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Stress Fracture in 4th metatarsal
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I have been diagnosed with a stress fracture in my 4th metatarsal based on MRI and X-rays that were done last week. My podiatrist told me not to run until the end of the month with will be 7 weeks without running. It has been 3 weeks without running and the pain is still really bad. Everything that I have been reading online has said that most people get put into a boot with this type on injury. I am wondering whether I should call my podiatrist back and see if I can get a boot so this will heal in time that I can get my run in decent shape for Eagleman?
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Re: Stress Fracture in 4th metatarsal [csturgeon] [ In reply to ]
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Ah dude that blows.

Can you bike and swim?
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Re: Stress Fracture in 4th metatarsal [csturgeon] [ In reply to ]
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What about water running? Is riding making it worse?
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Re: Stress Fracture in 4th metatarsal [matto] [ In reply to ]
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yea cleared to do both and doing them a lot
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Re: Stress Fracture in 4th metatarsal [csturgeon] [ In reply to ]
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You don't *need* a CAM boot for a less met stress fracture, but I almost always put people in them since just walking around all day generally irritates it pretty good. It doesn't really shorten the healing time that much (if that is what you are after). The issue becomes soreness/pain in the area once radiographic healing is noted. It will be tender for many months past "healed" and makes a lot of runners nervous or even alters gait enough to cause other issues.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Stress Fracture in 4th metatarsal [devashish_paul] [ In reply to ]
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I have been doing a little water running but it doesn't really give me much of a workout...as for riding my podiatrist told me its fine because I have no pain riding.
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Re: Stress Fracture in 4th metatarsal [csturgeon] [ In reply to ]
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That suck man. I fractured my 2nd metatarsal a couple years back, went to an orthopod who told me to wear steel toe boots instead of the medical boot. I settled for a pair of hiking boots. I think the idea is that your metatarsals need to be on a solid flat surface to heal correctly and to be protected from above. I believe the medical boot or a comparable shoe is a standard recommendation but it may depend on the location or type of the fracture. I would call back. Oh and avoid NSAIDs, there is research supporting that they inhibit bone healing.
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Re: Stress Fracture in 4th metatarsal [rroof] [ In reply to ]
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Thanks for the help. If I understand what you are saying just because I am still in a considerable amount of pain that does not mean that the bone is not healing? Also once I am cleared for running based on radiographic injury I will likely still be in pain but that is "normal" and at the point it becomes pain management?
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Re: Stress Fracture in 4th metatarsal [csturgeon] [ In reply to ]
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csturgeon wrote:
Thanks for the help. If I understand what you are saying just because I am still in a considerable amount of pain that does not mean that the bone is not healing? Also once I am cleared for running based on radiographic injury I will likely still be in pain but that is "normal" and at the point it becomes pain management?

You are correct in your understanding.

However, there is a fine line between a stress fracture (and since yours didn't show on initial plain films and you had an MRI), and an actual cortical fracture. That hurts a lot more and does take a bit longer to heal. Subtle/micromotion about the fracture actually induces external bone callus to form (which is what you want and will be seen on X-ray soon). Too much motion at your "fracture" site though can be painful and could delay healing. Doesn't hurt cycling since there is very little motion in a stiff soled cycling shoe.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Stress Fracture in 4th metatarsal [rroof] [ In reply to ]
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Ok now I am confused. The stress fracture appeared on both the X-ray and the MRI, maybe I did not make that clear in my first post. I happen to have the reports in front of me.

XR Findings: "There is focal amorphous osseous density identified between the 4th and 5th metatarsal bases on the oblique view. No radiolucent fracture line is identified. The joint spaces are preserved....Findings concerning for stress fracture at the base of the fourth metatarsal." MRI findings " There is bone marrow edema identified across the visualized portion of the fourth metatarsal on the fluid sensitive sequences with minimal changes of low signal on T1." MRI Impression "Findings concerning for developing stress injury/stress fracture at the fourth metatarsal."

And the motion of the "fracture" is what I am worried about since after 3 weeks of running I am still in pain while walking. The intensity of the pain seemed to subside after about a week but now the pain seems to be getting worse again.

Thanks for the help!
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Re: Stress Fracture in 4th metatarsal [csturgeon] [ In reply to ]
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On Thanksgiving weekend, I changed my daughters snow tires, and stupidly used my foot to loosen a lugbolt. Hit the ground hard and the end of my 4th metatarsal was either cracked or just bad bone bruise. Neither MRI or x-ray could confirm. It still bothers me, I wear stiff soled hiking shoes with orthotics, no running. Was advised by my PT it will be months. They are using Graston Technique to assist healing, just started and think it is working.

Good luck
Last edited by: steveandbarb1: Mar 4, 12 5:27
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Re: Stress Fracture in 4th metatarsal [csturgeon] [ In reply to ]
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csturgeon wrote:
Ok now I am confused. The stress fracture appeared on both the X-ray and the MRI, maybe I did not make that clear in my first post. I happen to have the reports in front of me.

XR Findings: "There is focal amorphous osseous density identified between the 4th and 5th metatarsal bases on the oblique view. No radiolucent fracture line is identified. The joint spaces are preserved....Findings concerning for stress fracture at the base of the fourth metatarsal." MRI findings " There is bone marrow edema identified across the visualized portion of the fourth metatarsal on the fluid sensitive sequences with minimal changes of low signal on T1." MRI Impression "Findings concerning for developing stress injury/stress fracture at the fourth metatarsal."

And the motion of the "fracture" is what I am worried about since after 3 weeks of running I am still in pain while walking. The intensity of the pain seemed to subside after about a week but now the pain seems to be getting worse again.

Thanks for the help!

That is odd for a couple of reasons. If a stress fx is showing on plain film X-ray, there is no reason to obtain an MRI! But, your location is NOT a common location for a less metatarsal stress fx. Also, "osseus density" between the mets there (they both articulate there with the cuboid) is a bit odd - likely the reason your treating doc wanted an MRI (ruling out a bone tumor, mass, etc.).

I will say, the more proximal the stress fracture, the longer they take to heal and the more likely I am to "boot" them. Most lesser met stress fractures occur up near the surgical neck or midshaft, not proximal like yours. Did you have any vague pain in the area prior to this occuring (i.e. cuboid syndrome, diffuse lateral column pain, etc.)?

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Stress Fracture in 4th metatarsal [rroof] [ In reply to ]
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Well actually the podiatrist originally thought it was a torn peroneous longus tendon and ordered and MRI to look at that. When I was getting the MRI they said that their radiologists like to have and X-ray to compare to the MRI and therefore just did both.

As for the pain...it came about very suddenly during one run early in the year. The pain has been very vague in general and hard to pinpoint an exact location. I know during my first appt before the XR and MRI he was talking about cuboid syndrome and put a wedge in my shoe that did not help with the pain at all. But the pain is definitely right at the head of the 4/5th mets and where they meet with the cuboid.
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Re: Stress Fracture in 4th metatarsal [steveandbarb1] [ In reply to ]
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I'm surprised no one on this "attention to detail" site caught this:

steveandbarb1 wrote:
On Thanksgiving weekend, I changed my daughters snow tires, and stupidly used my food to loosen a lugbolt. Hit the ground hard and the end of my 4th metatasal was either cracked or just bad bone bruise. Neither MRI or x-ray could confirm. It still bothers me, I wear stiff soled hiking shoes with orthotics, no running. Was advised by my PT it will be months. They are using Graston Technique to assist healing, just started and think it is working.


Now, using your "food" to loosen a lug bolt is rare indeed, but, what is a "metatasal?"
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Re: Stress Fracture in 4th metatarsal [Recoverie] [ In reply to ]
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me bad speller without editer....fixed

foot slowly healing.
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Re: Stress Fracture in 4th metatarsal [rroof] [ In reply to ]
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rroof wrote:
That is odd for a couple of reasons. If a stress fx is showing on plain film X-ray, there is no reason to obtain an MRI! But, your location is NOT a common location for a less metatarsal stress fx. Also, "osseus density" between the mets there (they both articulate there with the cuboid) is a bit odd - likely the reason your treating doc wanted an MRI (ruling out a bone tumor, mass, etc.).

I will say, the more proximal the stress fracture, the longer they take to heal and the more likely I am to "boot" them. Most lesser met stress fractures occur up near the surgical neck or midshaft, not proximal like yours. Did you have any vague pain in the area prior to this occuring (i.e. cuboid syndrome, diffuse lateral column pain, etc.)?

Our radiologists read early metatarsal callous as "ossification" or "osseous density" between the metatarsals as well sometimes. They argue that they can't differentiate that early whispy callous from vascular changes and HO. Obviously a ridiculous hedge, but I think this can be a regionally normal way to refer to early callous.

To the OP, I agree with everything Rodney has said so far. I'm maybe a bit more cavalier about metatarsal stress fractures depending on short term goals and the level of the athlete, but his is the party line.

Andy
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Re: Stress Fracture in 4th metatarsal [AndyPeterson] [ In reply to ]
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I have the same stress fracture, instead of a boot, I wear MBT shoes, they look like sketcher shape ups, and even allowed me to run a half mary in 1:43 (thought I would suffer and do 2 hours plus). Im not running fast though, and yes it is delaying healing a little bit maybe by 2-4 weeks... but I look at it this way, when there Im ready to romp and in condition.


http://www.coupleofathletes.com
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Re: Stress Fracture in 4th metatarsal [synthetic] [ In reply to ]
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synthetic wrote:
I have the same stress fracture, instead of a boot, I wear MBT shoes, they look like sketcher shape ups, and even allowed me to run a half mary in 1:43 (thought I would suffer and do 2 hours plus). Im not running fast though, and yes it is delaying healing a little bit maybe by 2-4 weeks... but I look at it this way, when there Im ready to romp and in condition.

That's interesting. I should do a study to see how well those shoes protect a lesser metatarsal stress fracture. Thanks for the idea.

I have some of our more elite runners in mid-season back off their volume by around 20-50%, use a trail shoe with a rock plate and stay on dirt and grass trails. We also have a couple of alter-G treadmills that they can spend some time in without hammering on their bones too much.

Never thought of using something like the MBT shoes, but I guess they might unload the forefoot.

Thanks
Andy
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Re: Stress Fracture in 4th metatarsal [AndyPeterson] [ In reply to ]
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Sure, rocker bottom shoes/mods have been around forever (when custom made). Use them occasionally to offload forefoot diabetic ulcers as well. MBT just had the patent for retail shoes until it expired 2 years ago. They are still pretty expensive compared with the multitude of knock-offs now, but they are quite a bit stiffer and better made IMHO. There are lots of gait force/pressure mat studies you can search for to see what kind of pressure reduction(s) you can get (mostly in the diabetic/neuropathic).

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Stress Fracture in 4th metatarsal [csturgeon] [ In reply to ]
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I've had a few stress fractures and in my experience cycling delays healing. It seems like the orthopods are split on this as I have some tell me to rock and roll on cycling and others say to just stop. In my N=1 experience, when I cycle it seems to take forever for them to heal, when I stop the cycling I am ready to resume all activities much faster. My only caveat would be that I've never had a metatarsal SF so that might be different. I'm about 8 months months out from a displaced metatarsal fracture right now and still can't run. Though at this point the inhibitor is all the problems that developed in the wake of not really be able to walk for 4 months.

Look at this as good opportunity to get better swimming. I still suck, but man am I light years ahead of where I was last year.

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Re: Stress Fracture in 4th metatarsal [zdesmond] [ In reply to ]
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zdesmond wrote:
I've had a few stress fractures and in my experience cycling delays healing. It seems like the orthopods are split on this as I have some tell me to rock and roll on cycling and others say to just stop. In my N=1 experience, when I cycle it seems to take forever for them to heal, when I stop the cycling I am ready to resume all activities much faster. My only caveat would be that I've never had a metatarsal SF so that might be different. I'm about 8 months months out from a displaced metatarsal fracture right now and still can't run. Though at this point the inhibitor is all the problems that developed in the wake of not really be able to walk for 4 months.

Look at this as good opportunity to get better swimming. I still suck, but man am I light years ahead of where I was last year.

heh swims are tough because the pain is so great you end up dragging the injured foot and kicking with the other


http://www.coupleofathletes.com
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Re: Stress Fracture in 4th metatarsal [zdesmond] [ In reply to ]
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I presently have a Sfx of the 2nd metatarsal. I am in week 3 of the "boot". My podiatrist is a marathoner and works with endurance athletes. He actually spoke with my coach and encouraged me to cycle seated on the trainer, and swim as much as I could. However, he made it clear to do all as long as I wasn't in any discomfort. That said, I've cut a few bike sessions short and immediately went to ice. I'm not sure that it was the cycling itself (doubt it) , but I am definitely not even 85 pct.

I too, am nervous about prolonging the healing process, but I have rev3 quassy and IMNY on the docket. Pd also recommended aqua jogging, but coach said if I'm at the pool, swim. Going this week and hopefully X-ray shows some healing. It's an annoying injury, but be careful and listen to you body and Dr.
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Re: Stress Fracture in 4th metatarsal [Dlyon19] [ In reply to ]
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Hey mate,
Im in day 1. Would love to hear how it panned out for you with your recovery.

Coaching - Future Endurance
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