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Long Runs and Marathons by Tyler Silverman, DPM

Tyler Silverman, DPM

Long runs, especially marathons, are exhausting. While there is evidence that humans evolved to run long distances, people who don’t do it regularly have trouble doing so and often need a prolonged recovery even if they are fortunate enough to have avoided injury. The lower extremity injury rate for long distance runners is high, with some reports stating that over 50% of runners get injured each year. A marathon takes over 50,000 steps, each of these steps generating forces many times your body weight. This contributes to the high injury rate in long distance runners.

Pay attention to what your feet tell you – if they hurt, it is important to not only relieve the pain but treat the source. Many injuries prompt consulting a podiatrist; s/he can provide a variety of assessments and treatments. These may include: form analysis, inserts, suggestions about alternative footwear, medication (including local injections), x-rays, immobilization, and sometimes surgery. Fortunately, there are techniques and tips to get you through long distance running with reduced likelihood of injury.

Here are some tips you can use in your training.

Diet and Lifestyle

Make sure to eat well. What you eat when training and before the race makes a difference. A typical marathon runner burns over 2,000 extra calories on race day. Sleeping is important as well; without adequate rest, the body struggles to heal worn out muscles and tendons.

Training and Strengthening

It takes months to build up the strength and endurance required to complete a 26.2 course. An experienced runner/trainer can help you design an appropriate schedule. Here are some tips:

  • Many people run a marathon in lighter shoes than they train in. These often have less support and a decreased heel to toe differential and can lead to increased use of different muscles. By strengthening certain muscles during your training period, you can help decrease risk of muscle cramping and soreness during the race. Two of the muscles that can get especially overused are the gastrocnemius and soleus muscles of the calf. These can be strengthened by doing heel raises on a step. Proper form is important to optimize benefit and avoid injury – so consult a trainer, rehabilitation specialist, podiatrist, orthopedist, or other health professional.
  • Bring plenty of water for your long runs.
  • There are some pains that you should not run through. One of the most notable is a sharp pain over the bones in your foot. This may be a stress fracture and should be promptly evaluated by a physician.

Warm Up and Cool Down

Before and after a hard run, it is important to do some slow running or walking as a warm up or cool down. This helps get the muscles ready for, or recover from, a long run. Although the value of stretching seems obvious to many, the literature does not have any clear advice on stretching. Nonetheless, many runners do feel better if they stretch after running. Therefore, stretching of your “running muscles” such as your quadriceps, hamstrings, and calves, may be beneficial. There are many stretching exercises available.


Treating yourself to a massage can make your muscles feel rejuvenated. However, when time or finances restrict your access to the real thing, you can do a lot to help yourself. Legs can be massaged with foam rollers, available at many sporting goods stores. Tennis balls make great foot massagers. You can compete with the dogs who grab them as they fly over the fence of a tennis court. Rolling a tennis ball on the arch of your foot is a great way to help treat plantar fasciitis, a common running injury.


Similar to stretching, icing may be beneficial after a long run. There are many ways to ice after a run. The simplest is to take ice packs and place them on your sore legs. Bags of frozen vegetables (such as peas) also work well. Ice massage is an effective way to ice. Try placing paper cups full of water in the freezer. After they have frozen, peel back the paper to expose the ice. This can then be rubbed over the painful or sore area. You can also use frozen water bottles on the bottom of the feet.


After racing a marathon, your body is exhausted. Your feet have done a lot of work to carry you 26.2 miles. You may have ignored chronic running injuries that were nagging you while training. You may have new acute injuries such as blisters. The hard work is over (until you sign up for next year’s marathon). Now you need to recover.

For the first few nights, make sure to eat well and sleep enough to allow your body to heal itself. For the first week afterwards, take a break from running. If you start to feel better, you can do low impact gentle exercises such as biking, elliptical trainer, or swimming. If you are feeling better after one to two weeks, you can resume running. Remember to start back gradually.

Most importantly, have fun! Running can be enjoyable. Remember that as you get to mile 20 during a race or look out the window preparing for a run on a rainy morning.

This article provides general information for educational purposes only. The information provided here, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider.

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