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Stress fractures in runners

Think you have a stress fracture in your foot? It’s very common to have aches and pains in your feet from exercising, especially running. But how can you tell if it’s a stress fracture? I’ve put together a quick post to give you some pointers on stress fractures and what the standard of care is for diagnosing one.

To begin with, the most common region to see a stress fracture in the foot are the metatarsal bones which are the long bones of the foot.  The literature describes seeing them most often in the 4th metatarsal.  The calcaneous or heel bone can also fall victim to a stress fracture but this is extremely rare. Many times chronic cases of plantar fasciitis are misdiagnosed as stress fractures of the calcaneous.

Although the fourth metatarsal is the most common encountered stress fracture, we definitely see stress fractures in the other metatarsal bones. The complaint is usually a sharp pain to the top of the foot just before your toes.
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The pain is usually constant and becomes worse with weight bearing. There will be swelling on the top portion of the foot making the tendons one normally sees not visible. Sometimes the patient will describe bruising which is really just engorgement (swelling with blood) rather than true brushing or underlying bleeding. Tendonitis in comparison would be pain in the similar area but would be worse in the morning when first getting out of bed and then slowly improve as your foot muscles and tendons warm up from walking. Usually 15-20 minutes. The pain will then gradually return as the days goes on with continued bouts of worsening after rest with slight improvement by warming up.

Stress fractures usually occur after increased amounts of activity too quickly. There is usually not a specific or traumatic incident. Tendonitis can result from the same type of activity making it difficult to diagnose.

Stress usually do not show up on radiographs until typically after two weeks of symptoms when we start to see healing of the bone. If initial radiographs are negative, and it is imperative to find out whether or not there is a fracture, an MRI will be ordered immediately. This will typically be done for competitive or elite athletes and sometimes for those training for an upcoming race and need to find out if a fracture is present. Insurance companies tend to deny payment however if treatment by immobilization in a cam walker is not first attempted. I utilize EIP, which is an open MRI facility and they can get my patients in within 24 hours.

Read my recent Podiatry Today blog post to see several examples of stress fractures in runners I have recently treated.

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