Today on the Doc on the Run podcast, we’re talking about somebody who stopped sports for two months and got two more stress fractures.
Today’s episode comes from a comment posted on a video on the Doc On The Run YouTube channel. The specific video that this person was watching, the viewer watched this video called “How can a second metatarsal stress fracture cause a fifth metatarsal stress fracture.” The fifth metatarsal is the one that goes to your pinky toe, the second one is the one sort of in the middle of foot next to the big toe.
He posted a comment, and he said, “This happened to me, I got a stress fracture on my right foot in the third metatarsal.” So, I presume it’s from running, but I don’t really know. But he said, “I stopped all sports for two months and somehow ended up with two more stress fractures.”
If you can imagine, if you have a stress fracture and you’re listening to this right now and if you started out with one stress fracture and then you sit still, don’t do anything for two months, how frustrating would be that you then get two more stress fractures. And interestingly, his wasn’t even on the same foot. Usually that is the case is that you get one on the second metatarsal and then you wind up with one on the fifth metatarsal. He got that, but he also got a stress fracture when he got back to activity, had a stress fracture in the fifth metatarsal on the other foot that wasn’t originally injured.
The original injury in this case still hadn’t healed and said he was fine for a couple of years. He then stubbed his fifth toe. So, he stopped sports for a month and adjusted his walking, which resulted in a stress reaction on the third and first metatarsals of that foot, where he stubbed his toes. So, this has got to be frustrating because this guy’s been through a couple of different episodes where he had multiple stress fractures. And he says, “I have been trying to figure all this out. If it could really just be from walking differently, because these keep happening to me.”
He’s also wondering like, if there’s some other problem, like an underlying medical problem, like a metabolic disorder or something, because he said that, you know, this second episode, he wasn’t actually doing sports. And so, he was thinking that maybe he had a vitamin deficiency or something else like that. Well, I can only imagine how difficult this must be to go through that because I talked to lots of runners with just one metatarsal stress fracture, and they’re really having a hard time.
The first thing, let’s talk about some of his underlying questions here. The first thing is what about walking differently? Well, yes, no question. When you get injured and you start limping, compensating all of the things that you do to take stress and strain off that one injured bone, you walk differently.
That becomes habitual. It becomes a pattern, a gait abnormality that we send you to physical therapy to do gait training. If I put you in a treadmill that has a camera, I will have you immediately start looking at your feet to try to make them look normal because you need to get your gate straight again. So yes, that can definitely contribute to it.
What about the vitamin deficiency? Well, I don’t know, but I would be highly suspicious of that too. So, anybody who’s young and healthy and can’t really explain why, like if you’re training for a 100 mile race and you ramp up too fast, or you’re training for a marathon and you ramp up too fast and you get a stress fracture, well, I understand why you increase the stress of bone above the ability of the bone to recover before the next workout.
But you’ve got to figure out if you have a story that doesn’t really fit with the normal routine for getting a stress fracture, then yes, you may have an underlying metabolic disorder, vitamin deficiency or something like that, and you want to check it out, try to figure that out. But I would never just wait. I would always try to formulate a plan to work out based on the stress fracture severity right now, not after months of getting weaker after some doctor convinced you that waiting was a treatment plan. Waiting is not a treatment plan. Waiting is a weakening plan.
Your bones get weak, stiffer, your ankle has less flexibility, that applies more stress to the metatarsals. And then afterward, even if you don’t have what you see as a gait abnormality, you are more likely to develop an overtrained injury like another metatarsal stress fracture. So, if you have a metatarsal stress fracture, it does not matter if you diagnosed it yourself or if a doctor diagnosed it with you two months ago and you’re still not better, here’s what I would do.
Step one is I would figure out exactly what the severity is of that stress fracture right now so that you can make a plan to recover. Now, if you have a doctor, talk to your doctor and get an idea on how you can tell if that severity is getting better or if it’s getting worse.
The second thing is that once you know the severity, you want to reduce the stress and strain on that bone so that the stress fracture has less stress and strain on it so that the stress fracture can heal faster. That is this critical step number two.
Step three is you immediately, not later, not two months from now, not 11 months from now, not when you gain 50 pounds, you start training and testing so you can maintain and rebuild your running fitness right now. That’s what I do when I get on calls with runners. I’m not trying to convince you to get on a call with a runner, but you cannot run without re-injury if you’re weaker.
If you are weaker because you’ve been in a boot or arm crutches or you just stopped running for several months, you should presume that your threshold for training is lower to cause another re-injury.
If you want to understand the exact process I use with runners who call me for second opinions and the exact process that I teach to doctors at medical conferences when I lecture on stress fractures, if you want to understand exactly what I would ask if you called me to figure out the severity of your stress fracture, to help you figure out how to stop wearing the fracture walking boot or figure out when you should start working out based on that severity, just go to www.stressfracturesecrets.com and I’ve created something for you there that you can get and download and use to figure out the severity right now. It’s free.
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