Today on the Doc On The Run podcast, we’re talking about how the risk free way to heal a metatarsal stress fracture and other unicorns.
When I lecture at medical conferences on stress fractures, I always start the talk with an image of a bad metatarsal fracture that is actually a lot worse than just a metatarsal stress fracture. The x-ray image I show on the big screens over the stage isn’t just cracked. It is shattered. And it looks terrible.
So I ask the doctors in the audience, “What is the treatment?”
“Cast and crutches” is almost always the first answer.
Strict non-weightbearing. Strict immobilization. Strict rest.
Well, I will concede that it is risky to step on a fractured metatarsal bone. Most doctors will say it is risky to let the patient even move a fractured metatarsal.
But it is only risky to move it in the early stages. At 10 days it is stronger and more stable than it was the day you broke it. At 4 weeks it is a whole lot stronger that it was at 10 days. You don’t have to wait six weeks to move your ankle. You don’t even have to wait for an x-ray, if you now how to tell when its getting stronger.
The whole lecture from that point on is about how it is also risky for runners and athletes to sit still.
A runner with a metatarsal stress fracture recently asked, “Isn’t it true that a fracture walking boot and crutches is the risk-free way to heal a metatarsal stress fracture?”
Although I hope you won’t tell my daughter, there are no unicorns!
And there is no risk-free way to heal a metatarsal stress fracture.
If you wear a fracture walking boot and use crutches to keep your foot off the floor, you will heal a metatarsal fracture faster than if you just walk on it.
But when you follow a plan of strict immobilization in a walking boot or cast and strict non-weight-bearing on crutches, you will get weaker and stiffer. You will lose your running form. You will become uncoordinated and less efficient.
Weakness, stiffness, poor form and uncoordinated running will load the tendons, bones and ligaments in your feet asymmetrically and with higher peak forces, and therefore will put you at higher risk of another running injury.
There is risk in crutches. There is risk in wearing a boot. There is risk in using a cast. And yes there is risk in early weight bearing and early range of motion.
But my primary contention and steadfast belief is that runners, as individuals, have to consider what goal is most important.
Is the goal to heal the metatarsal bone paramount?
Or is getting back to running as quickly as possible, more important?
Is competing in the Ironman World Championships most important because you finally qualified, and then got a stress fracture?
Is it more important to make sure you can keep running when you are 70?
These are decisions only you can make.
I get introduced at medical conferences all over the world as an “expert” on running injuries. But that doesn’t make me qualified to decide what is most important for you.
Your doctor is not qualified to make those decisions for you. Yet, any standardized treatment protocol actually attempts to take away your decision making capacity.
It is just crazy to think that the same stress fracture treatment protocol is right for everyone.
If you are in a doctor’s office waiting room right now, look around. Is it possible that the ideal stress fracture treatment for you would the same as that little kid over there, or that old lady with a walker over there. Or that guy in the double-wide wheel-chair over there.
If you are in traffic now, look around. Look how different everyone seems. It just seems illogical that everyone you see, if they had the same kind of stress fracture as you, would heal at the same rate as you. It seems improbable that whoever is in the car next to you would have the same goals as you.
The treatment plan you choose should be built around your running goal.
So before you start choosing the treatment for your metatarsal stress fracture, write down you goal first. In fact, One of the first lessons in the Metatarsal Stress Fracture Course for Runners walks you through a goal worksheet.
You can get that worksheet, download it and follow the instructions in the lesson to decide what goal is really most important to you. Having a clear picture of your goal, your return to running, will help you map out a course so you can get there. Just go to the bottom of the show notes page under the podcast section at DocOnTheRun.com to get it. It’s free.
Print it out, fill it out and it will help you figure out the best way to treat your metatarsal stress fracture, so you can get back to running.
Download the Healing Runner’s Goal Worksheet. It will help you take what you know about goal setting in running and use what you already know to focus your healing. It’s free. Go get it now!
If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!