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Stress Fractures in Runners

stress fx

Think you may have a stress fracture in your foot or leg from running? Here are some simple tips on what to look for to help differentiate a fracture from a soft tissue problem such as a tendonitis.

To put to rest all of the rumors that minimalist shoes cause stress fractures, here is a simple statement: Stress fractures result from overuse and osteoporosis. Not shoes
Why then are we seeing the reports of people getting stress fractures from minimalist shoes and running barefoot? Because they transitioned way too quickly and created an overuse phenomena that their foot was not ready for. It is no different then going to the gym and doing 300 bicep curls. You will overtax muscles that haven’t adapted and put excessive stress on the bones of the foot from faulty biomechanics as a result of fatiguing muscles.

So how do we tell the difference between a boney problem and a soft tissue problem?

Tendonitis tends to hurt more upon arising in the AM and then subside as we move around only to become painful again later on in the day. It may even feel great during a run, but towards the end, and especially after become more painful. When suffering from a chronic tendonitis you may actually have good days and bad days associated with activity and the healing process. Surprising as it may sound, complete rest is not always best for a tendonitis. Tendon repair actually occurs when positive stress is applied in a controlled manner such as with physical therapy.

Stress fractures will often present with constant pain that lingers most of the day and doesn’t improve with running or activity. It actually will get worse. Stress fracture pain is also very point tender, meaning the pain is in an isolated area and very sharp when pressing in that area. Stress fractures are most common to the fourth metatarsal in the foot, the tibia of the lower leg, and vary rarely in the heel bone (calcaneal stress fracture). Plantar fasciitis is commonly misdiagnosed as a stress fracture too often after a bone scan is ordered for further examination. MRI is the study of choice to diagnose a stress fracture when it is being considered in any runner. Many times an xray will not show signs of a stress fracture for 2 weeks when and MRI can show immediate changes. This is crucial because altering training patterns for two weeks when waiting for xray changes can be detrimental for any runner.


Plantar Fascitis commonly misdiagnosed as a calcaneal or heel stress fracture.
Plantar Fascitis commonly misdiagnosed as a calcaneal or heel stress fracture.
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