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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 It can be a great way to add variety and excitement to your daily routine. However, it comes with its own 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. This is due to inflammation of the metatarsals. They are bones located under your feet that connect your toes and form your arch. It can also be caused by repetitive jumping or pounding, trauma to the area or just the nature of your feet. 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. You can accelerate your recovery by stretching your calves, ankles, feet, and toes. 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. Ankles can become fatigued and distracted, which will cause them to lose their focus. Stitched ankles are quite common in trail runners. They occur when the ankle rolls or turns, stretching their stabilizing ligaments beyond normal motion. The injury can cause severe pain, swelling and tenderness. 

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. 

The best prevention strategies include strengthening the joints and wearing footwear that can withstand the challenges of 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. 

Wash your hands after you return home. You should not poke the blister. If it is burst then let it drain out before covering. Do not “deroof” the blister, i.e. Keep the skin's outer layer intact, as this protects the inside of the blister. 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. It should be examined by a doctor.

4. Cramping

A sudden raging pain in your calf almost brings you to your knees. You’re experiencing a muscle cramp or spasm. What is the cause? 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

If you feel a cramp during a run, the first thing to do is stop, then gently stretch the area. It will likely be an instinctive response. Stretching improves blood flow and should alleviate the cramp. Warm compresses can be applied to your cramps when you arrive home.

5. IT Band Syndrome

Iliotibial (IT) band syndrome – also known as Runner’s Knee – is one of the most common injuries among trail runners. Your hip runs along the outside of your knee. The IT band can become inflamed from repetitive, excessive flexion of the knee while running. The result is knee pain at 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? You can add this 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. It is usually a sign that you have first-degree or superficial frostbite. You should examine the skin's color and area. You should immediately protect your skin from any further injury if it appears yellowish or white. It is possible that you have reached second-degree frostbite. You should be aware of blisters around the area. 

Treatment Tips

Assess the situation. What is your distance from the nearest wilderness? How severe are the injuries to the skin? You can return home quickly if the frostbite has not spread to your feet or your upper body. If this is the case, you should let it thaw naturally as you travel back. You should not walk on frostbitten feet. Evacuation is a must.

What is the temperature 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. Do not use open fires or heat as they can result in burns. Talk to a physician if you need treatment. 


Trail running is a great way to add some adventure to your life and enjoy the challenges the wilderness has to offer. These common injuries are easily avoided by trail runners. 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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