#267 Bulge in metatarsal bone stress fracture on x-ray - DOC

#267 Bulge in metatarsal bone stress fracture on x-ray

Today on the Doc on the Run podcast, we’re talking about what it means when you see a bulge in your metatarsal bone when you’ve had a stress fracture and you get an x-ray.

I recently got an email from a patient who had done a consultation, thought they had a stress fracture, they got x-rays, and then when he looked at the x-ray with the doctor, he actually saw that there was a bulge or a knot in the metatarsal bone when he was looking at the x-ray, and of course this bulge or knot in the bone was right where he had had pain that was actually a metatarsal stress fracture.

As you know metatarsal stress fractures are really common in runners. 

But if you get a stress fracture, you have to figure out when you’re getting an x-ray, when you’re doing evaluation yourself, if you sign up for the stress fracture course for runners and you’re trying to figure out, is it okay for you to run on it? Is it really bad? Is it not really bad? And then you wind up getting an x-ray. You have to take that information and decide, is that a good thing or is it a bad thing? 

And that was really what the question was from this runner who called me for consultation. He just wanted to know whether or not that knot in the bone meant that it was stronger or that it was weaker or if he should do something about it. Is there some way that to make the knot go away? All those kinds of things, and I thought it might be useful for you to understand that.

Well, the first thing is, when you get a stress fracture and you get an actual tiny little crack in the bone, what happens is that you get bleeding in that little crack and that forms a blood clot, that gets collagen growth into it and it forms what we call a soft callus. Then over time, your body starts laying down more and more bone and calcium around the soft callus and it becomes hard callus. And when you get a knot around the stress fracture supporting the stress fracture, it’s basically like your body’s form of spot welding around the stress fracture to stabilize it, make it stiffer and support it.

And so when you look at it on an x-ray, you’ll see that there’s this bulge in the bone and as long as it’s solid and you can see these little wavy lines across there that we call trabeculation, well then we know that it’s stable, it’s strong, it’s actually supporting and reinforcing the bone. And in that moment when you see that, you know that it’s okay to run on it for sure. 

The problem is that’s what most doctors do, when they get an x-ray with a stress fracture, they see you repeatedly, do multiple series of x-rays and they’re waiting to see that hard solidified bone callus that’s reinforcing and stabilizing the stress fracture and that’s when they let you run.

You don’t always have to wait for that. So that’s what we walk you through in the metatarsal stress fracture course, to help you understand how it is that I make those assessments on people. When I see them in person and push on the bone, test the bone, remove stress from the bone, see how you respond, all that kind of stuff.

So you don’t just have to wait for x-rays, that’s sort of the longest possible way to get back to running is to just wait for you to see what doctors call radiographic signs of healing or this stable bone on an x-ray. But once you see it, to answer this guy’s question, if you see it and it’s solid and it’s stable, then that’s a good sign and you can certainly run on it at that point.

Now there is a situation where you have this big lump of bone where it’s actually a bad sign. And that is where you have somebody who had a stress fracture, they just continue to ignore the pain. You continue to run on it any way, you notice that it’s swelling, you notice that it hurts, you ice it and the pain goes down a little bit. If you just keep doing this routine of ignore it, run, ice it, ignore it, run, ice it, and that creates a lot of motion in an area where you already have an injury to the bone, you continue to irritate the bone, you’re continuing to apply the same damaging stress to the bone without any modification and it predictably gets worse. And then as it gets worse, you can actually get a little crack in the bone that is a true stress fracture.

Well then if you keep running on it and it develops into a big visible crack on the x-ray, then it’s actually what we call a pathologic fracture, where it’s actually broken in two pieces. And at that point when you have that there, that’s a real problem because it can move and if you keep moving it, your body will try to form that lump of bone around it. And if you get a huge lump of bone, that’s what we call a large bone callus. And a large bone callus is often indicative of excess motion at the fracture, and it’s actually a sign that the bone is actually not healing.

So you know, on your x-ray alone, just saying if you have a lump or you don’t have a lump, doesn’t tell you whether or not you can or cannot run. It depends upon whether or not it looks like stable callus and a stable lump of bone, and it’s usually not huge when you had that. But if you have a huge callus that’s forming around the stress fracture, that’s often a sign of too much motion and a sign that somebody should back off the activity and let the thing heal.

Check out the show notes for this episode and you can check out the stress fracture course for runners. If you think you have a stress fracture and you want to get back to running, you just have to understand the ways to decrease the motion, stress and irritation to that bone, if you really wanted to get back to running as quickly as possible.

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!

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!

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…

Top 10 questions to help decide when you can run if you have a stress fracture.

Watch the video now!


Top 10 questions to help decide when you can run if you have a stress fracture. Watch this video now!