What are five causes of foot pain after a metatarsal stress fracture heals? Well, that is what we’re talking about today on the Doc On The Run Podcast.
One of the most common causes of foot pain in runners is a metatarsal stress fracture and the metatarsals, of course, are these skinny bones on the top of the foot and usually when you get a metatarsal stress fracture, you get an aching pain somewhere in the center, top of the foot, maybe even out toward the toes, but it’s on the top of the foot and it’s because one of these bones is aching and injured.
There are lots of different types of stress fractures that we could talk about, but the main point of this episode is to try to just discuss some of the reasons that you can have pain after a metatarsal stress fracture has “healed” and you are starting to run again. There are really five that I think of when it comes to this topic.
The first one is that you had a crack in the bone, and it never actually healed. Now that sounds obvious, but I do see runners who have been told that they’re fine or they believe that they’re fine because the swelling went away, the bruising went away. They didn’t have pain when they were walking. They might have even done something called the hop test to try to check it themselves, which I don’t recommend by the way, but they feel like it’s improved enough and they go and they start running and then it starts aching again and it may be because the crack never ever actually healed.
A second reason is that there wasn’t ever really a crack there to begin with and instead of a true stress fracture where there’s an actual crack, you have a thing called a stress reaction. When you get a stress reaction, particularly if you have a low grade stress reaction that is not really that bad, you might end up running on it, slowing down, running less, running shorter, all those kinds of things, really dumbing down your workouts and it aches a little bit, but it’s not killing you, but it never really gets better.
When you have that circumstance, if you haven’t really decreased your activity enough to let it actually heal, well then the bone can actually have swelling in the bone that we think of as a stress reaction and that swelling in the bone actually causes pain itself just like the same kind of pain if you had an actual crack in the bone.
In addition to that, the third one is that you could have a thing called periostitis and the periosteum is the little thin covering of the bone. It’s a little fibrous layer that covers the bone and if you have that kind of injury to the bone where you are having a stress reaction, you are getting inflammation and swelling in and around the bone, sometimes you actually get inflammation of the periosteum where you have fluid accumulating between the bone and that outer layer of the bone and it stretches the periosteum and that causes pain. When you have that, we call it periostitis. So that is the thing sometimes you can see on an x-ray, you can often see on an ultrasound and sometimes you can even see it on an MRI.
The fourth circumstance is when you really did have a stress fracture. You had a crack in the bone and then the bone did heal, and you think great, well yes and no. If you really ran on it for a long period of time, you might have developed what we call a large bone callus and if you have a crack in the bone, basically you sometimes can see this little bulge or shadow around the bone on an x-ray and that is where the bone has really gotten thicker to try to reinforce the bone where you had that crack.
When you look at a foot model, you see these bones but there are also lots of little muscles sandwiched in between these bones and when you get a big bone callus or a big bulge in the bone, that can actually cause pain because you now have this hard lump pushing on the muscles in between the bones and it’s basically squeezing them and squishing them and then that causes discomfort.
The fifth reason is a similar thing. You have a large bone callus, you have a bone that is a lump or a knot right around where the fracture was and if it’s out at the neck of the metatarsals in this area, sometimes what that does is it pushes on a little bitty fluid filled sac that is in between the two metatarsal bones and where you have that bulge sticking over, it squishes that little sac that we call a bursa and causes inflammation of the bursa and then you have a condition called intermetatarsal bursitis.
That one often gets misdiagnosed as a neuroma or a stress fracture or lots of other things and it’s very difficult to see and you won’t see it at all on an x-ray. So, if you have irritation and inflammation of that little fluid filled sac, then the more you do, generally the worse it hurts. So, if you go out and run, it hurts more and this will oftentimes confuse people because you think, okay, well, if I ran more, that means the stress fracture is getting worse. Not necessarily, it could be any of those five things.
You could have any of these five different conditions that could cause aching pain on the top of your foot where you’ve had a metatarsal stress fracture, and it may bring back feelings or memories of that previous injury that you had when it first started but you have to make sure you understand what it is. Obviously, if you have a crack in the bone and you treat it like it’s bursitis, it’s not going to get better and if you have bursitis or inflammation of that little sac in between the metatarsals but you are treating it like it’s a crack in the bone, that is also not going to help. So, you have to make sure that you understand what is really causing the problem.
The other thing I talk about a lot in the Stress Fracture Secrets presentation that you can get for free. Well, that one is really simple. Most people want an imaging study. They want something fancy. They want something to test. But one of the biggest secrets about stress fractures is that most of the information that you really need to understand about stress fractures, you may be ignoring and you can get it for free all on your own by paying attention to the things that are going on with your own body the same way you would pay attention to things when you are in training.
If you want to learn more about that, just go to www.stressfracturesecrets.com and check it out and I’ll see you in the training.
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