#247 Which stress fractures are low risk in runners? - DOC

#247 Which stress fractures are low risk in runners?

Today on the Doc On The Run Podcast, we’re talking about what makes a stress fracture low risk for a runner. 

If your runner and you’ve been diagnosed with a stress fracture, it matters a lot whether or not that stress fracture is high risk or low risk. 

Because let’s face it, if you’re a runner you probably want to keep running and if you want to keep running and training even while you have a stress fracture, you would only want to do that if there’s a low risk of making your situation worse. 

All stress fractures are not created equal so the ones that are able to heal easily because they have really good blood flow, well those are generally considered to be low risk, and one interesting caveat with that is the heel bone. The heel bone is a thing that really doesn’t develop stress fractures that often, but it does happen and the heel bone has great blood flow. So many classification schemes and many published papers in medical journals say those are low risk. 

But even though I certainly help a lot of runners run with stress fractures, I say that calcaneal stress fractures are high risk because if you actually take what is a stress fracture and turned it into a real fracture where it breaks, it’s probably going to break apart into a bunch of pieces and that could make it very difficult for you to run down the road. So I think calcaneal stress fractures are actually high risk, not low risk.

But having said of that, let’s talk about the ones that are actually low risk.

Now the most common kind of stress fracture in runners, the metatarsal stress fractures, particularly when it happens to the ones in the middle of your foot, like two, three and four, well those are very low risk. So metatarsal stress fractures in the middle of your foot are low risk. They’re not likely to break, move out of position and completely disrupt your ability to run forever, and they have generally good blood flow so they can heal pretty easily. 

The same is true of the shaft of the fifth metatarsal bone or the bone on the outside of your foot, the one that goes between your midfoot and your little toe. Now that one is actually okay to heal as long as it’s out in the end of the bone, but if it’s at the base of the bone, that’s different. The blood flow is very different in the base of the fifth metatarsal bone and in that particular area, it’s higher risk than if you have a stress fracture in the neck or shaft of the fifth metatarsal bone out closer toward your toes.

Now the fibula is also a bone that is one of your ankle bones, so if you feel your foot on the inside of your ankle, so if you’re looking at your right ankle, for example, if you feel the inside of your right ankle or the left side of your right ankle, that is your medial ankle bone and that’s the tibia.

But on the outside of your foot on the right side of your right foot where you feel that knot of bone sticking out at your ankle, that is the end of the fibula and the fibula is a non-weight bearing bone. It doesn’t actually support your weight when you stand up. The tibia supports your weight, so you’re basically standing with all of your weight on top of your tibias. But this is not true of the fibula. The blood flow in the fibula is pretty good and it doesn’t really support your weight. So when you get a fracture in the fibula, it’s fairly low risk. 

You can also get stress fractures in the tibia or the shinbone, and there are really three kinds of different stress fractures that happen in the tibia or the shinbone and whether or not it’s high risk or low risk has a lot to do with the location. 

The one area of the shin that can get a stress fracture that’s low risk is what we actually call the posteromedial tibia, and your tibia again is a shinbone and post a row means behind or back, antero means front. So when we say posteromedial, medial is inside, so if you’re thinking about your right shin, that would be the left side of your right shin, so it’s on the inside of your shin toward the back. So if you feel your tibia, you’ll feel the anterior tibial crest, and that’s this sharp ridge of bone that you feel right down the front of your leg on your shin. That’s the anterior tibia. 

Now a stress fracture there is high risk, but if you work your hand across the flat part of the tibia and then you feel where it drops off and you can then feel a sort of squishy muscle belly right there where the edge of it drops off in the middle of your tibia that is the posteromedial tibia. 

That’s an area where you also get medial tibial stress syndrome or shins splints. If you have a stress fracture in that area, it’s a lot lower risk than when you have a stress fracture in your tibia at the ankle bone or the front of your tibia. So the main thing is if it’s low risk, you can probably keep running on it, but you have to figure out your goals. 

That is one of the most important things you can do when you have a stress fracture, because obviously you do not want to keep running on a stress fracture if you’re going to make it worse and the most helpful tool to do that as the injured runners goal worksheet. It’s on the website under this episode. Just go get it. Print it out, fill it out, and it’ll really help you figure out what you need to do to get back to running as quickly as possible.

One simple step you can take is start with 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!

Healing Runner’s Goal Worksheet










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!