Stress fractures

[Sasha Pachev]

I am interested in everything anybody knows about stress fractures. Areas of particular interest are the ones in the foot, more particularly the heel bone, that one can run on without extreme pain. Specific questions:

Is it possible to have a stress fracture in that area with the following symptoms: dull pain, running at slower speeds does not make it worse, a day of rest or reduced mileage does not make it better, running really hard makes it worse for a couple of days but then it goes back to the same level?

Demetrio Cabanillas (according to Bill Cobler) claims that a stress fracture heals at the same rate whether you run on it or not. I would like to hear any comments on that statement.

In my own experience I've never had a diagnosed stress fracture. So anybody who's had one, I want to hear from you.

[Chris M]

Just some ideas/thoughts:

From what I know from other people I was under the impression that if you actually had a stress fracture it would be too painful to run on?

Also the way of treating stress fractures that I am aware of is to take all weight off of the foot/leg eg using a kind of immobilzation boot such. This would suggest that it does not heal at the same rate with or without rest?

I am no expert for sure but what you describes sounds more like nerve irritation, when you run it aggravates it and when you stop it goes back to the same level but no worse. You mentioned a day of rest helps but have you tried a day of rest with not bearing any weight on the foot?

[dave rockness]

I'm no doctor, but I agree with Chris that is sounds nerve related.  I had similiar symptoms last November and was convinced it must be some sort of fracture.  My foot doctor, who is also a marathon runner (pr-sub 2:30), took x-rays and could find no structural damage.  He gave me simple, almost over-the-counter type drug to deal with the swelling and allowed me to keep running.  I took 3 or 4 days off and gradually worked my way into higher mileage without ever stopping.  My pain which started in mid-July '08 didn't go away until after Boston (April '09).  This included several months of 300-mile month training.  On 20-mile runs, I would hurt for 2-3 miles, even limp, but then the pain would dull and I would have no trouble completing the distance.  "Speed work" was painful and often required 3-5 miles of warm-up to even be tolerable.  A day or two off never seemed to help much.  Road races absolutely burned- didn't complain much on my blog, just learned to live with it.  I'm not sure when the pain stopped...but it did.  My foot is now 100%, no sign of pain. 

[AndyBrowning]

I had stress fractures in both tibias at the same time.  I ran on them for 6 weeks before they were diagnosed and only took 1 week off.  The pain is definitely not a dull pain.  It is a sharp localized pain.  Even though I continued to run on them I do not believe that they heal at the same rate whether you run or not. 

[April G]

I have had metatarsal stress fractures.  The pain was sharp and I absolutely could not run on it.  I also had a lot of swelling initially--my foot looked like a football. It is my understanding that calcaneus(heel) stress fractures are extremely rare.  I suspect, like the others, that you have soft-tissue or nerve-related injury that is just going to take a long time to heal, regardless of whether you run on it or not.  If you did have a stress fracture, running on it would probably prolong healing.  The bones have to be immobilized so they can grow together and mend themselves.  If you keep running and "breaking the seams" the bones would take longer to heal.

[Maurine Lee]

I had a stress fracture in my tibia and working out on it only exacerbated the pain (it took 6 weeks to get a diagnosis).  Immobilization was the only thing that allowed it to finally heal.

[Sasha Pachev]

Thanks for the feedback, everybody. Keep it coming. Let's collect everything we know about stress fractures in this thread.

[Josse]

Stress fractures are very different form person to person and place to place.  Some stress fractures will require time off for complete healing and are very painful, while others will require modified running and are not very painful.   I have known people who have run through them and other that have to take complete rest, meaning nothing (not even crosstraining) until it heals.  The only true way to tell if you have a stress fracture or not is to get a bone scan.  Until then it is only a guessing game.

[Jason]

Hey everyone, posting for the first time in a few months actually because of a sfx.  I was running my fastest times and I developed a pain that felt like shin splints.  Cut down the mileage and then ran a race and it was killing me.  Went to the doc for xrays and mri and they both showed nothing.  Went to three docs, was told to take off 3-4 weeks and then start again.  I did this, but the pain was still there so I went for a bone scan which revealed a sfx in my medial mallaleous.  Currently I am in a boot and have been swimming and biking to keep myself somewhat sane for the time being.  Also, I am using an exogen machine which is a bone growth stim machine to speed up the recovery.

[Quadraballer]

Having had multiple stress fractures, including one on my Talus, I can shed a little light on the subject.  Most of the time, the pain associated with a fracture will not be mild, it may start mild, but over time it will get quite severe.  Normally they will not hurt too much in the morning, but once you become load bearing on them, they become more sensitive and painful.  Running hard on them, if running is possible at all, will certainly create more pain due to the increase ground reaction force.  I have yet to have a stress fracture I could run through, although I have heard of people doing it.  In general, I do not believe they heal at the same rate if you stay active on them.  My worst fracture was in my left tibia, the more I ran on it (regardless if it was only a mile) the worse it got.  By the time I finally stopped running on it the pain was so severe I could barely walk.  A fracture on the heel would be a bit unusual, but not impossible, I would guess more the cause of trauma then repetitive stress. 

[Rhett]

I was worried about a stress fracture in my heal, had some X-rays taken that came out negative.  My podiatrist said that stress fractrues in the foot are usually more in the little bones of forefoot and mid foot and that the pain was most likely from the dreaded plantar faccia insertion point being inflamed.

[Bonnie]

I had a good friend in Nashville who had a tibial stress fracture for at least a year -- you could see the darn thing (it was a big bump).  After about a year her leg just broke, like 'snap'.  It is likely that if anyone is actually running on a stress fracture, it is not a stress fracture.  Stress fractures are a crack in the bone and if running is what caused it (stress), and you continue to run on it, the bone with break.  Did I mention 'snap'?  It was during a race ... it was horrible.  Dean had a stress fracture in his toe, it also eventually "fractured" -- like seen on x-ray fracture.  They saw a little "red blip" before it fractured (probably the stress reaction thing), but he continued to run, and then one day it broke, and he knew it even before the x-ray showed it.  I am trying to think of any stress fracture that someone could actually run through without the bone eventually breaking, and I just can't imagine.

[Toby Barlow]

I agree with all the other posters. 

I have a stress fracture in the heel and distial tibia and these were diagnosed via bone scan.  I was told NO impact exercises (swim and bike only) and can start light impact (elliptical trainer) after 6 weeks. Gradually come back to running.

My doctor told me that if I continue to run on it (no way I could have because of the isolated pain), the impact on the bone would cause it to break and I would be out 6 months.

Here are a few aqua running and "comeback to running" websites that I have found very helpful:

http://pfitzinger.com/labreports/9wkH2O.htm

http://www.pfitzinger.com/labreports/stressfracture.shtml

[James Winzenz]

There haven't been any posts on this for a while, but I thought I would add my 2 cents, since I am just coming back from a stress fracture in the front of my navicular (same place that Deena Kastor had a full fracture in the 2008 Olympic marathon in Beijing).  Stress fractures normally will not show up on an X-ray - my orthopedic surgeon told me that, and this was verified.  Looking at my foot on the x-ray, you couldn't tell there was anything wrong with it.  The only effective way to diagnose a stress fracture is with either a bone scan (what he ordered for me) or an MRI.  With the bone scan, it was immediately apparent there was something wrong.  There was a huge dark area of blood pooling, indicating the body was trying to heal an injury.  Like the others, mine was a sharp localized pain that only increased.  However, I was forced to stop running for several months (4) to allow it to heal completely.  I did not have to wear a boot and keep from any load bearing activity.  I did, however, have to get some orthotics (I didn't get custom hard orthotics - just the Dr. Sholls customfit orthotics) and then I was walking for about the last month to try to get in some sort of activity that wouldn't put a lot of stress on the joint.  I know that everyone is different, but that was my experience.  Of course, I had been dealing with this since May of last year and never gave it enough time to fully heal, so I wanted to make sure that it was totally healed before I started again - thus the conservative approach of waiting longer than I might have normally.

[April G]

Now that I am the owner of two stress-fractured tibias, I'll throw my two cents in as well.  I experienced some calf tightness and a vague pain at the bottom of my knee several weeks before running the Houston Marathon on January 30th.  It went away with a few easy days during the taper and the marathon went fine.  Recovery from the marathon went fine.  When I resumed marathon training everything was fine.  A few weeks ago after a day off I went for a run and it felt like somebody had slammed my knees with sledgehammers.  It didn't hurt to walk, only to run or hop, and the pain was easily doused by motrin, so I, foolishly, kept running, thinking it was just some weird soft-tissue inflammation-I have run through this kind of vague pain many times before and it eventually goes away.  This did not.  I could not localize the pain, or decide if it was my shin or knee that was the problem.  It was in the wrong place for shin splints and I kept thinking it was more my knee.  Eventually, I began to get this "unstable" feeling in my lower legs while running, and could not run without a motrin on board, and then even then the pain became too much.  I finally had my epiphany, realized it was time to stop, and went to doctor.  The bone scan showed bilateral tibial stress fractures at the very tops of both tibias at the knee.  I know undoubtedly that I made them worse by continuing to run, and there is no way I could have kept running through them and ever expected to heal--it was making them worse.  Now I am banned to the pool only with no weight-bearing exercise allowed at all(no bike, no elliptical, etc...)  I believe the cause was a combination of over-training(resuming marathon training and normal mileage too soon after marathon recovery), and a nutritional issue(vitamin D deficiency), with increase in treadmill running and untried shoes as possible contributors as well.  Get your Vitamin D because your calcium does you no good without it!