people running on treadmillsAs a Seattleite you love to run outside. But when the rains come and the cool weather hits you head to the gym and the treadmill. While you can avoid potholes and uneven surfaces, running on treadmills comes with its own foot and ankle problems.  

Treadmills can dramatically increase the amount of repetitive movement and alter the way you run. This is particularly true when using the incline or interval training. Treadmills can increase your risk for and worsen several common foot conditions.

Foot Conditions Caused By Treadmill Use

Plantar Fasciitis

If you have a particular foot type and other biomechanical issues, using a treadmill can tip the scales toward developing plantar fasciitis. Increased pressure on your feet can create small tears where your plantar fascia (connective tissue) inserts into your heel bone.  Use of the incline or interval training can make the problem worse.

foot conditions caused by running on a treadmillMorton's Neuroma

Morton's neuroma is another common foot condition that can flare up with use of treadmills. A neuroma is a benign growth of nerves found between the 3rd and 4th toe. It's a painful condition and can feel like a burning sensation or a pebble in your shoe.

Achilles Tendonitis

The Achilles tendon is the largest tendon in the body and it can withstand a great amount of force. However, many people suffer overuse injuries of the Achilles when running. Use the incline on a treadmill and your risk of  Achilles tendonitis increases dramatically.

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How to Prevent Foot Injuries On A Treadmill


Improve Your Balance

Before you get on a treadmill, it's important to ensure you have good balance. While this may not be a big issue for many young people, if you're 60 or older or simply out of shape, start out by doing balance exercises. 

Walk Before You Run

Before you start to run, you should learn to walk on a treadmill. Some of the guidelines in the video above include:

  • Start Slowly and Use the Handrails - start out by walking more slowly then you would outside and use the handrails to stabilize yourself.
  • How to Use the Incline - start out with an incline of 1-2%. This is better than flat because it's more typical of what you'd find when walking outside.
  • Speed - Start out by walking no more than 1.5-2.0 miles/hour for three to four minutes. Gradually increase your speed for up to 3.0-3.5 miles/hour. Any faster than that and you'll start to run.
  • Stride - strive for a normal stride length and walk from heel to toe.
  • Vary your workout intensity- work out for about 15 minutes to start. For example, try starting out for 3-4 minutes, walking 1.5 miles/hour at a 1-2% incline. Then move up to 2.5 miles/hour with no more than an incline of 4-5%. 

warm up before running on a treadmillWarm-Up and Cool Down Your Muscles

Running without a warm-up is never a good idea. I suggest Dynamic Warm-Ups as a great way to get you blood flowing and your muscles ready for action. To cool down, run and then walk at a slower pace for at least 10% of the time spent on the treadmill.

good posture for running on a treadmillPosture

Certain positions can throw off your run by putting too much strain on specific body parts and making it more likely you'll be off balance. Instead be sure to do the following:

  • Look straight ahead.
  • Avoid craning your neck to the left, right, or down.
  • To check your posture, pull up slightly from your mid-chest and imagine a string pulling you up from the top of your head.
  • Some experts suggest a 2% incline to keep your posture aligned.


Have you had injuries before or are you healing from one? To help yourself heal or prevent a reoccurence, interval training is probably your best bet. Run for five minutes and then walk for five minutes. When you run, do it at a slower speed than you normally would.

keep down resistance and incline on treadmillsIncline and Resistance

Many runners want to really boost up the incline (on treadmills) and crank up the resistance (on ellipticals) to get a more intense workout. That may be fine for some people who have worked up to it, but making your workout too extreme too soon can put you at greater risk for Achilles tendonitis. If you've suffered from foot problems before, keep your incline at 2% and resistance low if you use an elliptical.

Duration and Frequency

It's important to give yourself a break no matter what the state of your physical activity or feet. Don't work out too frequently or too long to prevent foot problems from occurring. If recovering from an injury, work out no longer than 30 minutes, using the suggestions above for incline and resistance.

get your feet measured and buy proper shoesPurchase Proper Shoes

Shoes wear out after 500 miles of use. Replace your shoes annually or more often if you run  more frequently. Here are guidelines for purchasing proper running shoes:

  • Go to a reputable running store
  • Replace the insert that comes with your shoes with Superfeet for more support
  • Get your feet measured; many adults feet get larger as they age
  • Test your shoes for stability (Watch video: How to Test Any Shoe for Stability)

Wear Inserts or Orthotics 

Certain foot types can increase foot problems with treadmill running. If you have flat feet, high arches, or other mechanic foot issues talk to your podiatrist about orthotics. Sometimes an over-the-counter insert can help with mild pronation. But if you've experienced heel pain or other foot conditions before, you'll likely need custom orthotics to prevent foot pain flares.

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Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.
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CAREN W 11/25/2022 01:14 PM
It's not clear to me whether using 1-2% incline on treadmill is OK if you have plantar fascitis. You say "This is particularly true when using the incline or interval training." But then later say 1-2% incline is OK. Should someone with plantar fascitis totally avoid the treadmill?
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Dr. Rion Berg 12/14/2022 02:33 PM
This is in response to the question regarding whether someone with plantar fasciitis should avoid the treadmill. The key here is that plantar fasciitis is an inflammation of the fascia where it attaches at its origin--the heel bone. My general rule is that this inflammation must be calmed down before returning to running. For that to happen, it’s important to identify what is contributing to the overuse. First, is your foot type. Do you have high arches or flat feet? Do you have tight calf muscles? Are your shoes stable? Problems in any of these areas can lead to plantar fasciitis and must be addressed first.
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