I am new to this forum, but wanted to get some opinions on an injury that happened to me yesterday. I was running a normal interval run and about 3.5 miles in I heard a snap in my left foot followed by quite a lot of pain. The only prior pain was about 1 minute before it happened, it was a stress fracture that broke all the way through, I just did not feel it prior to I guess.
So the x-rays reveal it is still in alignment, broken all the way through in my 2nd Metatarsal, and now about 2mm shorter then the right metatarsal. My Dr seems like he knows quite a bit about these injuries and says his opinion is to let it heal the way it is now. The 2mm shorter bone will actually take on less stress now. If he pins it just to make it even with the right foot, I do risk it breaking again, plus all the risks of the pin etc. But if I want to he will pin it just so it is the same length as the right, but the alignment would not be any better with a pin. But I need to decide ASAP.
Right now I have the space boot and am thinking to go with no pins and let it heal using the bone stimulator and the whole 9 yards. Anyone ever had this type on injury?
I am pretty sure this is from speed work over the last three weeks, but I thought I had a great base. I am only 30 years old, my regular run in 8.5 miles, 15 hour training weeks, and have done 3 sprints, 4 olympic, and 2 70.3 races this season so far. I do run on Newton shoes and I can’t help but think they contributed to placing more stress on my forefoot as well. This is the first season for these shoes.
I am quite disappointed as I had Chicago this weekend, US open in October, and Clearwater in Nov. I hope to still be able to do Clearwater though. I guess I will see how the healing goes…
Oh boy … I’ve treated (both conservatively and surgically) many patients with your injury. You sure you felt nothing prior to the “snap”? Yes, the Newtons did likely contribute to this unfortunately.
Clearwater is highly unlikely at this point, even with ORIF surgery, sorry. Good that you got an external bone stim with an acute injury - most insurance companies want to see a non-union (over 90 days at least) first. Absolute best case would be solid bony union in 6 weeks. This would be unusual with even just a 2mm gapping though - figure closure to 12 weeks to support running.
yes I really felt nothing at all in my foot until the run yesterday. I have had a minor stress fracture in my right lower leg before and I could feel that coming on for a long time. Me feet have never really bothered me at all. I did figure the Newtons had something to do with it as well.
So as far as the ORIF surgery goes should I look into this more? What are the advantages? The bone is still lined up straight. There is not a 2mm gap, but rather the bone as a whole is 2mm shorter as the break site is crunched together. Does that make sense?
The Dr said that the only reason to do the pin would be to get the bone back to the correct length. He could not straighten it much more than it is already. But he would be glad to do it and it was up to me.
As for the bone stimulator, my insurance would deny it for sure were going to try. But my sister just finished her 3rd metatarsal fracture treatments. Guess my family has bad luck or weak bones, I have been taking extra Vitamin D and Calcium since last year too.
Oh boy … I’ve treated (both conservatively and surgically) many patients with your injury. You sure you felt nothing prior to the “snap”? Yes, the Newtons did likely contribute to this unfortunately.
Clearwater is highly unlikely at this point, even with ORIF surgery, sorry. Good that you got an external bone stim with an acute injury - most insurance companies want to see a non-union (over 90 days at least) first. Absolute best case would be solid bony union in 6 weeks. This would be unusual with even just a 2mm gapping though - figure closure to 12 weeks to support running.
I am curious how you come to the conclussion that its the Newtons when he admits to training probably being the isssue. How exactly are you blaming the shoe? What about Newtons causes this injury? Mid/forefoot runing? There are people that run barefoot that dont get this injusry so I am still extremely curious how you came to this conclussion
Not a “conclusion” as you put, but … lesser met stress fx are caused by axial loading of the long bone which is increased in forefoot running. Newtons “encourage” this with the forefoot lugs. Nothing more. Plus, I’ve seen a dozen or so in the office trying this (in addition to posterior calf/achilles issues) Others transition just fine and run their best ever.
This isn’t a “new” runner with many races this year, high mileage, etc. Can’t directly comment to simple training increase causing this, but from his PMs with me, I don’t get that impression.
Please let me share some experience here with this. About a dozen years ago I snapped metatarsal #3 in my left foot half way through the Eagleman run. Rather than stopping, I continued. That was one of the dumbest things I have ever done in my lifetime, as to this day, and for the rest of my life, I am and will be bothered by that injury. The injury healed badly, the bone wound up shorter than it should have been, and a little off kilter. It has caused me to bail out of 1 Ironman on the run, and I can no longer reallyl run for more than an hour without pain in that foot due to nerve irritation caused by the scar tissue and poor bone alignment stressing the nerve. Far too many (failed) orthotics and cortisone injections later, I have really had to give up long distance running. I don’t feel it is worth sclerizing the nerve, nor do I think surgery is a good idea. That boneheaded decision to not do what my body was telling me (stop), has proved to be hugely idiotic.
I am coming off a 2nd metatarsal injury as well - not a surgeon so no medical advice on my end though. It was explained to me by my doctor that the 2nd metatarsal ends up taking the brunt of the loading during our run push off, so if it is injured let it rest and heal up otherwise it will be a constant source of discomfort. Take the time needed to let things heal completely before going back to the repeated stress that comes from running. It’s not a quick process and getting back up and running (no pun intended) will take some time. I was happy to be cleared to get out to do some 2-3 miles runs over the next few weeks to see how much I could handle. Good luck and be careful - there’s alway next year (and Chicago is disaster of a race anyway).
I am under the conclusion that a multitude of factors contributed to the fracture, including recent increase of speed work and the shoes. But what is done is done, I need to focus on how I can heal this injury the best way possible. I just do not want it to heal badly and will try for as fast as of recovery as I can.
I would like to hear from folks who have had surgery and those who have not. My Dr seems to know what he is taking about and spent over an hour talking with me and answering all my questions. He says that the majority of these types of fractures do not require surgery, but again he would be willing to do it if I feel it is necessary. So the bone is straight but slightly shorter now by 2mm because at the fracture point it has been pushed together. This may be an advantage as the stress will be less now on that bone, but I also don’t want more stress to transfer to the 3rd and 4th because of the short 2nd. make sense?
For all those that said I was for sure out of Clearwater, just wanted to let you know I raced and my foot felt fine. I had a good swim and bike, but my lack of run training had me in for a pretty bad run. I was hurting pretty bad, but finished with a 4:13 anyway.
i broke the 2nd metatarsal in my left foot 17 weeks ago. i dropped a box on it a couple days before running a 10k on labor day. x-rays after the race showed the break was displaced a couple mm’s in a top view but aligned in a side view. the ortho said it did not need to be aligned/set/pinned. i wore a cast for four weeks and a boot for 8 weeks. i’m on my feet most of the day. it still hurts noticeably to run, so i limit my runs to one mile at 12 min pace 4 days a week. the doc said the pain is the effect of the callous that’s formed around the break on the adjacent nerves and offered to give me a cortisone shot on each side of the break. a podiatrist said cortisone could permanently damage the surrounding muscles because they’re small. i’m wondering whether 1) not having had the displaced halves of the bone surgically aligned caused it to take so long to heal and 2) i should consider having the displacement aligned now. recommendations would be appreciated. thanks.
i broke the 2nd metatarsal in my left foot 17 weeks ago. i dropped a box on it a couple days before running a 10k on labor day. x-rays after the race showed the break was displaced a couple mm’s in a top view but aligned in a side view. the ortho said it did not need to be aligned/set/pinned. i wore a cast for four weeks and a boot for 8 weeks. i’m on my feet most of the day. it still hurts noticeably to run, so i limit my runs to one mile at 12 min pace 4 days a week. the doc said the pain is the effect of the callous that’s formed around the break on the adjacent nerves and offered to give me a cortisone shot on each side of the break. a podiatrist said cortisone could permanently damage the surrounding muscles because they’re small. i’m wondering whether 1) not having had the displaced halves of the bone surgically aligned caused it to take so long to heal and 2) i should consider having the displacement aligned now. recommendations would be appreciated. thanks.
Definitely avoid the corticosteroid shot around a healing fracture. Many lesser met fractures will hurt WAY past radiographic signs of healing for whatever reason - bending stress still, the external bone callus, etc. Surgery at this point would not be indicated since you would have to completely “re-break” the area, curettage the bone, put hardware in, etc. Would take another 6-12 weeks to heal. You will likely heal eventually at this point anyway, so I don’t think you would get many specialists recommending surgery unless a pretty bad malunion.
Others transition just fine and run their best ever.