From Blisters to Shin Splints: A Podiatrist’s Guide to Post-Marathon Recovery

You’ve crossed the finish line. What comes next?

Completing a marathon is a major achievement. Recovery deserves the same attention as preparation, particularly if your feet or legs are painful afterwards.

This article draws on the experience described by a sports podiatrist from The Podiatry Clinics who volunteered at the London Marathon in April 2023, alongside fellow podiatrists, physiotherapists and paramedics supporting runners.

Some general soreness can follow a long race, but a specific injury should not automatically be dismissed as normal recovery. Give yourself time to recover and seek advice if symptoms are severe, unusual or worsening.

Photos supplied with the clinic’s London Marathon 2023 article.

Managing muscle soreness after running

General muscle aching and stiffness may follow an unusually demanding effort. Reduce training demands and allow recovery rather than immediately returning to hard sessions.

Gentle movement can be more comfortable than remaining still for long periods. Keep it within your tolerance; stretching or foam rolling should not be forced through pain.

Looking after blisters

Friction from footwear and socks can produce painful blisters. Keep the area clean and gently pat it dry, then protect it with a soft plaster or padded dressing. A pharmacist can advise on a suitable dressing.

• Do not deliberately burst a blister.
• If it bursts, wash your hands, allow fluid to drain and cover it.
• Leave the remaining skin in place.
• Avoid the footwear causing friction until it heals.

Get advice for a very painful blister or signs of infection such as heat, spreading redness or pus. If you have diabetes, reduced sensation or poor circulation, seek individual advice promptly about foot wounds.

Knee pain after a marathon

Knee pain can have several causes. Training load, previous injury and the demands of the race may be relevant, but symptoms do not automatically mean you trained incorrectly or have the wrong foot posture.

Pause running and other movements that aggravate the pain. Assessment may consider the knee itself, strength, movement, training history and footwear.

Persistent pain, significant swelling, locking or difficulty bearing weight should be checked. Footwear advice or a foot assessment may be useful when relevant, but is not the answer to every knee problem.

Shin splints and lower-leg pain

Shin splints describes exercise-related shin pain. Continuing the activity that caused it can prolong symptoms, so reduce the aggravating load and build back gradually.

Footwear, running surfaces and changes in training may matter. It is too simplistic to blame every case on pronation or weak shin muscles.

Avoid assuming that all shin pain is shin splints. Severe or localised pain needs assessment to consider other causes, including bone stress injury.

Read more about shin splints assessment and treatment.

Outer knee pain and IT band symptoms

Pain on the outside of the knee during or after running may be associated with iliotibial band syndrome, but other problems can produce pain in the same area.

Reduce activities that reproduce symptoms. A rehabilitation plan may address strength, training load and movement where appropriate, rather than assuming one weakness or a single aspect of running form caused the problem.

If the pain persists or returns whenever you run, seek assessment before increasing mileage again.

Achilles and heel pain after running

Heel pain may arise from the Achilles tendon, plantar fascia or other tissues. The location, onset and behaviour of the pain help guide assessment.

Reduce painful running or jumping and seek individual advice about suitable exercise progression. Calf stretches and strengthening exercises need to match the condition and your stage of recovery.

Explore our heel pain and plantar fasciitis pages for related information.

When should you seek urgent help?

Do not wait for a routine clinic appointment if you cannot bear weight, have severe or worsening pain, substantial swelling or a suspected tendon rupture. NHS 111 can advise on the appropriate urgent service.

Very dark urine with unusually severe muscle pain, swelling or weakness after prolonged exercise needs urgent medical assessment. This can be a sign of significant muscle breakdown, not simply normal soreness.

Call 999 for chest pain, severe breathing difficulty, collapse or confusion after a race.

Returning to running

Recovery varies with your experience, race effort and any injury. There is no single return date that suits every marathon runner.

1. Allow symptoms to settle and prioritise sleep, regular meals and recovery.
2. Begin with comfortable everyday movement.
3. Reintroduce suitable exercise gradually.
4. Build running volume before returning to demanding sessions.
5. Get advice if pain changes your gait, persists or repeatedly returns.

Orthotics, gait assessment or other treatments should be recommended for an identified need, rather than automatically prescribed to every runner.

From the London Marathon

Watch the clinic’s video from the event.

Watch on TikTok