Bones Heal Slowly

A watched pot never boils.

Waiting for the third metatarsal of my right foot to heal feels like waiting for water to boil. At least with a pot of water, one can see some bubbles form on the side or maybe a little water vapor rise from the surface; I don't have much I can observe.

As mentioned in a previous post, I believe I heeded all the signs of a fracture in process and was able to avert a complete failure at the site of the fracture just in time. I assume that it should heal in less time than the seven weeks it took for a stress fracture last year when there was a clear instant of bone failure.

Part of the problem is not experiencing much pain. I wore a post-op shoe for about four days, then I was careful to wear a supportive shoe with an orthotic for several days, and lately in the house I haven't bothered with shoes. I would like to put some direct pressure on it to test it, but if I do enough to cause some pain aren't I also doing enough to cause some damage? And could I even be causing damage when there isn't pain? That's how a stress fracture develops in the first place, damage occurring little by little, step by step without pain until there is enough damage that the nerves are irritated and pass this information on to the brain of the always-in-denial runner.

Meanwhile, in 11 days I'm 3 pound heavier. Hmmm, maybe I should go for a run; the load of an extra three pounds can't be good for the foot, right? Must work that off. Maybe I shouldn't have put butter on those pancakes; well, too late to change that.

The plan is to not run or stress it for another week and then try it out with some easy runs. The most optimist time frame for recovery that I read from authoritative sources was 3-4 weeks for an incomplete stress fracture. 18 days is about three week.

Avoiding Rehab

For the past three days I wore a post-op shoe to protect the stress fracture in my right foot from progressing. While the shoe was suitable for protecting the foot, it was causing problems in the ankle (turning), calf muscle (tightness), and knee(stresses). The shoe is probably designed for someone who's recovering from foot surgery and needs to get from the bed to the bathroom, not for going about ones daily life.

The doctor had suggested I could probably wear a sturdy supportive shoe, maybe something like a hiking boot, so I decided to kick the post-op shoe last night. I switched to the most supportive running shoe I have and inserted some orthotics that I have from years ago which seem to direct much of the weight to the heel. I am able to walk normally with this combination. There is no pain, but since there is some flex in the sole I need to be careful about what I do.

My brain makes me laugh. I'm sure a drug addict doesn't think much differently. As soon as the pain wasn't present I found myself thinking I'll run one place or another. An addict might do some self-talk about rehab when in the scary throes of a high or crash but once in the clear seeks the next high. I have to be strong; I have to keep coming to my senses or I will have that overdose; I will complete the fracture and there will be rehab.

Hmmm, I was thinking three to four weeks, but if I can already walk ok....

Stress Fracture Breaking Point

For most of the summer I've been cognizant of a stress fracture in the early stages of the third metatarsal of my right foot. Each week I have been taking more rest days, a couple of easy jog days, and a longer mountain trail run in which I don't do any pounding. Tuesday evening I felt that I needed to get out for a real run and did exactly the kind of running I told myself to avoid. I ran 7.8 miles relatively hard on hilly trails and some pavement. I felt great; it's what I've been missing. It was clearly what I needed to avoid.

My stress fracture analogy is that you take a piece of copper wire and you bend it back and forth in the same place. It eventually becomes so weak that it severs. The same thing can happen to a bone under the right conditions; mine being that the bio-mechanics aren't quite right in my right foot. The difference between a bone a a piece of copper wire is that a bone can fix itself, but the repair happens slowly so if the "bending back and forth" outpaces the repair there will be an eventual complete failure like with the copper wire.

The foot probably needed total rest but I seemed to be getting away with the above-described running routine of 20 or so miles per week down from 40 something. If I stick with the wire bending analogy, on Tuesday, instead of long slow bends, I frantically did quick concentrated bends and took it right to the point of a complete break. I didn't even notice that evening, but when I got out of bed on Wednesday morning I couldn't put any weight down on the foot. I think if I had run to the mailbox I would have completed the break.

I tried wearing a shoe but found it didn't reduce the load on the foot enough. I still had a cam walker (boot) and a post-op shoe from last year's stress fracture. I wore the boot for six weeks; the post-op shoe was useless. I gave the shoe a try and it seems to offer enough protection so today is the third day wearing it.

I had been avoiding any NSAIDs over the past few weeks because they impede bone repair and I'm continuing with that. I had been taking 1000 mgs of calcium with magnesium and zinc and I have doubled that. Already, if I step down gently and evenly barefoot there isn't pain, but if I apply focused pressure up under the third metatarsal I feel pain so I plan to keep go with the post-op shoe for a week and then try some other presumably supportive shoe options.

With a complete break last year I was able to return to some easy jogging after 8 weeks. My hope is that I can rest this for about three weeks and return to the easy jogs and longer trail runs while favoring the foot the best I can. I'll see; if it needs more time, I'll take it. I want to do a 50K the last weekend of September.

Another Light Week and a Green Mountain Ascent

Another week of low mileage has passed. My hope has been that if I limit my outings to short runs, incorporate three or four rest days per week, while allowing a long slow trail run on occasion the pains and twinges I feel as a potentially pending metatarsal stress fracture will be averted. The plan seems to be working. I went out for a couple of three mile jogs this week pushing Elliott in the running stroller and on Saturday Alex joined me on a run to the summit of Green Mountain from the NCAR parking lot in Boulder and back.

Alex was not in the running condition necessary for such a run but with overall strength and youth on his side he was able to tough it out and make it up and back. I felt great. I probably could have run the entire ascent in close to an hour but Alex, who was also suffering from strained cartilage around the sternum from parkour that made hard breathing painful, needed an occasional rest and to walk some of the steeper sections. The temperature was around 90 and although he brought a liter of water I don't think he had hydrated adequately beforehand. I had eaten a hardy breakfast, hydrated during the night, and downed a quart of Gatorade beforehand so I was prepared. I didn't even need a gel on the way.

The elevation difference between NCAR and Green's summit is about 2100 ft., but there is an ascent and descent before the trail starts up in earnest in Bear Canyon so overall gain is probably 2400 ft. I think the route is the most runnable of any of the climbs to the summits of the peaks on the edge of Boulder. There are no stretches where a well-conditioned trail runner would have to break from a run motion to a power hike. The overall ascent was 4.2 miles so there is roughly a 10% average grade.

We took in the view at the top for a couple of minutes, were awed by hundreds of dragon flies swarming, chatted with some hikers taking a rest and headed back down. I had assumed that Alex would let loose on the descent and that he'd be waiting for me but the irritated cartilage was even more painful running downhill, we assume because of increased arm movement for balance, so I was a bit torn between going slower and staying with my invited guest or letting fly. Once we were about halfway down and I found myself alone I just kept going; I figured Alex might be better off at his own pace without feeling he was influencing what I was doing or that he was having to push himself through pain.

My foot did not seem impacted by the run although there was some increased irritation of the Achilles tendon in the left foot. Today is the start of my last week of summer vacation before the school year begins so I'm going to try to fit in two long runs.