As a runner, triathlete and podiatrist in San Francisco, one of the questions I get most often from other runners is whether or not they should run when think they have a stress fracture in the foot. This should help explain what will happen if you run and you do have a stress fracture.
Stress fractures in the foot are one of the most common injuries among runners. In fact, stress fractures account for about 10% of all running injuries.
Although you actually have 26 bones in each foot, it is usually one of the five metatarsal bones that develops a stress fracture in a runner. Of all five metatarsal bones, it is often the second metatarsal bone that gets the stress fracture. This is because the second metatarsal bone is usually longer and takes more abuse that the other metatarsal bones.
When a runner in training gets a second metatarsal stress fracture, they are usually complaining of pain in the forefoot. Often the pain is on the top of the foot just behind the bases of the middle toes. Runners with high arches, a supinated foot-type or some other conditions may develop stress fractures of the fifth metatarsal bone. They usually complain of pain on the outside of the foot.
Although a stress fracture in the foot is just a tiny little crack in the bone, they can bleed enough to cause bruising of the overlying skin. So if you have a sore aching foot with a bruise, it could be a sign of a stress fracture.
If a runner calls me complaining of pain and bruising over the top of the foot or outside of the foot, I would want to make sure that the bone isn’t broken. As you can see in the xray image here, the fifth metatarsal is broken. This is because the pain and achy sensation from the stress fracture was simply ignored by the patient. As a result, the bone cracked and broke all the way across.
Base on these x-rays we can tell that the bone has been broken for some time.
This patient would have been much better off calling and getting treatment earlier. But unfortunately, I have treated more than one runner who ignored all of the foot pain and stress fractures symptoms, and just kept running on that sore aching foot.
If you run on a stress fracture long enough to crack the bone and move it out of place, you could wind up in surgery. If you are a runner, you should try your best to avoid surgery.
The next x-ray image is from another actual patient who ignored the pain in the foot even though he thought he might be getting a stress fracture. In this close-up of the foot x-ray, you can easily see where the fifth metatarsal bone has cracked all the way across and the broken bone has even shifted out of position.
That is actually a big problem. Because once the bone breaks and moves out of the way, all of that force that was originally causing a fifth metatarsal stress fracture just gets applied to the bone next to it. So as a result of this, there is now also a stress fracture of the fourth metatarsal which is also cracking, causing another broken bone in the foot.
If you have foot pain and think that you might have a stress fracture, you really shouldn’t run on it. Instead, it is important to see an expert so that you don’t wreck your training and ruin you whole season with an injury that might go away in a short time with the best treatment.
Running on a stress fracture is never the best treatment!
At Doc On The Run, our podiatry practice specializes in house calls for busy athletes in the San Francisco Bay Area. Our podiatrist runs around town… so you don’t have to! If you have a sore foot with aching, throbbing pain when you run and are wondering how to tell if you have stress fracture, you can call Dr. Segler directly at 415-308-0833. And yes, you will actually get to speak with the sports medicine podiatrist (unless he is in surgery on on his bike descending Mt. Tam!) (415) 308-0833.