Is pain and fear normal after a fourth metatarsal stress fracture? Well, that is a good question and that is what we’re talking about today on the Doc On The Run Podcast.
Today’s question comes from Priscilla, and Priscilla was watching a video called “Proof you do not have to stop running with a metatarsal stress response.” She says, “I am a distance runner, I got a fourth metatarsal stress fracture, I was in the boot three months”. That is way too long by the way in my opinion for most things. “X-ray is showing some healing but not 100%. I’ have been walking but I fear it will open up again. Is pain and fear of putting full pressure without the boot normal? I want to run, it is frustrating.”
Okay Priscilla, I feel your pain. I would be frustrated, and I would be fearful too because three months in a boot is way too long for a wild animal to be held in captivity, that is for sure. Three months, crazy long time. So, I don’t know why they did that but that your injury, your fourth metatarsal fracture must have been serious for somebody to put you in a boot for that long or the doctor really doesn’t care if you ever run again.
I would be very frustrated, I would be very fearful and there are two things here. Number one, if you’re putting pressure on the foot and you’re feeling pain, I would be very, very worried. I would be extremely fearful myself because that is a bad sign. What most runners miss is the severity of the injury and when you say it’s really bad, you have to know how bad it is. You have to have some way to quantify that.
The fact that somebody locked you up in a fracture walking boot for three months tells me that it’s probably pretty severe but there’s no indication anywhere in any of the information Priscilla provided to us that says how severe it was. There’s a very big difference between a stress reaction and a stress fracture and there’s even a little bit of difference between a really mild stress fracture and a really severe stress fracture.
Like if you just have a tiny crack in the bone, that is bad but it’s not as bad when it’s cracked all the way across. One that is cracked all the way across is not nearly as bad as one that is cracked and has moved out of position. You can get pain for lots of reasons. So, the biggest concern of course would be that you’re having pain because you’re moving the bone and it’s tweaking and pulling on the crack where it’s trying to heal. That would be the worst thing. Well second worst thing. The worst thing is you’re moving the bone out of position. Second worst thing is you’re just tweaking it and you’re preventing it from healing because you’re moving it.
Even if you have a really, really mild stress fracture and you do that for months because you’re walking on it, you can develop such a huge bone callus around the fracture that it hurts because it’s pushing on all of the muscles and nerves and all this stuff that is in between the metatarsal bones. At that point you basically have like a space occupying lesion where it’s almost like a tumor that is pushing on everything around it and causing discomfort just because there’s extra stuff in your foot that is taking up space that is not supposed to be there. That would be the other concern.
Irrespective, it’s 100% normal to have fear. Fear is a good thing. Fear protects us from hurting ourselves by doing something stupid. Fear also can hold you back as a runner. It can prevent you from doing things like maintaining your running fitness. It can prevent you from getting it to heal by stressing the bone the appropriate amount at the appropriate time. That is the big thing that you have to be working towards. So, it’s crucial that you follow your doctor’s instructions but it’s also crucial that you understand the severity of the injury and that is what I just don’t know.
If you want to understand more about the differences between stress response, a stress reaction, a mild stress fracture, or severe stress fracture and you want to know the exact strategy that I use with elite athletes and that I teach to physicians at medical conferences when I lecture on stress fractures, you can get all that for free in a thing that I’ve just revised, changed a bit to try to make it better for you as runners. It’s the Stress Fracture Masterclass. You can go sign up. You can get it for free at www.docontherun.com/stressfracturemasterclass. So, go check it out and I will see you inside.
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