I was recently asked asked about a blog I did on stress fractures a little while back and thought the following important as we set our training plans for the upcoming season. Although our weather forecast here in Virginia calls for 6 - 12" of snow tonight, athletes everywhere are creating training plans to fit race schedules this Spring and Summer.
So many posts on ST involve self-induced injury! Time and again when a poster reports a physical issue, and after a few rounds of questions comes up with an, “I know when I did it” type of answer, I think about prevention. Any list of the most common overuse injuries in runners would include : 1) Patellofemoral pain (21%), 2) ITB friction syndrome (11%), 3) Plantar faciitis (10%), 4) Meniscal injuries (6%), 5) Shin splints (6%), 6) Patellar tendinitis (6%), 7) Achilles tendinitis (6%), 8) Gluteus medius injuries (4%), 9) Tibia stress fractures (4%), 10) Spine injuries (3%).
In one medical study, 6 young men presented with midshaft tibia stress fractures which failed to heal with the usual conservative care of rest, immobilization, etc. and 5 went on to complete fractures!! Think having a rod place down the middle of your tibia might alter your training?
We also think of the metatarsal bones in the foot as commonly seen sites of stress fractures but I was taught that they’ve actually been reported in all 26 bones in the foot and the sesamoids.
The take away lesson here is that none of us is immune. Running programs which ramp up more quickly than the athletes body can take can be hazardous to ones health, and that when weather or life get in the way of training, the better choice might be to just forget a work out or two rather than accept overload at a later date. Each of us is different as we define overload so just because a training partner can work at a certain level does not necessarily mean we can. If we just think before we make choices and listen to what our legs are telling us, we reduce the potential for self induced injury. And, we’re more likely to kick butt in that first tri. Good luck.
The take away lesson here is that none of us is immune. Running programs which ramp up more quickly than the athletes body can take can be hazardous to ones health, and that when weather or life get in the way of training, the better choice might be to just forget a work out or two rather than accept overload at a later date. Each of us is different as we define overload so just because a training partner can work at a certain level does not necessarily mean we can. If we just think before we make choices and listen to what our legs are telling us, we reduce the potential for self induced injury.
You are right, but don’t expect the usual aspiring athlete to heed your warning. They’re not known for their common sense.
=1 on people not listening to your advice. however, great post. Scary thought. I had a guy who felt “groin pain” 18 miles into a marathon and fractured his femoral neck at mile 20. Have a huge screw put into your hip at late 20s or a rod put in your tibia…not fun! Good advice
Yes, I’ve seen this type of problem before. But, hopefully, those readers who are relatively new to the sport can learn from those who’ve walked in these shoes before. The whole theme of my blog is prevention of injury in the endurance athlete. Post race parties are fun and even more so when you’ve accomplished your pre-race goal whether it’s to win your age group or merely run at a sub 10 minute pace for the first time.
Is there any other way besides an X-ray to tell if you have a stress fracture? For about 3 months now I have had what feels like a bruised left forefoot. I feel it on the ball of my foot in the middle of the area supporting my 4 non-big toes. This is pretty much where my foot comes down when I run or walk. I have had 2 xray’s done and nothing was apparent (one was at a clinic and the other by a podiatrist). It doesn’t hurt when I push it on it with my hand. Can you bruise something in this area instead? It may be a coincidence but my PF seems to have started up shortly after I started feeling this (my first bought with PF ever…lucky me!),
Plain x-rays are generally normal/negative early in the course of stress injuries. Bone scan is a nuclear (more affectionately known as unclear) medicine exam that is positive early on, and MRI generally shows bone marrow edema early but is more expensive.
in regard to Onboost91’s reply about pain at the ball of foot and stress fractures. For about 5 weeks I have had the same symptoms with kind of, sometimes, shooting pain in the effected toes. My Doc said right away - metatarsalgia. With rest - only swimming - it seems to be slowly getting better. Without a bone scan, I still wonder if it is a stress fracture at or near the metatarsal ball? Anyone else have experience with metatarsalia or these symptoms?
“metatarsalgia” isn’t a diagnosis at all - just a generalized term for a variety of pathologies. Pretty much encompasses all the usual culprits: Morton’s neuroma, less metatarsal stress fracture, Frieberg’s infraction, less MTP joint capsulitis, plantar plate tear, etc.
So, pain in the ball of foot, one can easily say “right away - metatasalgia”, but why? Rest will pretty much heal most of the usual culprits, but without finding a clear diagnosis, it gets hard to find a reason, which then is hard to find a treatment, and so on.
I think ultrasound is an often overlooked diagnostic tool. I stumbled onto someone who knew what they were doing, and they were able to image two neuromas and bands of inflammation along the metatarsals that is a precursor to stress fracture. It’s a non-invasive and relatively inexpensive procedure, with no radiation exposure.
If you need professional help, go to a clinic/doc/PT that specializes in runners. The first round I didn’t and wasted 2 days/week for three months. Second round I decided to drive 2 hours to teaching hospital with a runner’s clinic–in five PT sessions I was back on track.
Whatever the case, don’t run through recurrent, sharp pain in the foot. I did, ended up in pain so severe I could barely walk, no weight bearing exercise at all for four months, and nearly a year of running lost. I’m still working up to where I was a year and half ago.
The up side is I went back to swimming, and now I’m registered for my first tri in March.
How long does minor soreness or tenderness from a third metatarsal stress fracture typically last? My wife is working on a year and still has soreness and about 6 months for me. Not enough to stop you form any activities, just sore.
Residual soreness is common and usually lasts MUCH longer than it take the stress fx to heal - most notice something (albeit minor) for up to 6 months. 1 year is pretty long though.
