Long story short, I developed pain in my left forefoot mid March. I was in the middle of a marathon training cycle when it happened. However, I had not run for about a week when the pain started because right calf had flared up and I was taking a week or two off to rest it. Over the course of a couple days. For this reason, I thought I had tendonitis. My foot hurt when walking barefoot and definitely hurt jumping on it barefoot, but I almost didn't feel it at all when wearing shoes. I also had no spot tenderness. Initially, the pain was on top of the foot but soon went to the bottom as well. I couldn't run on it for more than a few minutes in shoes before the pain would start.
I ended up taking a month off from running. My foot started to feel better. I could only feel it walking if I was intentionally trying to weight the area of the injury. It still hurt to hop barefoot, but the pain wasn't unbearable as it had been before. When I first started running again in mid April, I felt a niggle in my foot and very occasional sharp pain (like one or two sharp pains in the course of a 6-8 mile run). However, after a week of running, the pain returned and seemed to be even worse. At this time, I felt it walking even in shoes, the pain radiated to the arch of my foot, and I had just a small amount of tenderness on top of the fourth metatarsal.
I ended up going to see a sports orthopedist who quickly diagnosed me with a fourth metatarsal stress fracture. He did some palpations to rule out extensor tendonitis and a morton's neuroma and said that pain that persists return after taking a month off, fairly localized pain and spot tenderness all indicated a stress fracture. The x ray wasn't definitive but the doctor said that the shaft of the fourth metatarsal didn't have the same clean lines as my other metatarsals which indicated a stress injury. He then told me that 90% of stress fractures don't even show up on X rays.
Anyway, he put me in a boot for a month and limited exercise to spinning in the saddle with light resistance in the boot, swimming, and pool running. For the first three weeks, I thought that my foot felt a little bit better, but I ramped up my activity a bit the fourth week mainly just by walking around more outside with the boot and testing walking around the house without the boot and the pain came right back.
When I went back to the doctor, he said I needed to be in the boot for another two weeks and then could start weaning my foot out of the boot as long as I wasn't having pain. However, i feel like the pain will get somewhat better with rest but then return as soon as I increase activity. Back in March, I didn't run for a month and the pain improved but as soon as I started running, it quickly returned. I just feel like I am caught in this vicious cycle.
Is there anything that could prevent this from healing correctly? Is it possible it healed incorrectly or I could be misdiagnosed?