stress fracture 3rd metatarsal

What kind of doctor did you see? Ortho? GP? Sports Med jack of all trades?

I just got a sfx on my third met after getting back into shape from a sfx on the 2nd. This time, the ortho said to stay off running until there was no pain and then return to running. No boot, air cast, etc. Maybe 4-6 weeks total off of running.

For the second met, I only did about 2 weeks in the boot and was off running for about 7-8 weeks total. Treated by an ortho for that sfx.

They said stationary bike was ok as long as I stayed in the saddle.

I have heard that some think that the bone needs some stress in order to promote the healing process vs. the conventional wisdome that every bone break needs immobilization for 6-8 weeks.

Any idea what caused your sfx? Pronated foot? Leg length discrepency? Other?

I am seeing an orthopedic guy too. The biggest problem I see is people's definitions of "no pain". Runners inherently block out pain so it's possible what you think is no pain or just sore is actually considered damaging to Docs.

I've been going by: if it hurts don't do it. And I mean literally no pain. I think pain could be bad when it comes to bone healing. Think of it like if you cut your arm on something, let the wound partially heal, and then start digging at it with your finger nail. The pain might be tolerable but not good for healing. The same goes for your bone if you are too rough with it while it's healing. The question is how much pain is ok and how much is just "digging at the wound"?

It would be only a little sore to do stationary bike like you say, I could work through it, but I'm opting on the side of caution for now...If you got another sfx so soon after the first one, don't you think you might have pushed it too much by getting out of the boot after only 2 weeks and biking?

I had arthroscopic surgery in my ankle on that same leg about 8 months ago and was starting to get back into running and then this happened so it's pretty disappointing. I would assume the sfx may have been at least indirectly caused by the return from surgery, maybe overcompensating on that foot, or landing improperly, or just starting back up to 40+ miles per week too fast.

I had a stress fracture in my third metatarsal a few years back diagnosed by an x-ray. I waited until I was pain free for a week, then started running again and haven't been bothered by it since. I think I was in the air cast for 3 weeks, and by the fifth week I was running. My advice: Drink lots of milk.

RockyMountainRunner wrote:

I had a stress fracture in my third metatarsal a few years back diagnosed by an x-ray. I waited until I was pain free for a week, then started running again and haven't been bothered by it since. I think I was in the air cast for 3 weeks, and by the fifth week I was running. My advice: Drink lots of milk.

Agreed, i had a stress fracture in my 2nd metatarsal and i started running 1 week after walking around pain free

got hit by... wrote:

Agreed, i had a stress fracture in my 2nd metatarsal and i started running 1 week after walking around pain free

This is interesting. For those who had a quick return to running, how long did you have to rest before you were pain free? And were you diagnosed via x-ray or imaging (i.e. was the diagnosis close to the onset of symptoms or a while after)?

I had about 5-6 weeks before the pain went away. and i waited another week to run. in total i rested 7 weeks before running again

I was diagnosed with a stress reaction on my 3rd met 6 weeks ago and have been in a boot ever since. I still have some swelling over my 2nd and 3rd mets which is unexplainable. I got a cortisone shot yesterday in hopes of taking away the remaining swelling. It is only tender to the touch when the doctor really presses on it. Other than that I have never been in any pain. Also, the tendon over the bone above my arch is prominent, but no longer is sensitive to tying up a shoe (I wear it when I do a workout on the bike). No fracture, still some swelling, how much longer. I haven't run in 7 weeks and lost my outdoor season!

got hit by... wrote:

I had about 5-6 weeks before the pain went away. and i waited another week to run. in total i rested 7 weeks before running again

im sorry to say this but, you have to wait until it does not hurt to walk or touch, then wait another week, and then you'll be fine.

Commonly stress fractures in the middle metatarsals are signs of low bone density. Get a DEXA scan to rule out another variable.

I had a 3rd metatarsal stress fracture last year. I never wore an air cast. I limped around in comfortable running shoes for a week and then the pain subsided enough for me to walk like a normal person.

I did my first run after 2.5 weeks with no pain. However, I decided that was irrational and waited until I was 1 day shy of 4 weeks, and then I started consistent running.

I was lucky enough to have access to an Alter-G, so I started immediately with 40min runs at 45% body weight. If I didn't have the Alter-G I would have started with a walk/jog type regimen.

My foot definitely felt weird when I started running, but it felt less weird every day.

Search for some of Malmo's old posts, he once took 3 days off for a metatarsal stress fracture.

12 weeks is ridiculous.

To clarify: I didn't wait for 2.5 weeks pain free to try running, my first run was 2.5 weeks after my last run, which I was suffering on when my doctor broke the news. My official come-back was just shy of 4 weeks after my diagnosis.

Sounds like most of you guys think my recovery diagnosis is a bit too conservative?

8 weeks in the boot (no activity except swimming allowed)

12 weeks no running

But it also sounds like a lot of you still had some pain after getting out of a boot after 4-6 weeks in it and trying to run. Was that just dull pain and easy to run through and did it go away within a few weeks? Lastly, was the post-boot pain only when you were trying to run? i.e. were walking, hiking, biking all immediately pain free after the boot was gone?

Sounds like most of you guys think my recovery diagnosis is a bit too conservative?

8 weeks in the boot (no activity except swimming allowed)

12 weeks no running

But it also sounds like a lot of you still had some pain after getting out of a boot after 4-6 weeks in it and trying to run. Was that just dull pain and easy to run through and did it go away within a few weeks? Lastly, was the post-boot pain only when you were trying to run? i.e. were walking, hiking, biking all immediately pain free after the boot was gone?

Bump.

I'm heading into week 6 with a VERY similar injury to the one described above.

Initially had the bone scan. Dr diagnosed as stress fracture in the third met (right foot).

3 weeks later: x-ray and checkup. Dr tells me to continue to wear the boot.

3 weeks after that (today): Annoying signs from injury that things still aren't healed.

If the doc tells me I have to wear the boot for another 3 weeks, I just might go insane.

I thought I should follow up here on my progress.

Tuesday I went to the doctor and he said I could start walking without the boot but still no running for 6 more weeks (12 weeks total). All he did was push on my metatarsal to see if it hurt still and had me walk like 10 feet across the room. Apparently that was the whole lose the boot test. So that was 6 weeks in the boot and now just walking and other low impact activities allowed.

I went for a 3 mile walk and I cannot say that it is 100% pain free to walk "normally". By normally I mean the way I walked before the injury with heel-toe push off. I can simulate the way the boot made my foot land and push off by just landing and pushing off using mainly my heel and back of the foot.

I made sure to ask the doctor what to expect and he said it will still be sore for a while but I just need to make sure it isn't that sharp pain I felt at the beginning. He also seemed to say that pressing on the bone not causing pain was a good indicator of how well it's healing.

I am wondering now how much should I still be resting now that the boot is off and how much I should be pushing through soreness/pain. He said I can bike, elliptical, walk etc as pain is tolerated, but unfortunately as runners we can tolerate a lot of pain...

hasbeen3 wrote:

but unfortunately as runners we can tolerate a lot of pain...

Did you get an xray? Could you see the bone callous forming?

Interesting. My 3rd met sfx has gone in a very different direction than yours. It has been 6 weeks since I first hurt it. I went to an ortho after 3 weeks and you could just see the beginning of the bone callous forming on the inside (medial) of the 3rd met about 1 cm from the top of the met (the joint with the toes). Dr. said to ease back into running when pain subsided and did not recommend the boot. That weekend, I was starting to feel pretty good when I took about three quick steps to grab my cat and it felt like someone hit the 3rd met with a sledge hammer. After limping for about a week and a half, I could again walk normally. Now, after six weeks total, I am back running easy and feeling ok.

I guess the major unknown with stress fractures is the severity. I have see posts going both ways (back running after 3 weeks rest to chronic issues after 6-8 weeks in the boot and weeks of easing back and re-injuring). Bottum line is that this injury is a bitch. My feeling is that there may be some good in putting the bone under some stress as opposed to being booted. But there is also danger of trying to push through the pain and re-injuring.

Good luck.

No follow up X-ray whatsoever. Dr. says at this point (6 weeks in a boot) it's more about how it feels than how an image of it looks. I would assume if I don't have callus forming after 6 weeks then I'd be feeling very sharp pain still and there's probably something wrong with my bone healing overall.

I think running after 3 weeks is a little soon for anyone. Also I'd say keyword is to EASE back to prevent a setback. That doesn't mean start on a 4 mile run every day because that used to be your easy. It means start like you've never run before in your life.

This rehab schedule looks a little ridiculous for serious runners but I bet this is how little running you need to do for the first 7 weeks back to really heal properly:

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