#737 Are “stress reaction” and “metatarsalgia” the same? - DOC

#737 Are “stress reaction” and “metatarsalgia” the same?

Are stress reaction and metatarsalgia the same terms? Well, that’s what we’re talking about today on the Doc On The Run Podcast.



Today’s question actually comes from one of the YouTube viewers, Tasnim, who wrote in and wanted to know whether or not stress reaction is the same terminology that’s used in the UK for the term metatarsalgia.

This is a great question, and it points out how confusing these two terms can be when you have forefoot pain that might be a stress fracture, might be a plantar plate sprain, could even be a neuroma.

Let’s talk about these two different terms. Metatarsalgia, if you actually look at the root of the word. It really and truly means pain in the metatarsal area. So, in your hand you have the metacarpals, so these bones here, those are the metacarpals. You have the same kind of bones in your foot. They’re just called metatarsals and those long bones in the forefoot can become stressed and strained. They can lead to a stress fracture or get a precursor of something like a stress fracture. And when you have pain in that area, in one or more of those metatarsals, a doctor might refer to it as metatarsalgia.

This is not a great term for a couple of reasons. One is that if you go to the doctor and your head hurts and doctor says, “You have a headache” and you say “Yeah, I know that’s why I’m here.” That’s not a diagnosis and neither is metatarsalgia.

So, metatarsalgia, that term is not specific to the degree of injury. It could be a stress fracture or a stress reaction or it could even be something that’s not an injury to the bone at all. It could be a soft tissue injury next to the bone, like a plantar plate sprain. Stress reaction is a different term. It’s also not specific with regards to the type of bone or this specific bone such as the second metatarsal for example, but it could actually happen in any bone meaning a metatarsal, your heel bone, your fibula, the shin bone, the femur, it can be any bone, but it is much more specific to the degree of injury.

What do I mean by that? Well, really simple, if you get a stress fracture. Stress fracture means you have a crack. Now, what precedes that is a stress reaction. That’s where there’s inflammation within the bone. The bone has been stressed beyond the point of recovery before the next workout, and it’s about to become a stress fracture. Before that is a stress response.

All of those are specific to one particular bone, and they tell you the degree of injury. So obviously, a bone that has a teeny crack is probably better than one that has a huge crack and is in two different pieces that aren’t even close together anymore. All of the stress reaction where you don’t have a crack at all and the bone is inflamed should be better than a bone that actually has a real crack that you can see on an x-ray.

But to me, when a doctor makes a diagnosis of metatarsalgia, it leaves more questions than answers. So, if your doctor says you have a stress reaction, first of all, that’s better in my mind than hearing you have metatarsalgia, but you need to know which specific bone. It would at least tell you that there is no crack and from there you can start to make a plan for getting back to running. Hopefully this helps clear it up.

If you haven’t checked it out yet, and you think you have a stress fracture, stress reaction or metatarsalgia, maybe you ought to check out the stress fracture masterclass. If you enjoyed this episode, please like it please subscribe, and I’ll see you in the next training.