Today on the Doc On The Run podcast we’re talking about questions that make a stress fracture more, or less likely in a runner.
Earlier today I was talking with a runner who felt some pain in her foot during a run yesterday. So she got worried she might have a metatarsal stress fracture in her foot. So she booked a consultation call and we had a discussion on the phone about the possibilities.
Here is what she asked:
“I had an aching pain for a few steps during my run yesterday…is that a stress fracture? The aching pain was on the top of my foot for a few steps today…I want to know if it could be a stress fracture?”
You can get pain in your foot when you’re running for many different reasons. Certainly a metatarsal stress fracture could cause pain and most likely pain on the top of the foot. So the short answered her question was “maybe.” So what I was really thinking was “probably not,” I needed more information before we could figure that out.
So I thought it might be useful to talk about some of the questions I asked her to help figure out whether or not her foot pain might actually be a metatarsal stress fracture, or something else.
Here are some of the questions that can help you figure out whether or not you have a metatarsal stress fracture:
Was yesterday the first time you felt the foot pain when running?
Basically what happened was that this runner had been out on a 13 mile trail run. She was about 10 miles into the run when she started to notice the pain. Specifically, she was running downhill on the trail along declining stretch of the run. She started noticing this aching pain on the top of her left foot. It happened every time her left foot hit the ground. But the pain didn’t even last for the rest of the run. It was just on that downhill section.
So the first thing I wanted to share to use that her case is a little bit unusual people most people do not call me when they first start having pain during a run. Most people do a lot more damage before they seek help. So if you have pain and you want to make sure you’re not heading for trouble you’re definitely going to be a lot better off than the typical runner who ignores the pain, sticks their head in the sand and makes things worse.
But in any event back to our specific runner with her foot pain…
The fact that she was only having pain during one section of the run and it happen to be later in the run when she was running downhill, we can assume that she was tired, worn-out and her running form was likely falling apart. When that happens, we tend to absorb forces less dynamically and more statically. In essence, we start shock loading the skeletal system. And that can certainly increase the chances of getting a stress fracture.
In addition, she was running downhill. And when you’re running downhill you’re falling further, gravity is at work, and you are absorbing more force through the skeletal system which can also increase the risk of developing a stress fracture.
How much did your foot hurt?
On the brighter side, she said that it wasn’t really that painful. She said it was noticeable only in her left foot, but could really put a number on the level of discomfort. So that in itself is a good sign.
Did it hurt when you pressed on the foot in one spot?
Unfortunately, she did not check the foot right after the run, or anytime yesterday. So it would’ve been interesting to know she could reproduce the discomfort by poking around on her foot right after the run.
Where exactly was the pain?
If you’re starting to develop a stress fracture you’re probably going to have tenderness when you push on the bone if you’re having pain when you’re running on the bone. So unfortunately today when she was poking and prodding around on her foot she couldn’t actually find a spot to determine the exact location of trouble. If she had done this yesterday right after her run she probably would’ve been able to find the exact spot where she was having pain. That certainly would’ve been useful information in our quest to determine whether or not she might actually be getting a stress fracture.
Does the foot hurt when you walk on it?
The day after her run, less than 24 hours after first developing pain, she does not have any pain at all when walking on the foot. No pain walking in running shoes. No pain walking barefoot. Those are also both very good signs in terms of the risk for having a stress fracture.
Does the foot hurt when you are sitting and wiggling your toes?
When I asked her this question she actually said, “what does wiggling my toes have to do with a stress fracture in my foot?”
Fair enough question, I suppose. Wiggling your toes doesn’t really have anything to do with the stress fracture unless it’s a truly horrible stress fracture. If you have a really bad stress fracture and you apply pressure, force, torque or you try to bend the metatarsal at all it will elicit a painful response. When you bend the toes up-and-down it actually does slightly torque or bend the metatarsal bone. But that amount of force would only hurt if you had a truly horrible stress fracture.
What I was more interested in was to find out whether or not she a developed any inflammation within the tendon sheath on the top of the foot that runs on top of the metatarsal bones. When you wiggle the toes the extensor tendons move in and out of the extensor tendon sheath. If you have inflammation within the tendon sheath that will cause pain. It is certainly important to determine whether or not you have a problem with the metatarsal bone or a completely different structure like the extensor tendons.
So I had her wiggle her toes and check a couple of other things and in her case, it didn’t seem like she was having any issues with the extensor tendon sheath.
So given what she described, all of the answers to her questions and what she described when I had her move her foot, wiggle her toes, push on different areas of her foot, it seemed like it was most likely that she actually did have a problem with one of the metatarsal bones. But that doesn’t necessarily mean a stress fracture.
In her case it was probably not a stress fracture. Probably not even a stress reaction. In the case of this particulate runner, this was way more likely to be a stress response. But I had to make sure she understood that if she kept on running, in the same way and applying forces in the same areas that aching foot pain on the top of the foot could certainly develop into a true metatarsal stress fracture.
All she really needed to do was go through the Metatarsal Stress Fracture Course for Runners, make sure she was doing something to decrease some of the stress applied to the metatarsal bone so it wouldn’t progress from a stress response to a stress reaction and then finally develop into a full on metatarsal stress fracture. I also thought the Metatarsal Stress Fracture Course for Runners might help her better understand how to look at her own foot (because it does teach self-diagnosis) the next time she started have pain make sure she wasn’t really developing a metatarsal stress fracture.
Just remember, every over training injury is nothing more than just a little bit too much stress applied to one particular piece of tissue like a metatarsal bone. All of your tissues are getting stressed and are sustaining a very mild injury every single time you train.
That’s not a training error, that’s the actual goal of training.
You have to slightly injured the tissues to promote a healing response to get them to heal and become stronger over time. That’s just how training works. You just don’t want to take that stressed too far and develop a stress related injury like a stress fracture.
You can only get a stress related injury when you apply too much stress and then you do not sufficiently recover before you apply stress again during your next workout session. That’s why rest is important and that’s why specific strategies to recover during training are also crucially important.
What has always been so interesting to me is that I notice the runners to develop over training injuries and don’t seem to be healing, who are not recovering, they have basically just stop doing the things that they knew were working for them when they were training.
When I do consultation calls with runners almost every time I can find very specific strategies runners use when they’re in training that they are not using or applying to their recovery from the overtraining injury, right now. That’s a crucial step to take in your recovery if you want to get back to running as quickly as possible.
One easy way to do that is to let take a look at everything you know about training figure out how to apply it to healing and recovering as quickly as possible. I wrote the Runner’s Rapid Recovery Journal to help walk you through some exercises to figure out exactly what you are ready know that you can do that you’re not doing right now to accelerate the recovery process and get back to full training. This is really the same process I use when I work with runners in person through a phone consultation or a WebCam virtual doctor visit.
Any over training injury is really nothing more than an exaggerated version of the same thing you do to your tissues during your normal workouts. You just want little too far. So what you need to do now is really and truly look at all of the things that made you recover faster when you were training and apply them to your recovery and your healing.
That’s really the key!
Right now the Runner’s Rapid Recovery Journal is on sale and you can get it at discount. You can get an instant download version today. You can find a link in the show notes at the bottom of this episode at docontherun.com under the podcast tab.
Go check it out!
After years of lecturing to doctors at medical conferences and helping injured runners start to recover when they stagnate, the one thing I have learned more than anything else is that the runners who get back to running faster are those who take what they have learned in training and apply it to their healing to create an active recovery plan.
If you have a stress fracture
You’re probably really freaked out right now and think you’re going to lose all of your fitness while you heal. But it doesn’t have to be that way. I teach doctors how to help runners heal and maintain running fitness.
If your doc said “Stop Running”
You don’t have to stop running. You just have to reduce the stress to the injured bone so it can heal. You just have to be thoughtful about how you maintain your running fitness so you can keep healing.
Run without making it worse
The worst thing you can do is sit still, stop exercising and lose all of your running fitness. It is possible to maintain your running fitness while you heal your metatarsal stress fracture. This course shows how.
Enroll in the Metatarsal Stress Fracture Course now!
If you have a question that you would like answered as a future edition of the Doc On The Run Podcast, send it to me. And then make sure you join me in the next edition of the Doc On The Run Podcast.