When can I start running after a metatarsal fracture if I have no healing on the X-ray? Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
If you get a fracture of the metatarsal, it doesn’t matter if it’s a stress fracture, a pathologic fracture where you stepped in a hole or tripped or fell off a ladder. It doesn’t really matter how you got the fracture, you have to make sure that it’s healed before you start running on it. The most common way doctors decide that the fracture is actually fully healed is by taking an X-ray.
X-rays are great for showing fractures in bone and when you break a metatarsal and you look at the X-ray, you have white bones, and when there’s a crack, it’s a black or dark gray line between the two pieces with a broken bone. And so, seeing that odd line across your X-ray indicates that you have a fracture and when the bone heals across that gap and it ossifies or mineralizes, you get calcium deposited in there, then that’s when you actually see it turning white again where there used to be that dark line.
Does that mean that you have to wait until that to run? Well, the fact is, is that most doctors will make you wait until you see that line go away on your X-ray because that indicates that it’s solid bone across there. How long do you have to wait? You have to wait until you can prove that it’s okay for you to do that. Otherwise, obviously the doctor is going to make you wait and what does that mean? Well, one way is to wait until it actually looks like it’s fully healed on the X-ray. That’s the safest thing in terms of making sure that the fracture is totally solid and ready to go.
However, you might not have to wait that long. In fact, if your doctor does ultrasound and can see ultrasound indications of healing of the fracture instead of waiting for the X-ray, you may be able to get back to running a lot sooner. But if your doctor doesn’t do an ultrasound, you can expect that your doctor is going to make you wait.
To be clear, if you get an X-ray and there’s still a crack or the radiology report says no evidence of fracture healing, that means no radiologic evidence of fracture healing. Meaning that the X-ray is just not yet showing it. If you see that, don’t presume that it’s okay for you to run on it just based on some timeline because the timeline for fracture healing could be anywhere from 4 weeks to 52 weeks, depending upon how healthy you are what you do and how carefully you protect it and what you do to stimulate more healing in the fracture.
Again, you can ask your doctor to do ultrasound to try to assess the healing if your doctor knows how to do that. But if they’re just waiting for the X-ray to show them that it’s okay for you to run, you probably have to wait a little bit longer. It just means you’ll have to do a lot more work when you’re trying to rebuild your running fitness and make sure that you don’t get another overtraining injury later.
If you enjoyed this talk, please like it, please subscribe and if you haven’t checked it out yet, you might want to check out the stress fracture masterclass where I kind of go into a lot more detail about stress fracture healing and what it takes to get back to running you can get it for free at www.docontherun.com/stressfracturemasterclass. So, go check it out, and I’ll see you in the training.