Metatarsalgia to Frostbite: 6 Trail Running Injuries – All Health Wellness | Amazon Affiliate Store
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Metatarsalgia to Frostbite: 6 Trail Running Injuries


Are you ready to break out of your comfort zone and give trail running a try? Or perhaps you’ve already been bitten by the off-road running bug and had to deal with some of the common hazards of wilderness running. 

Running on different surfaces can add great variety to your routine, but it also has its risks. You’re putting your body under a different kind of stress and strain – especially when you first get started

We’ve put together the 6 most common trail running injuries to be aware of, plus treatment tips to help you get back on your feet.

6 Common Trail Running Injuries + Treatment Tips

1. Metatarsalgia

Metatarsalgia is a common overuse injury for all runners. It is often described as feeling like there’s a pebble in your shoe under the ball of your foot. The condition is caused by inflammation of the metatarsals, which are the bones in the ball of your foot that form your arch and connect to your toes. Inflammation can be the result of recurring pounding or jumping, trauma to the area, or simply the way your feet are built. If you suffer from bunions or hammer toes, you’re more likely to experience metatarsalgia at some point. 

Treatment Tips

Stay off your feet and ice the affected area. Stretching your calf muscles, achilles, ankles and toes can speed up recovery time. Anti-inflammatory painkillers like ibuprofen or naproxen will relieve the pain initially, but it’s important to take the time to rest your feet. Research shows that toe exercises to build toe grip strength can improve metatarsalgia.(1) If you’re concerned about losing your hard-earned fitness gains, try cross-training with low-impact cardio workouts. 

2. Sprained Ankles

If you’ve tried trail running, then you know that running on paths peppered with rocks, fallen trees, ditches, or streams demands your complete concentration. As you tire and lose your focus, your ankles are likely to suffer. Sprained ankles are relatively common among trail runners and happen when your ankle turns or rolls, stretching the stabilizing ligaments beyond their normal range of motion. This results in sharp pain, swelling, bruising, tenderness and you may hear a popping sound at the time of the injury. 

ankle close up of a trail runner

Treatment Tips

Rule number one for a sprained ankle is to stay off it. Most people think RICE  (rest, ice, compression, elevation) is the best treatment for soft tissue injuries, however, there is insufficient evidence to show whether this is always the best option.(2) Since the severity of a sprain can vary greatly, it’s important to consult your doctor to determine how much damage has occurred and what the appropriate treatment plan should be. 

General prevention tips include strengthening the muscles supporting the joint and wearing shoes that provide you with proper support for the challenges posed by rough terrain. After recovering from a sprain, you’ll need to include specific exercises to restore mobility of the joint.

3. Friction Blisters

We’ve all had to deal with them at some point in our lives. Whether caused by a wrinkled sock or shoes that don’t fit right, friction blisters are those painful, fluid-filled pockets of skin caused by rubbing and pressure. Usually it’s just a minor irritation that will heal on its own with time and rest. However, if you don’t treat a friction blister properly, it can get infected and create a bigger problem, such as cellulitis or sepsis.

Treatment Tips

You’re out on the trail and about 30 minutes into your run you feel a blister forming. Stop and check whether it’s a wrinkled sock or tightly laced shoe that’s causing the problem. If adjustments don’t help, you’ll have to continue your run and deal with it later – shorten the route if possible. 

When you get home, wash your hands. Avoid puncturing the blister, but if it has burst, allow it to drain before covering it. Do not “deroof” the blister, i.e. leave the outer skin layer intact as it protects the wound underneath. Cover the blister with an adhesive bandage or – even better – a cushioned blister bandage to prevent further damage. If the blister is open and emits an unpleasant odor or yellowish fluid, it’s probably infected. Have a medical professional look at it.

4. Cramping

A sudden raging pain in your calf almost brings you to your knees. You’re experiencing a muscle cramp or spasm. Why? Some think it’s caused by dehydration or not enough electrolytes, while others see a connection between muscle fatigue and overexertion. Research shows that, whatever the cause, muscle cramps are highly unpredictable and there is no single strategy for prevention or treatment.(3)

man resting on a trail run

Treatment Tips

Preventive measures could include getting enough rest, staying hydrated and stretching before you head out on the trails. If you’re concerned about your electrolytes, try hydrating with sports drinks

However, if a cramp hits you during your run, your first plan of action should be to stop and gently stretch the affected muscle. This will probably be an automatic response; stretching helps improve blood flow to the area, which should relieve the cramp. When you get home, apply a warm compress.

5. IT Band Syndrome

Iliotibial (IT) band syndrome – also known as Runner’s Knee – is one of the most common injuries among trail runners. The iliotibial band runs from your hip to the outer part of your knee. Overuse and repetitive flexion of your knee during running can cause the IT band to tighten up and become inflamed. This results in knee pain on the outside of your knee. One of the main causes of IT band syndrome is weak glutes and hips. Prevention involves strengthening those muscle groups with bodyweight training. 

Treatment Tips

Anti-inflammatory medication such as ibuprofen and naproxen may help ease pain and inflammation. Stretching the tightened band with these 7 exercises can provide relief when incorporated into your exercise routine, but wait until the acute pain and inflammation has decreased. Have you ever tried foam rolling? This is a great addition to your post-run cool-down.

Man stretching on a trail run

6. Frostbite

Depending on which trails you run and whether you’re a four-season runner, frostbite can be a very real risk. Running at higher elevations exposes you to extreme temperatures. Pay attention to the symptoms of frostbite and be prepared for adverse conditions – especially in lower temperatures. If you get injured or stuck outdoors for longer than expected, you need to have the right gear to keep yourself warm. 

Frostbite starts with a tingling sensation that turns into numbness if you don’t warm up. This is a sign of superficial or first-degree frostbite. Check the area and color of your skin. If it is white, yellowish, or bluish, looks waxy and you notice an unusual clumsiness, you need to quickly protect the skin from further damage. You may have already progressed to second-degree frostbite. Keep an eye out for blisters on the affected area. 

Treatment Tips

Assess the situation. How far out in the wilderness are you and where is the skin damage? If you can get home relatively quickly and the frostbite is on your toes or upper body, the best option is to let the tissue thaw spontaneously as you make your way back. If your entire foot is frostbitten, you should avoid walking on it due to the risk of permanent damage. You need to consider evacuation.

How cold is it outside? If the temperature is such that you risk refreezing the skin, do not try to warm it until you can be sure that it will remain thawed. If your skin freezes, thaws, and refreezes, you will cause greater damage.(4)

When you return from your run, immerse the area in a warm water bath to stimulate blood flow to the area. Avoid other heat sources like an open fire, as the temperature change can lead to burns. Consult a medical professional for necessary treatment. 


Trail running is a great way to add some adventure to your life and enjoy the challenges the wilderness has to offer. Be aware of these common trail running injuries and know how to treat them if they happen to you or your running buddies. Pay attention to the signals your body is sending you while you’re out in the wild to avoid putting yourself or others at risk.

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