Today on the Doc On the Run Podcast, we’re talking about the only 2 reasons you should get an x-ray for a metatarsal stress fracture.
If you are runner and you started having pain your foot and you concerned you have a metatarsal stress fracture, you may think you need to get an x-ray of your foot. But why?
You probably want to know how bad it is!
You want to make sure that you don’t see some glaring crack, that you’re not going to move the bone out of position, you don’t want to make it worse. And more than anything else, you probably want to know whether or not you can run without making it worse.
Now the problem is, and the thing you really have to understand, that X-rays are probably not going to give you the answer you need. If you’re a runner, you really just need to figure out how bad it is, and you have to remember, that stress fractures are a whole range of trouble. Most stress fractures aren’t really a crack that you’re going to see on an X-ray. You’re not really going to see the bone in two pieces in your foot when you get a stress fracture, and you’re a runner.
I see runners all the time, with stress fractures, and that’s not what you normally see. Yesterday, I saw a guy, he has a stress fracture in his foot, I did not order X-rays for him because he doesn’t need X-rays. I was able to look at him, hear his story, push on his foot, figure out that he had what’s really a stress response, not a true stress fracture, and I know that we don’t need to get X-rays of his foot.
But if you see a doctor, many times, in fact, I would wager almost all the time, they will probably X-ray your foot to take a look and see, as they say, whether or not you have a metatarsal stress fracture. But I can tell you right now, in most runners, X-rays are low-yield. They usually don’t show anything.
So why is it then that doctors really do want to do X-rays of your foot, when you’re a runner, and you think you have a metatarsal stress fracture? Well, to explain that, let me tell you a story. When I was in residency, I was working with this guy, we rotated through lots of different doctor’s offices, lots of different clinics, lots of hospital rotations, all that kind of stuff. And one day, I was in a guy’s office, and somebody came in with a suspected metatarsal stress fracture.
And the doctor looked at the intake sheet from the patient. It said he has foot pains where he has a stress fracture. He told assistants in the office to do X-rays of the patient, and then we would go in and see the patient. Now keep in mind, this guy has not even seen the patient. He already ordered X-rays on the patient. He told the staff to get X-rays of the patient before we would even go in and look at the patient, or talk to the patient.
I did the same stuff when I had a regular practice. I don’t do that now, as I said, I saw someone yesterday, and didn’t order X-rays for him because he doesn’t need X-rays. But this doctor explained to me. He said, “Well, from a medical legal perspective, or making sure that you don’t get sued when you’re a doctor, you should just get X-rays so that you have some sort of proof that there isn’t something really horrible going on, like some really rare bone tumor, or something like that.”
And he said, “As a side benefit, you get paid each and every time you do X-rays on the patients, and X-rays are a real money maker in the doctor’s office.” And he said, “If you tell the patient, look, we’re going to see if it’s healing. You’ll see evidence of healing on an X-ray, as the stress fracture starts to heal. So we’ll have you back every couple of weeks, and we’ll X-ray the foot, and make sure everything’s going okay, and then we’ll be able to confirm when it’s okay for you to start ramping up your activity and doing more stuff.”
So it sounds kind of like a convincing sales pitch. It sounds like you need to have X-rays every couple of weeks, and it sounds like X-rays are going to tell you when it’s really safe for you to start ramping up your activity. But like I said, I see runners all the time, who have stress fractures. It’s one of the most common things I see.
In fact, it’s so common, that I actually created the Metatarsal Stress Fracture Recovery Course, so that any runner who has a stress fracture, can figure out exactly what I would do if I were sitting in your living room, looking at your foot, poking on your foot, telling you whether or not you have a stress fracture because it’s not that complicated.
Almost all runners can look at their own foot and figure out what’s really going on with their foot, figure out whether it’s a stress response or a stress reaction, or a stress fracture, and figure out what they need to do to get back to running way sooner than the normal routine.
There’s really only two reasons you need to get an X-ray for a stress fracture, only two reasons. The first reason that you should get an X-ray for a metatarsal stress fracture, is that you think it’s really broken. Your foot’s black and blue, you’re concerned that you cracked the bone in half, and that it’s really damaged, and you’re having unstable fracture that could move out of position, and wind up in surgery. That’s the first reason that a runner should get an X-ray of the foot to check for metatarsal stress fracture.
The second reason is that you want some kind of absolute, rock solid, 100% confirmation that your stress fracture is healed. And that’s what most doctors do, they basically do an X-ray at first to tell you that you don’t have this horrible problem, where it’s really broken in two pieces. And I can tell you that most stress fractures that I see don’t need X-rays at all, they’re not broken in two pieces, and it’s fairly obvious when they are. That’s one of the things I show you in the Metatarsal Stress Fracture Course, how I would tell, looking at your foot whether or not it’s really broken in two pieces.
And then the other end of that spectrum is, doctors will tell you, “Okay, we got an X-ray. We didn’t see a stress fracture, but over time, at some point, you’ll start to see it reveal itself. As it heals, you’ll get this little lump of bone where the fracture is, and when we see that, when we can see that you have all this calcium deposited all over that area in the metatarsal dome where the stress fracture was, that’s when we know that it’s really healed.
Of course, what they tell you to do, is they tell you to wait. From that day you first go into the office to the day you come back at four weeks, six weeks, eight weeks, 10 weeks, whatever it is, when they finally get an X-rays that shows that it really appears to be healed on the X-ray, that’s when they finally release you to do activity. But you don’t have to wait that long because the bone’s getting stronger all the time.
So if you want to get an X-ray to just confirm it’s not in two pieces, you can do that, although that’s a waste of time for most people. And you can also get a confirmation that it is healed on your X-rays much, much later if you want to, but you’re obliterating all of your running fitness if you’re just waiting for it to show up as perfectly healed and done on the X-ray.
So I don’t think that’s the best way to do it. But those are really the only two reasons you should get an X-ray when you have a metatarsal stress fracture. Keep in mind, it’s not rocket science, you can figure out how bad the metatarsal stress fracture is without X-rays, in the overwhelming majority of cases. Now, obviously, if you push on the bone, and it’s excruciatingly painful, and it feels like the bone is moving, well, that’s not a good thing. And yeah, you should probably get an X-ray, in that case, but that is an incredibly rare thing in most runners.
Most runners with metatarsal stress fractures simply do not need to get X-rays, and I think it’s a waste of time, money, and radiation for most runners to get X-rays when they just suspect they have the beginning or first stages of a metatarsal stress fracture.
I have a video here 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 re-injury later. So, make sure you go check out that video. It’s free.
There are several question you need to ask if you think you have a stress fracture and want to get back to running as quickly as possible. I’ll walk you through them.
Get instant access to the video here…