Racing on a potential stress fracture

Triathlon Forum
1

First and foremost, I know there are a bajillion threads on stress fractures and they all pretty much conclude that running on them is stupid. This isn’t exactly one of those threads.

I’m racing in the Duathlon Nationals (no, I’m not fast, but I was going to be in Minneapolis for work and thought it would be fun) this Saturday (7/19). Last Wednesday, I developed a sharp pain in the fifth metatarsal shortly after doing speed training (5x1000m intervals) for my Chicago Marathon training program. I hobbled around for most of Wednesday, Thursday and Friday before I could go in to see a doctor. The pain was very sharp the stiffer my shoes were. Dress shoes were awful, training running shoes (Mizuno Wave Rider 16 with carbon superfeet insoles) were not great, Racing shoes (Mizuno Hitogamis with superfeet black insoles) were okay, and barefoot was almost pain free unless I landed awkwardly on my foot. My working theory is that I have mild pronation in my left foot which shoes of almost any type correct. When I’m walking barefoot, there’s barely any weight on my fifth metatarsal, so it doesn’t hurt very much.

My doctor and I reached a deal of sorts on Saturday: If the x-rays showed signs of a fracture, I’m out for the race on Saturday. If they did not show signs of a fracture, I’d wear a walking boot as a precaution and if I was pain free by Friday night, I could race on Saturday. The x-rays did not show signs of a fracture, so I’ve been in this stupid boot since Saturday (Walking the length of O’Hare in a boot sucks, by the way). One thing that the doctor did caution me on was that x-rays are not conclusive for stress fractures.

Since then the pain has steadily decreased, however I haven’t walked with a regular shoe on my left foot since Saturday. I brought my entire stable of running shoes, because I don’t really care how slow I am in transition, I just don’t want to break my foot. Basically I’m looking to the experts of Slowtwitch to make a shoe recommendation for me. I have the following shoes at my disposal:

Mizuno Wave Rider 16 - this is a neutralish training shoe. A little heavy, pretty well cushioned. Mizuno Hitogami - This is my half to full marathon racing shoe. Not very much cushioning, but I think that might be a good thing. I noticed that if a shoe has a lot of cushioning, it basically distributes the weight across my entire foot, including the fifth metatarsalMizuno Wave Universe 3 - I walked around in these shoes this weekend with almost no pain. This shoe is pretty much as minimal as it gets and it’s like having a very small amount of padding under my heel and forefoot (I’m a heel striker and damn proud of it). Typically I would hesitate to run a 10k race in these because I’m a heel striker and there isn’t a ton of cushioning, but this would be a little under 10k, split up into 2 halves, and I’m very comfortable running a 5k in these shoesNike Free Flyknit - These are the shoes that I was planning on racing in before all of this happened. They’re really fast in transition because they slip on and off super fast, and they hug my feet. I can also wear them barefoot, but I wouldn’t in this case because there’s no swim. I wore these around my apartment this weekend with a fair amount of pain. I think it’s because they have a fair amount of cushioning and it was distributing the weight across my entire foot.

Race Details:
Run 1: 4.6k
Bike: 30k
Run 2: 4.4k

Other questions:
Is there anything I can do to help take weight off the outside of my foot? Taping? Insoles? Other?
Any other tips anyone may have?

Thanks in advance for your help!

2

There is really nothing to consider here. DO NOT RACE. Its as simple as that. Better to properly recover then to get a prolonged injury from doing something stupid and ego driven.

3

I hear you.

I should note that I’m currently pain free (with 0 pain killers), and the doctor’s criterion was to be pain free by Friday.

4

Developed after speed training. Now where have we been talking about interval work and injuries? :o)

So if you Doc gave the green light, go for it. Worse case you break it during the race and get an early off season.

Good luck!

.

5

I would go out for an easy 3-4 mile run tomorrow. If it feels good go for it. If sharp pain is back I wouldn’t race.

6

Yeah, that’s good advice. This is what I was planning on doing tomorrow night. I might try at least a short distance in each pair of shoes to see what feels best. I’ve got extra speedlaces too, so depending on what I want to run in, I can switch out the laces.

7

My thought with injuries and whether one should race/train on the injury is that if you have to ask the question you already know the answer.

8

We’ve dealt with stress fractures on the opposite side of the foot (sesamoid for me). What I found was that mine was a product of having wide feet. This might be something for you to explore. I tried switching to EE wide shoes. But that didn’t get it fixed, because the problem was the profile of the forefoot in these shoes. I would recommend that either was you look into Altra Provision shoes. It blew me away the first time I laced these up. The zero drop feature is what it is (i happen to buy into it), but the reason to buy these shoes is the shape of the toe box. Your toes have room to splay and thereby have much less force on the outsides of your feet.

Also, taping seems to work for some people, but for me it made the situation worse. Less range of motion meant that the area had more force put on it. My foot needed more room to move not less.

9

Simple test - can you jump on it?

10

My thought with injuries and whether one should race/train on the injury is that if you have to ask the question you already know the answer.
This.

Though if the injury was caused by something unrelated to the upcoming training/racing, sometimes you’ll be OK. I know a guy who broke something in his foot just before an alpine skiing vacation. His ski boots so completely supported the injured bit, so there was no problem skiing.

Similarly I know several people who have been broken bones in bike race crashes, but have been able to keep riding no problem since the motion of riding isn’t related to the broken part.

11

Simple test - can you jump on it?

That’s a good one. If you can’t do simple running drills like skipping… probably not healed enough to race on… or even train on. That was my test for my Achilles.

The exception might… I say might… be if you have an end of season race that represents a major lifelong goal that can’t realistically be postponed or delayed or put off a year. Then, you might consider risking it realizing you’ll be deep, deep in the pain cave on the run.

12

I though that I had a stress fracture in my 5th metatarsal but it turned out to be peroneal tendonitis, this is something worth looking in to as the symptoms can feel similar. If you also have a muscle/tendon type pain in the front of your shin then it is more likely, the tendon runs down the front of the shin and because of where it inserts around the foot and ankle, if it is tight it can cause a lot of foot pain. Running faster than normal could very likely aggravate this.
Worth checking out - http://www.firstaid4sport.co.uk/Peroneal-Tendonitis-Ainjury_peronealtendonitis/

13

You could get a tuning fork test from a podiatrist or an ultrasound test from a physiotherapist. If either of these cause pain then it’s probably a stress fracture.

Hokas might help with the race. You would want the big ones like the Mafate. Not the newer more-flexible Hokas. The big Hokas keep the foot rigid and act as a rocker.

I did Ironman CdA this year with a stress fracture in my 2nd metatarsal head. I lasted about 12 miles on the run before all the pain started. I’m still recovering now.

14

I fractured my 5th MT at the end of last year - rolled my ankle onto the outside of my foot. I also had stress reactions (the oedema you get prior to a fracture) in both femurs at different points last year. So a bit of experience…

What you might have is tendonitis around an attachment point on the MT. Or you might have a stress reaction on the MT caused by the tendon pulling on it (you need an MRI to determine whether there is oedema on the bone). Did you have any pain around the MT prior to this? And can you jump on it now?

You need to understand that if you don’t yet have a fracture, the issue isn’t whether your 5th MT is weight bearing or not (good luck with finding a running style that keeps your weight off it, irrespective of your shoes). It’s the pull on the bone by a tendon, which snakes up around your ankle and into your calf. That tendon will be working every step you run, and it’s going to work away at the 5th MT whatever shoes you’re wearing.

Bottom line: if you can’t walk without pain, you’re flat out nuts considering running. Asking for a shoe recommendations is completely missing the point.

PS: you can run with a fractured 5th MT. I did - about a km to get home. It hurt a lot, and occasionally a step would make it hurt a real lot. The risk is that the tendon ends up ripping the base of the MT away from the shaft. Which, as my Doc told me when I said I didn’t want the boot, is fine, as long as I don’t mind him fixing it with a drill and some screws, and then having it completely non-weight bearing for 6 weeks.

15

ultrasound test from a physiotherapist
x2

I shouldn’t have wasted money with an ortho after I “failed” that test. Spending $500 for zero treatment was a waste once I knew it was a stress fracture and that only 6-8 weeks no running would heal it.

16

I had a “potential/pending” stress fracture in my left chin earlier this year, right before a 26.2. The doc said I could run the race, but would be in crutches for 6 weeks after.
He told me to shut down running (just swim & bike) for 8 weeks.
Glad I did. Since then I did a 13.1, and two 70.3’s.
To the OP…I think it depends on the pain if any when you jump or use a jump rope. What does the rest of your season look like, if you do the Du & make it worse, can you afford to cancel future races?
Also, if you do the Du, can you jog/walk/wog the run portion to make sure you don’t make it worse?

Best of luck…

17

Do you still want to try to run the Chicago Marathon? If yes, I wouldn’t race Saturday.

18

http://www.thestar.com/sports/amateur/2014/04/28/gutsy_runner_completes_halfmarathon_with_broken_leg.html
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19

Since you have no diagnosis and 5th met stress fractures are rare, why have you not had advanced imaging (i.e. techetium bone scan, CT or MRI) to confirm or rule out? Then you know for sure and can get on with your “plan”.

20

Thanks for everyone’s concern and advice (and if it wasn’t genuine concern, I’ll just assume it was :slight_smile: )

As an update, I did race, and I finished the race. For the record, under normal circumstances, I would not have raced, however this race was hardly under normal circumstances. 3 days before my race, I found out that my varsity nordic ski coach from high school had lost a 13-year battle with cancer and passed away from liver failure on 7/4. She wasn’t just my coach, but also my math teacher, mentor and a second mother to myself and everyone else on our team. She was the one who really instilled a love of endurance sports and a never-give-up attitude in me and I could think of no better way to honor her memory than to finish the race. Not racing was not an option in this case.

On the second run there was a non-trivial amount of pain, but not something that I couldn’t finish with. I’m back in the boot for now and I have an appointment scheduled with an orthopedic specialist who, I’d assume, will order more advanced imaging so we can see how bad my emotionally charged decision was. I didn’t get advanced imaging done earlier because I travel Monday-Thursday for work every week and I didn’t have time before I left.