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stress reaction in foot?
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First post here,
I am frustrated trying to get a diagnosis on a foot injury. brief background-2 weeks ago felt pain under large toe when it bent up after an easy 5 mile run. Didn't think much of it but it was stabbing pain only 0.5 miles into a run the next day. gave it several days off and decided to see a doc. Initial dx was stress fracture of metatarsal 1. Asked for a referral and saw a podiatrist. No evidence at that time of a stress fracture on x-ray (I understand it would be early to see such a thing) and physical exam made stress fracture unlikely due to lack of pain with tuning fork and other odd instruments. DX at that time was potentially a partial ligament tear or an inflammatory process with the sesamoid. He taped it with metatarsal padding and told me to return to activity and give him a report. Pain decreased but was still present running. He ordered an MRI. His nurse called today, said MRI was inconclusive but radiologist is calling it a stress reaction. I have a call out for the doctor to call me back, but she told me I had 2 options:
3 weeks off in a boot
or
an injection and take off 3 days then evaluate

Anyone have a similar experience?
Any idea about this injection?

only change would be adopting more of a midfoot strike-I have been converting to Pose running. Perhaps this was the culprit.

Thanks
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Re: stress reaction in foot? [skivt] [ In reply to ]
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I had a stress reaction of the second metatarsal last spring. It was treated the same as a full stress fracture. I stress reaction, as I understand it, means the bone is compromised so no injection will fix it. I reduction inflammation might speed the healing, but otherwise it's the boot for you.

I had six weeks in a boot and it's still bothering me eight months later.

Hope your prognosis is better.
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Re: stress reaction in foot? [skivt] [ In reply to ]
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something is not quite right ...

First, a stress fracture (reaction) of the 1st metatarsal is pretty unusual. If your pain is more plantar at the sesamoid, do you mean a "stress reaction" of the sesamoid? Tibial sesamoiditis is pretty common, and simply offloading generally works well, but it will likely take longer than 3 weeks to settle down unfortunately. Normally you don't want to put a corticosteroid near a stress fx, but if sesamoiditis, it can be helpful.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: stress reaction in foot? [skivt] [ In reply to ]
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Had same in 3rd meta. Tried to run and ride through it. Ended up in a boot. Missed Kona. Took 8 months to fully recover.
I'd suggest boot now instead of later.

Other suggestions; setup bike trainer with platforms so you can pedal with your heals only. Aqua jog. Swimming, avoid pushing off wall with that foot and no fins.
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Re: stress reaction in foot? [rroof] [ In reply to ]
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Thanks for the reply. Originally he thought the problem was in the region of the sesamoid so possibly a stress reaction there. They mentioned because I have a split sesamoid it's tricky to determine if thats normal anatomy or a fracture. I am hoping for more information today or I think I am going to request a referral to sports med to figure out what I can and can not do.
Do you think an injection is appropriate if the diagnosis is unknown? The plan there was to see if it improved in 3 days or not. Can that inhibit the bone from healing?

Thank you!
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Re: stress reaction in foot? [skivt] [ In reply to ]
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oh and to clarify it is the foot (under 1st metatarsal) not tibial. I appreciate your input
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Re: stress reaction in foot? [skivt] [ In reply to ]
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It sounds like you have some early changes of a stress fracture on your MRI although I would need more detail to say for certain. What you need to remember is that a stress reaction and stress fracture are on the same continuum. If you keep loading a stress reaction you will progress to a stress fracture and eventually to a complete fracture without proper treatment.
Your initial injury sounds like it could be a sprain to the capsule at the first MTP (metatarsal-phalangeal joint) which would cause pain directly under the joint of the the first toe. You could have also injured your sesamoid. You have 2 sesamoid bones that sit under the joint (the tibial one sits on the inside and the fibula/lateral one sits towards the outside). You could also have a congenital (from birth) bipartate sesamoid which just means the one sesamoid bone has two parts. Some times it is difficult to tell a bipartate sesamoid form a sesamoid fracture. An easy comparison would b to look at the other side. If you have a bipartate sesamoid there it is less likely that you have a sesamoid fracture. Also, the MRI should show a sesamoid fracture.
With respect to the injection, there is no way I would inject a stress reaction along the metatarsal shaft. This is just wrong!!! If you have a capsule strain you could potentially inject this, but from what you are saying this is not the case.
As stated above, a stress reaction in the first metatarsal will heal with protected weight bearing but will likely take longer than 3 weeks. 6 weeks is the typical healing time for a stress fracture.
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Re: stress reaction in foot? [dogmile] [ In reply to ]
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dogmile wrote:

Had same in 3rd meta. Tried to run and ride through it. Ended up in a boot. Missed Kona. Took 8 months to fully recover.
I'd suggest boot now instead of later.

Other suggestions; setup bike trainer with platforms so you can pedal with your heals only. Aqua jog. Swimming, avoid pushing off wall with that foot and no fins.

None of us are able to diagnose without all the information. I'd say this is probably the best info in the thread.

The only thing we know is that you have an injury.
We also know that its December.
Be careful now because it will have little detrimental affect on your training. (Most likely, depending on race schedule)
Don't put yourself in a position to need to take time off in the future.

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The above poster is employed by CU Sports Medicine and Performance Center. However, statements made are not on behalf of CUSMaPC nor reflective of CUSMaPC in any manner. Unless they are good statements, then they count.

http://www.CUSportsMedCenter.org / @RobertPickels
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Re: stress reaction in foot? [xtrpickels] [ In reply to ]
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thanks everyone for the great advice.

Spoke with the podiatrist today. The MRI results showed inflammation around the sesamoid. No evidence of a stress fracture. Differential dx of sesamoiditis or stress reaction of the sesamoid. He said he is going with stress reaction due to level of discomfort when running. Put me in a fracture boot up the leg thing and told me to re-check in 2 weeks. Said sure to swimming and biking, if it hurts don't do it. Offered a steroid/lidocaine foot injection for pain. I declined.
Here are 2 questions if anyone knows:

1. can sesamoiditis usually be differentiated from sesamoid stress reaction?

2. Will IB profen delay healing if I take it? Same with caffeine from coffee? (found some things online that said so).

I also am going to see a sports med md on Monday who is a triathlete just to make sure.

Again I appreciate the comments.
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Re: stress reaction in foot? [skivt] [ In reply to ]
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sesamoiditis -> sesamoid stress reaction -> stress fx -> fracture is a bit of a continuum. I differentiate sesamoiditis from a stress fx, but the associated joint capsulitis can also cause some significant symptoms in a runner, and ice/steroid inj can work well in these instances to get the athlete back to training faster.

Yes, some newer evidence that NSAIDs may slow down "bone healing" (though we used them for years). I *personally* would not give up caffeine with your situation ;-) I would avoid the steroid injection for now. You are likely going to be frustrated with how slow these tend to heal as well. Good to be initially aggressive in the CAM boot in a type-A triathlete. I've lost count how many tibial seamoids I've removed now since many athletes rarely give these enough time to fully heal and they often turn into chronic problems (so beware!)

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: stress reaction in foot? [skivt] [ In reply to ]
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Cut out soda. Not good for bones (if you have a bone thing).

((((hugs))))

Proud member of Fishtwitch and the ST Grammar Police
send a PM for blog accesshttp://www.tigerchik2.wordpress.com
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Re: stress reaction in foot? [tigerchik] [ In reply to ]
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did anyone find the CAM boot to be uncomfortable? That it still lifts the forefoot up a bit to put pressure on the sesamoid area? Maybe there is an adjustment period...
Last edited by: skivt: Dec 15, 11 18:47
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Re: stress reaction in foot? [skivt] [ In reply to ]
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Cam walkers suck....they typically cause a leg length discrepancy for the time you wear it. You need to offload pressure from the first ray....problem is biomechanically we are meant to transfer approx 60% of our bodyweight directly through that area.

A rocker soled shoe such as Xcelero from Instride could accomplish the same thing as the cam walker in a more comfortable way than the cam walker.

good luck

peace
mf
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