metatarsal fracture, wtf am I to do?

Seriously, I've been taking it easy, I promise I have, and yet it won't heal completely.  The fracture is right behind the major knuckle on the second metatarsal.  Doc confirmed it was a hair line fracture back in mid Feb.  He says it's in a good spot because any higher and it would have been the joint which I would have greatly regretted it to be so.  He says it should heal fine and be just as strong if not stronger then before.  I can barefoot run just fine with no issues but I haven't gone more than a mile a week since I saw the fracture in xray; at least until I was able to do so with no symptoms.

Normally, I go barefoot or shod.  My experiences running in Treks is what caused the fracture in the first place.  Last weekend it was feeling normal again, completely.  So I decided to do some trail running for a change, just a 1.25 mile easy 10-11 min/mile pace in my treks.  Now the fracture has been aching to the degree that I Feel I have to baby it again lest it get worse.  It is gradually getting better but I can feel it whereas prior to that trail run I didn't feel it any longer.  I'm beginning to feel rather frustrated that I can't seem to get the hang of running in VFFs without hurting myself but I can run barefoot just fine.

To anyone that has experience, How long can I expect this to go on?  I know it's in a odd spot, but the bone should be strong enough by now.  Because of where it is, I would imagine it is having a hard time healing completely due to the way the foot flex and bends; so perhaps I should chill a bit.  but if it's going to be this way every time I think its fine again then I might as well go back to shod heal striking it or not were VFFs at all when I trail run at least, I guess.  Should I just start wearing a boot to better isolate it while on my feet?  The doc didn't think it was necessary, he just said to take it easy and wear a more stiff shoe for now, which I have been.  I swear I didn't start bare footing it again until I was sure there would be no symptoms.  I guess I'm just hitting too hard in vffs and need more time to learn better form.  /shrug.  I don't mean to sound rude or anything, I'm just kind of tired of it along with my piriformis issues.  At least the latter seems to be getting better.

Comments

  • I'd lay off the vff's for a while, and try taping the toe to either of the adjacent toes...This will help keep it from flexing as much...It'll still flex, but not as much, which might give it the reprieve it needs to fully heal. May not help at all, but it's better than not being able to run in my opinion.
  • I had a metatarsal stress fracture at this time last year.  My foot first starting hurting in March, and I tried to do what you've been doing - very little running (maybe a mile here or there), a bit of walking in VFFs, mostly wearing sneakers.  Big.  Mistake.

    Stop running - completely.  Not one mile, not a half, not a quarter.  Not to catch a bus.  I know this sucks.  Believe me, nobody knows that more than I do.  But a fracture is not like tendonitis or other injuries where you can "cheat" a little bit and get away with it as long as your ice and take it easy the next day.  The bone has to heal completely before you run again, even a little.

    I screwed around "taking it easy" for about 10 weeks before a podiatrist finally took x-rays and put me in a walking cast/boot (the first podiatrist I saw assured me it wasn't a stress fracture and thereby set me back weeks on the recovery).  I had to wear it for two weeks and then the fracture was healed.  When you're in a cast, again, no cheating.  That means you wear it at all times when you're putting weight on the foot (one exception: shower).  I literally did not take a single step or stand for even two seconds (again, except for the shower) without my foot in that boot during those two weeks.  Kinda sucked, but it worked.  Keep in mind that I was probably half healed from the 10 weeks of not running, which is why it only took 2 weeks.  The standard recovery for a metatarsal stress fracture is 6-8 weeks in a boot if you get booted as soon as the fracture is diagnosed.

    I'm not a doctor and am not trying to tell you to go against what your doctor said, but as you can see, I had a very similar experience, and I really wish I'd just bit the bullet and gotten the cast much earlier.  A fracture has to be allowed to fully heal with no stress on it or it's just going to drag out.

    good luck.
  • You shouldn't run at all for 4-6 weeks, then 2 weeks more of progressive reconditioning with walking mixed with short running. During the resting period I would recommend you to take off your foot from the inner side pushing with your big toe, that way you won't stress your metatarsal so much.
    I haven't been running during all March because of TOFP, but it was probably a stress fracture in the 4th metatarsal of my left foot. I didn't bother to have an X-ray radiography because most stress fractures can't be spotted and I didn't want to waste my time since in any case the treatment would have been the same: rest for several weeks until whatever it was had heeled. In fact, an X-ray visible line of fracture like yours is indicative of worse prognosis.
    I went to run for the first time last Saturday. I ran barefoot 3 km and 2 km more in VFFs. I didn't feel pain again but the foot wasn't perfect either. Perhaps it was too much (I didn't know then that I would have to spend 2 weeks more with progressive walking-running conditioning). Hopefully if I don't abuse too much my foot would be ready in 2 weeks.

    Here you have a fragment of an article about stress fractures posted in the blog of a sport clinic:

    Most non-critical stress fractures will heal with 4-6 weeks of rest (no running). For the medial tibia and metatarsal stress fractures, I will often prescribe a walking boot for a few weeks as in general this makes walking more comfortable and my experience is that runners typically get back to full training sooner if we take this more conservative step early on. During this time the runner may remove the boot for sleeping, showering, driving, and cross-training. I prefer deep water running, but the elliptical and bike are good choices, too. Try to pattern your cross training workouts to replicate what you would normally do on land. The return to run program commences after 4-6 weeks and progresses gradually. I often start the runners on a walk/jog program where they walk a minute/jog a minute for a couple weeks before they begin regular running. During the transition back to full training, cross training supplements the progressive run training.
    http://uvaendurosport.wordpress.com/2010/06/17/stress-fractures/

    I would add that if you continue wearing shoes, it'd be probably better to wear shoes with a zero heel-to-toe drop. Any heel rise would load more weight on your metatarsals.
    Besides there are a few things you can do to accelerate bone mineralization: add oily fish or fish oil to your diet (raw, boiled, steamed, baked but not fried, nor fish sandwiches: http://www.nlm.nih.gov/medlineplus/druginfo/natural/993.html), a few minutes of exposure to sunlight with as much skin exposed as possible around noon, when the UV radiation is highest, also enough calcium, phosphate, boron, fluoride in your diet. A good source can be the same fish bones, also enough protein but not too much, otherwise its catabolization would make your body more acidic thus inducing bone resorption, enough sleep and some physical exercise (but not running). Better plant food than animal (except to fish) because most plant food leave alkaline ashes after its complete oxidation whereas meat will leave acidic residues. There are some exceptions with plants though, any food rich in methionine or cysteine (such as cereals) would probably leave an acidic residue (H3O+), on the other hand, food rich in citrate, malate, lactate, etc. will leave basic ashes (HCO3-):

    Sulfur-containing amino acids in protein-containing foods are metabolized to sulfuric acid. Animal foods provide predominantly acid precursors; dietary animal protein intake is highly correlated with renal net acid excretion (r = 0.84, P "less than" 0.0005) (9). In contrast, vegetables and fruit contain not only amino acids but also substantial amounts of base precursors; the metabolism of organic potassium salts (citrate, malate, and gluconate) in fruit and vegetables yields potassium bicarbonate (10).
    Diets that are rich in animal foods and low in vegetable foods, typical of industrialized countries, lead to a dietary net acid load that has a negative effect on calcium balance (11, 12). The magnitude of this detrimental effect increases with age. With aging, the glomerular filtration rate falls and the kidney’s ability to excrete this dietary acid load is impaired (13–16). Thus, otherwise healthy individuals develop progressively increasing blood acidity and decreasing plasma bicarbonate as they age (13, 17).



      [li]Sellmeyer
    et al. A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Study of Osteoporotic Fractures Research Group. Am J Clin Nutr (2001) vol. 73 (1) pp. 118-22
    http://www.ajcn.org/content/73/1/118.long
    PMID: 11124760 (http://www.ncbi.nlm.nih.gov/pubmed/11124760)[/li]


    For some examples evaluating the effect on the body internal pH of different diets:


      [li]Sebastian
    et al. Estimation of the net acid load of the diet of ancestral preagricultural Homo sapiens and their hominid ancestors. Am J Clin Nutr (2002) vol. 76 (6) pp. 1308-16
    http://www.ajcn.org/content/76/6/1308.long
    PMID: 12450898 (http://www.ncbi.nlm.nih.gov/pubmed/12450898)[/li]

  • on 1302111216:

    I had a metatarsal stress fracture at this time last year.  My foot first starting hurting in March, and I tried to do what you've been doing - very little running (maybe a mile here or there), a bit of walking in VFFs, mostly wearing sneakers.  Big.  Mistake.

    Stop running - completely.  Not one mile, not a half, not a quarter.  Not to catch a bus.  I know this sucks.  Believe me, nobody knows that more than I do.  But a fracture is not like tendonitis or other injuries where you can "cheat" a little bit and get away with it as long as your ice and take it easy the next day.  The bone has to heal completely before you run again, even a little.

    I screwed around "taking it easy" for about 10 weeks before a podiatrist finally took x-rays and put me in a walking cast/boot (the first podiatrist I saw assured me it wasn't a stress fracture and thereby set me back weeks on the recovery).  I had to wear it for two weeks and then the fracture was healed.  When you're in a cast, again, no cheating.  That means you wear it at all times when you're putting weight on the foot (one exception: shower).  I literally did not take a single step or stand for even two seconds (again, except for the shower) without my foot in that boot during those two weeks.  Kinda sucked, but it worked.  Keep in mind that I was probably half healed from the 10 weeks of not running, which is why it only took 2 weeks.  The standard recovery for a metatarsal stress fracture is 6-8 weeks in a boot if you get booted as soon as the fracture is diagnosed.

    I'm not a doctor and am not trying to tell you to go against what your doctor said, but as you can see, I had a very similar experience, and I really wish I'd just bit the bullet and gotten the cast much earlier.  A fracture has to be allowed to fully heal with no stress on it or it's just going to drag out.

    good luck.


    I hear ya.  I'm not on my feet most of the day anyways save for a few hours window at work when I have to stand for a bit to relieve muscle tension in hamstrings and piriformis.  At this point, I wish he would have issued a boot for me instead of the bone stimulator.  But I guess I can get one on my own or just wear my keens and walk with more on the heel.  I mean, the damn thing does heal but not COMPLETELY, like you said.  I really feel it has to be immobilized in a cast or something at this point because I'm not putting up with this crap any longer.  I did get a follow up x-ray about 10 days ago and I couldn't even see the fracture compared to the first x-ray.  I mean I had to look really hard and even then it was hardly present save for what looked like a fuzzy hair along the bone.  Granted, the doc said give it another month of stiff shoes and no running and it should be fine.  I gave it less than that.  I can say this:  wearing VFF with a metatarsal fracture is damaging.  I notice more discomfort with them on versus just walking barefoot; mainly because I can better control foot movement with the big toe.  I like VFFs and all, but I'd rather just be barefoot or wear some sort of minimalist sandal after this damn fracture finally heals.  I'm certainly not doing any trail running any time soon and even then I'll be wearing shods.  I'm not chancing dragging this out any longer.

    Thanks for your story, sounds like I'm in the same boat.

    I would add that if you continue wearing shoes, it'd be probably better to wear shoes with a zero heel-to-toe drop. Any heel rise would load more weight on your metatarsals.
    Besides there are a few things you can do to accelerate bone mineralization: add oily fish or fish oil to your diet (raw, boiled, steamed, baked but not fried, nor fish sandwiches: http://www.nlm.nih.gov/medlineplus/druginfo/natural/993.html), a few minutes of exposure to sunlight with as much skin exposed as possible around noon, when the UV radiation is highest, also enough calcium, phosphate, boron, fluoride in your diet. A good source can be the same fish bones, also enough protein but not too much, otherwise its catabolization would make your body more acidic thus inducing bone resorption, enough sleep and some physical exercise (but not run). Better plant food than animal (except fish) because most plant food leave alkaline ashes after its complete oxidation whereas meat will leave acidic residues. There are some exceptions with plants though, any food rich in methionine or cysteine (such as cereals) would probably leave an acidic residue (H3O+), on the other hand, food rich in citrate, malate, lactate, etc. will leave basic ashes (HCO3-).


    Indeed, I have been doing this very thing the last few weeks.  I take about 10k IU of vitamin D3 per day as well as very good quality fishoil and cod liver oil and I always feel better (regardless of illness) when I'm in the sun, aaahhh.  In addition, I'll just have to religiously use that ultrasound bone stimulator the doc gave me.  Since it's just a hair line stress fracture, I presume that is what he didn't think the boot is required but I can see why it can help a great deal.
  • I've recovered from both a stress fracture and 5 broken bones in my foot from a hiking trip gone wrong. Took 8 full weeks of no running to get the stress fracture to heal enough to where I could start to slowly begin jogging again. I started by walking 1/16 mile and then jog 1/16, repeat twice. I'd take at least 48 hours off to determine if I was okay, or needed more time off. Slowly I would add more repeats. Wasn't fully back to running normal for an additional 3 months - total recovery time almost 6 months.

    Still working on adding mileage from my June 19th, 2010 hiking fun. Up to doing 1.5 miles three times a week now. It takes time to come back from injuries. Remember : Pay me now, or pay me later.

    You must be disciplined during recovery.

    Rgs, Jeepman
  • I could not stand more than 3-5 hours at work due to severe pain in both feet as result of plantar fasciitis. After receiving proper treatments and wearing the orthofeet shoes I can happily say that I am able to stand for 12 hours at work and be pain free in both my feet. They feel great and I love the colors. Have helped my knee pain tremendously.
  • The Biosole-Gel insoles shoes have really given me pain relief from my year long battle with plantar fasciitis. I have are so comfortable and really helps my planter fastidious. Able to walk now even long distances without much pain. Will definitely be buying another pair from orthofeet! I would recommend them to anyone with any kind of foot pain. Wonderful support all the way around.
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