Today on the Doc On The Run podcast we’re talking about what a runner should do when you have a rupture of the plantar fascia and metatarsal stress fractures.
This episode is based on a question sent in by a runner who was listening to the Doc On The Run podcast. This comes from Victoria. She sent in a question and she wanted to know what to do about a rupture of the plantar fascia and some metatarsal stress fractures.
What she explained was that she wasn’t really training for a specific race. She just runs every day, a little over 200 miles a month.
Her question was, “I’m 30. I’ve got medium arches. I have no prior injuries. But seven months ago I started having some left medial ankle pain at the calcaneal insertion.”
So the first thing is, I’m not sure exactly where that was, because if it’s ankle pain, that’s one thing. But if it’s at the insertion of the plantar fascia, that’s on the bottom of the foot and not in the ankle. So not really sure exactly what the trouble is, but she does say that she got an MRI. The MRI confirmed a plantar fascia rupture of the medial cord. She said that she was told to just ice and stretch, but then she also mentioned that she has a distal fourth fracture on the right, which I assume is fourth metatarsal, on both feet at once. What should I do? It hurts.
Well, this is a good question.
Obviously, this sounds like a pretty serious injury, because if you’re a runner and you have not only a partial rupture of the plantar fascia, you also have metatarsal stress fractures, that implies you have a whole lot of trouble. But there are a couple of things that are a little bit puzzling to me.
It sounds like Victoria didn’t really get the full explanation from her doctor, or she was left with some questions that were clearly unanswered. So she said that she was having this ankle pain. If you got an MRI for the ankle pain and then you discover that you have a partial rupture of the plantar fascia, the first question is whether that’s old or whether it’s new, or if it’s a chronic thing that was there before and it just became irritated and inflamed.
Based on the recommendation that she got of just ice and stretch, well, that implies one of a couple of things. It implies, first of all, in regard to the plantar fascia, that if the approach the doctor gives you is to just ice and stretch, that implies all you really need to do is loosen things up and reduce the inflammation, because we know that icing will reduce the inflammation. And, obviously, stretching will add some pliability to that tissue.
Now, if you think about this for a second, if you have a cut on your arm, if it’s a fresh injury, like a cut or an incision, and you stretch it, it is not going to get back together and it’s not going to heal.
When I hear that somebody’s told that they need to stretch, that implies that either it’s not really a true rupture or it’s a really old rupture that really is never going to heal. So then the approach is to treat it more like somebody that had surgery to release the plantar fascia and actually where the surgeon actually cuts the plantar fascia. Or, it’s a thing where we assume it’s never going to get better and so you’re going to treat it like plantar fasciitis and ice and stretch.
Now, obviously those are the mainstays of treatment for somebody that has plantar fasciitis. That’s what I talk about in the Runner’s Heel Pain Course, about how to tell the difference, first of all, between a partial rupture of the plantar fascia, or just plantar fasciitis, or neuritis, or bursitis, or a calcaneal stress fracture, or other things that can mimic plantar fasciitis. You have to figure out, first of all, is your doctor really considering this to be a fresh partial rupture of the medial cord or the medial band of the plantar fascia or not?
But the treatment that was recommended implies that’s not really what the doctor’s thinking at all. So not really sure where to go from there, but certainly going back to the doctor and getting a clear understanding of whether or not this is an old thing, that it’s not expected to actually heal in the classical sense of the tissue joining back together and looking like a complete plantar fascia in the future, but it’s a minor injury and perhaps an old injury that we think you just need to calm down by icing and stretching. So that’s the first thing to figure out.
Now, the second thing is in regard to the metatarsal stress fracture. Her question implies that she has fourth metatarsal stress fractures on both feet. The first thing that confuses me about this is that we know if you have medial ankle pain and you get an ankle MRI, the MRI usually stops at about the bases of the metatarsal bones. It doesn’t go out to the toes. It doesn’t even go to the distal part of the metatarsals. It sounds like she had a different MRI than the standard ankle MRI that would have revealed these stress fractures. But the treatment here is just stretch and ice.
Stretching really doesn’t do that much for metatarsal stress fractures, unless you’re talking about stretching the Achilles tendon to reduce the amount of force it takes to push the foot upward and decrease the stress on the metatarsals that way. But it doesn’t really sound like Victoria was complaining about metatarsal stress fractures when she went to the doctor.
It may be that when she had the MRI to look for this trouble that was deemed a partial rupture of the plantar fascia, that she actually found inflammation in the metatarsal, where it looks like a stress reaction, a stress response, or a stress fracture. So the second question, the big question for the doctor is, is this a true stress fracture in the fourth metatarsal bones? Or is it a stress response or a stress reaction?
Those are totally different. You can totally keep running if it’s a stress response. You probably want to reduce some stress and strain to the metatarsal if you have a stress reaction. And if it is a true stress fracture, you definitely need to modify things and you need to focus very quickly on how to maintain your fitness while it heals. But you’ve got to get straight answers from your doctor.
What this thing highlights more than anything else, this series of questions here, from this particular runner, who obviously has a concern about three different injuries, is that if you go to the doctor and you are a runner and you’re running a couple of hundred miles a week, your goal is not to sit still. Your goal is not to just get an ice pack.
Your goal is to figure out what you can do to maintain your running fitness, keep your fitness and get back to running as quickly as possible. So if the doctor goes to all this trouble to examine you, to do an MRI, to order the MRI, review your MRI, but doesn’t explain to you what you really should be doing, your questions are not getting answered. You deserve those answers when you go to see a doctor.
Hopefully, that’s helpful. Without seeing the MRI myself during a second opinion consultation, actually going through it and reviewing it and looking at it and hearing the whole story, I can’t really say what you should do next in terms of, is it safe to run or not, because I have no idea. Now, the only information I have certainly implies that it might be okay, but I don’t know what the patient was told. I don’t know what the doctor said. And I certainly haven’t seen the MRI or examined the patient, so I can’t make a judgment call on that. But it’s very important that you understand your goals when you go to the doctor. It’s very important that you go in with all the information you can compile to help the doctor make a decision on what you should do next.
When you think about this in terms of what you do with your running coach, you tell the coach all this stuff. They go through an intake interview. They want to know how much you sleep, how much you eat, how much you’ve been running, how fast you’ve run previous marathons, if you’ve ever run at all, how much you’re running right now, how long you’ve been running. All those things go into play in terms of determining what your goal is and what the next appropriate goal for you would be. The same is true when you can get an injury.
You need to be able to go in and explain how much it hurts, what it feels like, everything else. So both the Runner’s Heel Pain Course and the Metatarsal Stress Fracture course could be very helpful to help this person figure out whether or not these things are really a problem, because it certainly sounds like she left the doctor’s office without any clear answers at all.
So make sure you get the answers you need. Make sure that you know what to do. Make sure you can tell whether or not it’s one problem that’s serious or something small. Then figure out how to reduce the stress and strain to that injured tissue so you can maintain your running fitness and get back to running as quickly as possible.
If you think you have an overtraining injury, and you are trying to figure out whether or not you can run, you need to check out How to Fast-Track Your Running Injury in Record Time!
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Metatarsal Stress Fracture Rapid Recovery For Runners
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 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.
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.