Saturday, July 23, 2011

Averting a Metatarsal Stress Fracture in Progress

I've been sensing some dull pain and odd twinges on the top of my foot for at least the past two weeks. I've worried that I have another stress fracture in the works. Last year at this time my right foot had been in a protective boot with a stress fracture of the second metatarsal. I don't want another break, but I don't want to stop running either.

To confirm that the pain was related to a metatarsal I took a golf ball, placed it on a half inch foam pad, and stepped down on it at the second and third metatarsals heads. I used my left foot as a control and there was no pain or discomfort. The second metatarsal on the right foot (the one that fractured last year) seemed OK probably because it ended up stronger through the healing process, but there was definite discomfort when applying pressure on the ball under the third metatarsal. There was even some lingering pain. The discomfort was also not to the level of the two or three days leading up to the eventual break. My self-diagnosis is Stage I or II of a stress fracture in which there is crack initiation or an area of stress for Stage I or even some stress propagation in which any repair that is occurring is happening slower than the damage that is being done if I'm at Stage II. Stage III is complete failure; I know what that feels like and I am not there. It is a pain that can not be run through or even handle any weight bearing.

I did some googling and found that all advice suggested a rest period. I want to rest it, but I'm wondering if I can just rest that particular metatarsal. One bit of hope was the mention that the other metatarsals act as a splint to some extent for the distressed metatarsal. My thinking is that if I can divert most of the load that falls on the third metatarsal to the first and second and to a lesser extent, the fourth and fifth it may be able to recover while "going along for the ride".

It seems to me that if the metatarsal head weren't to bottom out during the foot strike that it wouldn't receive the forces of bearing weight. At this point, just wearing a shoe feels better than being barefoot. To relieve the metatarsal of its duty I cut a hole in the insert under the forefoot at the third metatarsal. The hope is that the metatarsal head doesn't bottom out and that it just enters the void in the insert.

For a test run I ran 3.3 miles pushing Elliott in the running stroller on pavement. I tried to heel strike a bit more and focus on getting the front inside edge of the running shoe down to the ground. The foot felt fine running, but walking around later, especially barefoot, the dull ache and an occasional hot twinge were apparent.

The question will be whether I've isolated the bone enough so that it can repair itself faster than I damage it. I'm assuming that reducing the upward force on it will be enough, but there may be lots of torsional stresses that occur that I haven't taken into account. I'm imagining the healing process to be similar to a cut on a knuckle that gets a lot of movement; it will eventually heal, but it takes longer than a cut on the forearm. Less movement should be better, but are the dynamics of bone healing different from skin? Look for updates in subsequent posts.


  1. I hope you are mending faster than you're wrecking. Be careful.

  2. That's the plan. I'm going to avoid the junk miles-I'm either going short and easy or steep and long, no hour or so runs. Today was all rest.