove difficult immediately after crossing the finish line. Baker advises seeking professional evaluation if a foot is red, warm, swollen, and unable to bear weight. Mild, achy discomfort that merely causes annoyance during walking without swelling typically points to overuse tendinitis, which can be monitored for two to three days before consulting a podiatrist. X-rays can help determine the precise extent of any damage.
Medical experts also stress the importance of preparation to prevent severe trauma. Dr. Mario Porciello-Donnarumma, a podiatric physician at the University Foot & Ankle Institute in Southern California, warns against wearing untested gear on race day. Breaking in new running shoes for a minimum of four to six weeks beforehand helps prevent severe blistering. Furthermore, runners who suffer traumatic injuries during a race are urged to stop immediately and seek medical attention rather than attempting to push through the pain, as continuing to bear weight can transform a minor injury into a surgical emergency.
