Running Foot Pain or Foot Stress Fracture?

As a runner, pain is often your most loyal training partner.  Pain has no social calendar to work around or a sleep disorder to leave you pounding the pavement all alone during those early morning 5 milers.

Determining which pain is your friend and which one merits a visit to your local sports medicine specialist is the difficult part of that relationship.  I’d like to help you with this problem to keep you healthy and happy….and running pain-free.

The Inside Scoop on Foot Stress Fractures

Stress fractures in the foot are usually characterized as an overuse injury of weight bearing bones.  High impact sports involving running and jumping contribute to simple foot pain and, if left untreated, it can contribute to a stress fracture.

Bones generally respond to stress by hardening along the outer margins of those bones.  When bones are suddenly exposed to great forces or repetitively exposed to increasing stress, there is insufficient time for those bones to adapt.  Meanwhile, when the muscles associated with the feet become fatigued, they lose their shock absorbing capacities. These uncontrolled forces are inadvertently transferred to the nearby bone and possibly resulting in small cracks in the bones, better known as stress fractures.

A common location for stress fractures for distance runners is along the outer ridge of the forefoot over the 5th metatarsal bone.  This is often called either a Jones Fracture or a Dancer’s Fracture, depending upon the location of that metatarsal fracture.

Statistically, women are more prone to stress fractures than men.  The reason for this increased risk factor is based on biomechanics, nutrition and possibly menstrual cycles. Excessive miles in a short period of time with insufficient rest will increase the risk of generalized foot pain, plantar fasciitis, turf toe, metatarsalgia and stress fractures.

Obviously any underlying bone diseases or disorder will drastically increase the risk got a painful foot.

Signs & Symptoms of Stress Fractures in the Foot

  • Localized pain on any bone of the foot, especially during running.  The pain can be dull aching or sharp, occur during activity and may persist with rest.
  • Mild widespread swelling and tenderness over the foot.
  • The pain may worsen with prolonged exposure to ice and during sleep.
  • An initial sensation of sharp pain followed by intensifying aching is common.
  • Associated lower extremity symptoms such as lateral thigh/knee pain, low back tightness and/or Achilles tendonitis due to an alteration of a runner’s foot mechanics.

Professional Treatment for Running Foot Pain

  • Rest and Ice.
  • Avoid excessive weight bearing on the affected foot.
  • Wear shock-absorbing footwear with walking and if symptoms worsen, a walking boot is a great tool to help control the stress on the injury site.   
  • Eat healthy and ingest Recommended Daily Allowance (RDA) amounts of calcium and vitamin D can help restore bone integrity.
  • Strength training for the arch, toe flexors and weak muscles, which may have contributed to the initial injury.
  • Maintain range of motion of the surrounding muscles and joints.  This especially relates to the Achilles, calf, plantar fascia, great toe and ankle joint.

Asking the Right Questions like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. What would you consider to be the main reasons why this injury occurred?
  2. How can I best manage this pain and to safely return to running?
  3. Do I need orthotics and if so, who is the very best foot doctor for runners to discuss this option?
  4. Do I need to be concerned with any long-term issues with this foot pain?

Elite Sports Medicine Tips from Mike Ryan

  • Reporting Time – See a sports medicine specialist as soon as symptoms appear to manage this foot pain quickly.
  • Rest Rocks – It’s the boring option but REST is the #1 tool to quiet down a stress fracture.  For how long?  It may be 2 to 6 weeks if the symptoms persist.
  • Return to Running – Resume your running slooooowly. Include pool running, run/walk routines and running off-road while increasing your miles by no more than 10% per week.
  • Cross Train – Cross Training is King. Adding biking, swimming, yoga, strength training, Elliptical trainer,…etc. are great ways to stay in shape and to save your marriage during this “downtime”.
  • Stability – Wear stable and proper fitting shoes upon your return.  It’s not about needing a feather shoe, it’s about protecting your feet.
  • No Big Break – Stress fracture can easily develop into a typical bone fracture if gone untreated.  Limitations early can help you to easily avoid the “big break”.