#151 12 Steps to healing and running with a metatarsal stress fracture - DOC

#151 12 Steps to healing and running with a metatarsal stress fracture

Today on the Doc On The Run Podcast, we’re talking about  the 12 Steps to healing and running with a metatarsal stress fracture.

If you are a runner with a metatarsal stress fracture, you can simply stop running and wait for the bone to heal. The other option is to figure out how to heal it faster and keep running while the stress fracture is still healing.

The process for healing and getting back to running is not that complicated. There really are 12 steps to healing and running on a metatarsal stress fracture. 

Step 1: Confirm you have a metatarsal stress fracture

The very first step, when you have a metatarsal stress fracture, is you have to confirm you actually have a metatarsal stress fracture. 

You need an appropriate diagnosis, you need to make sure that that is what is causing the trouble. Now, that may seem elementary, but the fact is, a lot of runners think they have a metatarsal stress fracture, and they have something else. So you have to make sure that it really is a metatarsal stress fracture, that it’s not something like a neuroma, or a plantar plate sprain, or tenosynovitis, or some other condition that might be causing trouble on the top of your foot, just sort of masquerading as a metatarsal stress fracture.

So that is step number one. There are basically three different ways you can confirm you have a metatarsal stress fracture. 

One way you can do that is to do a self-diagnosis, to figure it out yourself, to go through, figure out what you have to do, how you push on it, what it sounds like, what it looks like, all of that, and that is really easy to do. In the Metatarsal Stress Fracture Course, that is what we’re walking you through. In the course, we show you exactly how I do that with patients, and how you can do that yourself. That is one way is to do it yourself, to figure out whether or not you really have a metatarsal stress fracture. 

The second way is to go see a doctor. If you see a foot and ankle specialist, you see a podiatrist, you see an orthopedic surgeon, you see somebody that specializes in feet and runners, then they can make the diagnosis for you. They can look at your foot, push on it, and tell you whether or not you actually have a metatarsal stress fracture. 

The third way, the kind of longest, most expensive, most drawn-out way, is to try to rely on imaging, to get X-rays or an MRI, or a study that shows you have a metatarsal stress fracture. The first thing is that X-rays don’t show you right away, an MRI can show you sooner, but it doesn’t tell you exactly how bad it is. So, there are three different ways that you can really do it, but that is the first thing. 

Step one, figure out and confirm that you have a metatarsal stress fracture before you start trying to figure out how to run on it, make sure you have the right condition, so that you can know what to do and treat it appropriately so you can get back to running right away.

Step 2: Determine severity

The second step is to figure out how bad the stress fracture really is. Once you confirm you have a stress fracture, step two is to figure out how bad it really is. There’s a whole range of trouble, all the way from just a little irritation and swelling within the bone, a stress reaction or a stress response, all the way up to a real stress fracture where you are getting a crack in the bone, or you actually can see a crack on an X-ray, or the bone’s completely broken in two pieces and it’s even shifted out of position. 

There’s a whole range of trouble with stress fractures. And, not surprisingly, if you are at the beginning of that range of trouble … you have a minor stress fracture, not a major stress fracture … it takes a lot less reduction of stress and consequently, a lot less time to actually get it to heal. 

So that is step two, you have to figure out how bad the stress fracture is. 

Step 3: Timeline for healing

Step three is that you need to determine your timeline for healing the metatarsal stress fracture. What I mean by that is, you have to figure out what your goal is, you have to think about what your timeline is, because if you have a race on the calendar that you need to be ready for, then you need to figure out how quickly you have to heal to resume your training. Understanding your timeline will also help you figure out what you have to do to maintain your fitness in the time you are waiting to heal. But you have got to figure out that timeline. 

Step 4: Your most important goal

And that brings us to step four. You must know what your most important goal is. 

If your goal is to do the Boston Marathon and that is only two months away, well, obviously that affects your timeline, right? But then you have got to be really aggressive about getting the stress off of that metatarsal bone and maintaining your running fitness while you heal it. 

So you need to think about really carefully what is your goal, what is your timeline? You have to figure those things out before you can really proceed. 

So step three is figure out your timeline for healing, and closely associated with that is step four, is figure out your most important running goal. Is it doing some race that is a month away? Is it skipping that race? If that is not important to you, could you skip that race and then you have another race that is even more important that is six months away? You must figure out what your goal is. 

So before you do anything else, figure out what your goal is, your really most important goal, the thing that is critical to you, the thing that you just really do not want to give up. You have to figure that out before you can proceed.

Step 5: How dedicated are you to healing quickly

After that, step five is you must decide how much effort you are really willing to put into healing quickly. Healing a stress fracture is a lot like training, the more stuff you do, the faster you are going to get better when you are running. It’s true of healing, too. The more things you are willing to do to make it heal faster, the faster you will heal. Do not think healing is a passive process! There is a lot of stuff you can do, but you have to figure out how much effort you are willing to put into the recovery. You have got to figure that out if you really want to get better as quickly as possible.

Now, the next few steps  are really keys to healing a metatarsal stress fracture.

Step 6: Stop the inflammation

Step number six is to stop the inflammation in and around the bone. 

A lot of the discomfort you feel is actually from this extra fluid that is in the bone, so if the bone is in its early stages, like a stress reaction or a stress response, Much of the discomfort you feel is actually from extra fluid accumulated in that bone. 

To feel better and heal quickly you must get that extra fluid out. 

If you actually have a real crack in the bone, when you get collagen stabilizing the bone, chronic inflammatory fluid is not your friend. There are degradative enzymes in that inflammatory fluid that actually break up collagen bonds. So as you have collagen forming trying to repair the fracture, yet you have these degradative enzymes degenerating that new collagen as it forms, that slows the healing process. 

So you must get the inflammation out if you really want to heal as quickly as possible.

Step 7: Decrease stress applied to the bone

Now, step seven, this one’s kind of obvious, but you need to decrease the stress applied to the bone. 

There are lots of ways to do reduce street applied to a metatarsal bone. 

We go through those all in great detail in the metatarsal stress fracture course, but basically you must change something. 

There is a whole range of stuff you can do. Yeah, you can stop running, that is one way to reduce stress, but that is not the only way. 

You could use crutches, that is one way. That is not what I usually recommend for runners. 

You could use a fracture walking boot, that will reduce the stress, but it will also cause other problems. 

So, you can reduce stress in lots of different ways. For example, you can decrease the pressure to the one injured metatarsal bone by adding pads to the inserts in your shoes. You could also reduce the stress by removing some of the material under the bone. You could reduce the stress applied to the metatarsal bone by wearing different types of shoes. There are lots of methods to decrease the stress applied to the injured metatarsal bone. 

But remember, it’s a stress fracture! If you want it to heal, you need to reduce the stress to that bone. The more you do to reduce the stress on that healing bone, the more activity you can do while it continues to heal. So, this step is crucial!

Step 8: Feed the healing process

Step eight is you have to foster healing all day long. This really needs to be top of mind. You need to think about how frequently you are eating, what you are eating, and how much you are hydrating. You need to do everything you can all day long to promote healing and make sure that you are not doing something that could disrupt or slow that healing process.

Step 9: Watch for healing

And then step nine is to watch for signs of healing. You do have things that give you indications of healing, like your swelling going down, like bruising going away, and the pain going away. There are lots of different things that show you that it’s healing. You have to watch for those signs so that you know you are on the right track. That is really, really important.

Step 10: Increase activity to match healing

And then at step ten, with each stage of healing, as you notice that you are improving, as you notice it is healing, with each of these different stages, you need to increase your activity. 

Remember, your goal isn’t just to heal…your goal is to run!

Remember, back in the earlier steps, in step four when you wrote down, “What is your running goal?” That is your goal. If you are want to achieve that goal and you are gonna stick to your timeline, you are will need to increase your activity at every single stage of healing. 

Remember, it’s a continuum of healing! It’s not broken on day one and miraculously healed on week six. Stuff is happening all along the way. It’s getting more and more stability, more strength, more inherent stability that can withstand stress as you heal. 

So at each phase, every few days, every few weeks, there’s exponentially more strength in the bone, and your goal is to match your level of activity with that level of healing in the bone. That is what you really have to do. So, you need to make sure that with each stage of healing, you are increasing your activity to match that stage of healing appropriately. 

Step 11: Monitor closely

Step eleven is to monitor the bone closely for signs of trouble. 

Most patients when they call me for a consultation, they really want to find some way to monitor this with some kind of technology. They want a bone scan or an MRI or an X-ray that is gonna show them that the bone is totally healed. Well, an X-ray can show you that the bone has totally healed, but I promise, if you wait until you see signs of healing on an X-ray before you get out of a fracture walking boot, stop using crutches, start exercising or start running again, you will completely lose all of your running fitness. You may have permanent damage from that healing process that is going to really interfere with your running and make you more prone to overtraining injuries later.

You have to look for another way to do this, and the truth is, the old fashioned way, just clinically looking at your foot, looking at it, pushing on it, observing it, is really the way to monitor it. 

The good thing about runners is that you (as a runner) can feel more and tell more about how your body feels than average people. You know what it feels like to run as a forefoot striker or a heel striker. And that same sort of sense of where your feet are landing and the way that things feel will give you a way to manage this, and watch for trouble. 

Basically…pain, bruising and swelling, those are the three things you are watching out for. But you have to understand the specifics of how you manage signs of trouble, how you watch for it, and how you can tell what that really means while you are starting to get back to running.

Step 12: Adjust accordingly

The twelfth step is that you have to adjust the plan and decrease the stress accordingly. So if you note any new pain, any increase in pain, you have any swelling that comes back, you notice any bruising, then you know that you’ve applied too much stress and you have to do something to adjust the plan. 

You must be prepared to change direction when something goes wrong. Look, everybody makes mistakes. 

If you didn’t make a mistake that led to a stress fracture, you wouldn’t be reading to this right now. 

We all make mistakes in training, right? 

Sometimes you get sick and then you try to jam a couple of workouts too close together to fit them in so that you can keep your weekly mileage total to whatever it was supposed to be on your training plan, and maybe you get an overtraining injury. Maybe you run in the wrong kind of shoes just because that is what you happen to have with you when you were on vacation. 

All of these little mistakes can lead to trouble, and so, if you make some small mistake it’s not the end of the world. 

Unless you do something really foolish, it’s unlikely that you can undo all of the healing that has been happening in your foot. But you have to be prepared to adjust and change course when necessary. You must pay really close attention to what is going on in your foot as you are returning to running, increasing your fitness, and getting back to your full state of running fitness that you had before you got the metatarsal stress fracture. 

Those are really the 12 steps that you have to follow if you want to heal and keep running on a metatarsal stress fracture.

If you have a question that you would like answered as a future edition the Doc On The Run Podcast, send it to me, and then make sure you join me in the next edition of the Doc On The Run Podcast. Thanks again for listening.