#854 Calcaneal stress fracture in runners good news bad news - DOC

#854 Calcaneal stress fracture in runners good news bad news

Today on the Doc On The Run Podcast, we’re talking about calcaneal stress fractures in runners and I have some good news and some bad news.



If you’re out on a run, and you have some heel pain that suddenly develops, all of a sudden it hurts a lot and you get bruising and swelling, you may have a calcaneal stress fracture. And if you go see a doctor, they take an x-ray, and they don’t see anything at all but they squeeze your heel and it hurts and they get an MRI that actually shows you have a calcaneal stress fracture, they’re probably going to tell you, you can’t do anything.

You have to sit still, because the heel bone itself is sort of like a hard boiled egg. It’s got this thin shell, and it’s solid, but kind of soft in the middle. And it’s very prone to blowing apart into a whole bunch of pieces when you break it. So, if you’re rock climbing, and you fall on land on it, if you’re working on the ladder, cleaning the gutters, and you fall off the ladder, and you break the heel bone, it typically blows apart in a whole bunch of pieces.

Now, here’s what’s really important for you. There are a couple of things that are very interesting about this. Number one, we never like calcaneal fractures. When you blow it apart, when you break it, it can cause a lot of arthritis and a lot of disability and so, we don’t want that to happen. So, any doctor that tells you, you should just sit still, because it’s too risky to do anything with a calcaneal stress fracture, they’re just trying to protect you. That’s all it is.

But there’s another side of this that you need to understand. The bad news is, is that it’s really risky and most doctors will tell you that don’t do anything. The next thing is, the good news is that the heel bone is one of the fastest healing bones in your foot because it has a great blood supply. In fact, it’s so good at healing, that if you fell off the ladder today, and it hurt, but you didn’t really think it was that big of a deal and you waited a couple of days and it really swelled up and you went to the emergency room, they took an x-ray and they said you have a calcaneal fracture, you blew it apart, we’re going to have to do surgery to fix it. They couldn’t fix it that day.

Why? Because you have so much swelling and when we make that incision on the side of the heel, to peel the skin away and actually put all those pieces back, put a plate a bunch of screws on there, you can’t close the incision, it’s too swollen. So, we have to wait about two weeks before we do that surgery if we don’t see you immediately after it happens and do the surgery before the swelling happens.

So, what does that matter to you when you have a calcaneus stress fracture? Well, it’s really simple. What happens at two weeks when we go in, the biggest problem is that all those pieces, those little pieces that are blown apart and sitting in the wrong position, we have to put them together like a jigsaw puzzle, they’re already starting to solidify in the wrong place. So, we actually take an osteotome which is like basically, like a medical chisel and we pry those little pieces apart. And then we put them back where they go. We recreate your heel bone on the side where the wall is blown out. Then we put a plate on it. We put a bunch of screws in there to hold it all together. And then we get it to heal.

What does that matter? Well, again, it heals very, very quickly. So, a metatarsal stress fracture is not going to be healed, we have to pry it apart in two weeks, but the heel bone will. What that tells me is if you really protect it, you really do this stuff to promote healing initially, you can probably start running a lot sooner than you think. You’ve just got to think about those variables, discuss it with your doctor or somebody who really understands runners.

If you want to learn more about all of these issues related to the heel pain, you can check out the heel pain masterclass. It’s a deep dive in all these topics specific for runners. You can get it for free at www.docontherun.com/heelpainmasterclass. So, go check it out, and I’ll see you in the training.