Today on the Doc On the Run Podcast, we’re talking about the top 3 conditions misdiagnosed as a stress fracture in a runner.
If you get pain on the top of the foot, or on the bottom of the foot, or the ball of the foot, and it hurts when you’re running, it hurts when you’re pushing off, it hurts when you’re walking around barefoot, you may think you have a stress fracture. In fact, you might have been diagnosed with a stress fracture when you saw a doctor.
Now, a stress fracture, more specifically a metatarsal stress fracture, is probably one of the most common running injuries that you could get when you’re training for a long distance event like a marathon, or an ultra marathon, or even a half marathon or a 10K, if you’re relatively new to running. But the problem, of course, is that not all running injuries that seem like stress fractures are actually stress fractures.
If you just talk to one of your buddies or you went to see a doctor and you had a very short visit and you’re diagnosed or you think that you have a metatarsal stress fracture, you could have a different condition. And unfortunately for you, if you have one of those other conditions and you treat it like a stress fracture, it’s probably not going to get better. So, I thought we’d just talk quickly about the top three conditions that are often misdiagnosed as a stress fracture.
Now, the first condition is something called extensor tenosynovitis. And that’s a complicated name, but all it really means is that you get inflammation of the tendons on the top of the foot that overly the metatarsal bones and cover the metatarsal bones. They’re very easy to see. If you put your feet flat on the floor, and you pull your toes up off of the floor, then you’ll see these bands of tissue that sort of radiate and fan out towards the toes on the top of the foot.
If you run with shoe laces that you’ve tied too tight, or the running shoe is essentially just too small for you and the tongue is pushing down on top of the extensor tendons, you can aggravate those tendons. The tendon sheath or the tube around the tendons starts to swell, it causes pain, and it causes a lot of pain on the top of the foot.
The reason that it can be misdiagnosed as a metatarsal stress fracture is that you push on the tendons and you think you’re pushing on the metatarsal bones, but you’re really just compressing those inflamed tendons and it hurts. So, then you think you have a metatarsal stress fracture.
Most treatments that are designed to heal metatarsal stress fractures don’t necessarily relieve the pain and swelling and inflammation in the tendon sheath, that is on the top of those metatarsal bones. If you have extensor tenosynovitis and you treat it like a stress fracture, it’s probably not going to get better.
Plantar Plate Sprain
The second condition that gets misdiagnosed as a metatarsal stress fracture is something called a plantar plate sprain. And the plantar plate is a little ligament on the bottom of the joints where the toes connect to the foot, at the ball of the foot. If you get a plantar plate sprain, and you treat it like a stress fracture, unfortunately, it’s really not going to calm down. Believe it or not, plantar plate sprain is, even though it sounds like a minor thing because it has the word sprain instead of fracture in it’s name, is actually significantly more difficult to heal quickly than a metatarsal stress fracture.
The difference between the previous condition we were talking about and a plantar plate sprain is, that when you get a plantar plate sprain, you have more pain on the bottom of the foot at the ball of the foot, right at the base of the toe, where the ligament is located and where it’s been injured and sprained. But you have to do some stuff to decrease the inflammation in that joint and you have to decrease all the tension that’s being applied to the plantar plate ligament, if you really want it to get better.
Treating that like a stress fracture, will not do those things, and it will not get better, predictably if you’re treating a plantar plate sprain the same way you would treat a metatarsal stress fracture.
The third condition that’s often misdiagnosed as a stress fracture is a neuroma. And a neuroma is basically just inflammation and swelling within a nerve in the foot that runs between the metatarsal bones. That’s part of the reason it gets misdiagnosed a lot as a stress fracture, is that it’s in a similar location. It does feel different. It has a different kind of pain and certain things set it off that don’t necessarily aggravate metatarsal stress fractures.
But of course, this is an injured nerve. It is swelling around the nerve. It is not an injury to the metatarsal bones. So, if you treat it like a metatarsal stress fracture, you do a bunch of stuff to just decrease the pressure and irritation of the metatarsal bones, it’s not going to do anything to address the nerve, and you’re not likely to get the problem to resolve and go away.
So, one of the most important things you can do when you have a metatarsal stress fracture, is first of all make sure that you have a stress fracture and not one of these other conditions. Then if you’re pretty sure that you don’t have a neuroma, you’re pretty sure you don’t have a plantar plate sprain, and you’re pretty sure you don’t have extensor tenosynovitis, then you really just need to be thoughtful about treating the stress fracture in a way that’s going to make it heal and yet allow you to maintain your running fitness, and then get back to running.
If you go to the show notes episode for this particular podcast, I have a video there that I think you’ll find helpful. It’s called the Top 10 Questions to Help Decide When You Can Run if You Have a Stress Fracture. It’s really not complicated, but you need to just ask yourself 10 specific questions to decide when it’s okay for you to get back to running when you have metatarsal stress fracture.
And of course, the sooner you get back to running, the better off you’re going to be. The longer you take off from running, the weaker, the stiffer, the less coordinated and all of those things that put you at a risk of reinjury later. So, make sure you go check out that video. It’s free. Go get it. It’s on the show notes page.…get it here….…
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!