Today on the Doc On The Run podcast, we’re talking about whether or not you have to stop running to rest a metatarsal stress fracture.
I was recently talking to a runner who got a metatarsal stress fracture and then called me for a consultation and it was a great question that she asked…
“Isn’t it true that you have to stop running and fully rest a metatarsal stress fracture to get it to heal?”
Well, sort of.
If you go back to the question, do you really have to rest a metatarsal stress fracture, well, that’s yes and no. And no, you don’t have to do that unless you want it to heal. But all kidding aside, what we’re talking about is strict rest, absolute rest, complete rest. No running, no walking, crutches, a fracture walking boot, that sort of thing. That, I can tell you, is not always necessary. A great way to think about this and a great analogy for metatarsal stress fractures in runners and rest, is to think about a team of rowers in a rowboat, in a competition.
In each foot you have 26 bones. You have five metatarsal bones so you have a total of ten metatarsal bones in your feet.
If you think about having 10 rowers in a boat and one rower gets tired or injured, has a shoulder injury or something like that and really can’t row at the same pace and force as everybody else in the boat, does the boat have to pull over? Does it has to stop? Do the rowers have to just sit on the shore and wait for that one rower to feel better and recover before they can start moving the boat again? Well, of course not. That’s ridiculous. You just rest that one injure rower.
Remember, you have 10 metatarsal bones in your feet and if only one of them is injured, you don’t necessarily have to stop all activity. But you do have to take the stress off that one injured metatarsal bone so you can allow it to rest enough that it will continue to heal while you maintain your fitness.
Stopping all your activity is not a good thing when you have a metatarsal stress fracture. We know if you have zero stress, if you’re non-weight-bearing, if you are in outer space, we know that you will get rapid decrease in bone density. That actually puts you for a higher risk of another stress fracture later…so you don’t really want to do that.
You want to decrease the stress as much as necessary to start the healing process, to continue the healing process and to speed up the healing process, but you don’t want to lose all of your fitness if you’re a runner. That part is crucial. We as doctors, we typically tell you to back off activity and back off running and things like that that we know apply a lot of stress to an injured metatarsal bone, but that is not the problem.
It’s removing the stress and force from that one bone and that’s a big part of what we teach you in a metatarsal stress fracture course for runners, but it’s not really that complicated. You just have to remember, that running, the force applied to your foot when you’re running, that’s not really the problem.
Excessive stress, excessive strain, excessive pressure, excessive force on that injured metatarsal bone that has the stress fracture, well those are the problems. If you have a metatarsal stress fracture and you keep running on it and you just ignore it, well you haven’t done anything to modify the stress to that bone, yes, you could break it and that could slow your recovery and prevent you from getting back to running as quickly as possible.
But if you’re thoughtful about this, if you know some ways that you can reduce some of the stress on that injured bone and you can decrease the amount of stress and strain and pressure and the excessive forces that have been applied to that bone that led to the stress fracture, well then you can increase your activity without expecting that you’re going to make it worse or break it again. You just have to figure out what you can do to decrease the stress and strain and pressure to that injured metatarsal bone so that you can really allow it to rest just like one of the tired injured rowers in that boat.
You just have to let everything else take up the slack and do the additional work. If you do that, then you can really make a lot of progress a lot quicker and get back to running a lot sooner.
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.
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