Consult with
Sock Doc WorkshopsA stress fracture occurs when there is an overload of stress in a bone because of poor biomechanics and sometimes accompanying nutritional imbalances. Poor biomechanics occur due to muscle imbalances that are a result of mechanical and nutritional problems. Improper footwear is a very common mechanical factor resulting in muscle imbalances and subsequently a stress fracture. Those who wear footwear that is designed to absorb shock and control motion can be setting themselves up for a stress fracture as major muscles that help disperse and absorb shock naturally will no longer be working correctly.
Orthotics and Footwear
Orthotics typically cause similar problems, as do arch supports and shoes that lift the heel too far off the ground and put excess stress on the mid and forefoot. This type of footwear disrupts normal gait, causing muscle imbalances and dispersing stress to isolated areas that is not meant to handle such a load. Eventually the area breaks down – literally. For most, wearing minimalist shoes is very important when you walk and run so your gait is not altered, and even going barefoot at times can be very beneficial. When you’re walking around the house and office, going barefoot is preferable to strengthen all the muscles, tendons, and ligaments in your foot that affect your gait and entire body. Remember to gradually work your way into minimalist shoes and barefoot if you’ve been wearing supportive shoes and/or orthotics for some time.
Another mechanical factor that can contribute or directly cause a stress fracture is poor gait mechanics but not because of improper footwear. Your gait is a reflection of muscles and joints working in harmony and when this is disrupted, an injury often results. If the injury is impacting a bone, an athlete can all of a sudden develop a stress fracture, though often it has been weeks or months in the making as an improper gait has slowly been isolating stress to a specific area that is meant to only handle so much stress.
A lot can affect your gait other than just what is on your feet. Past injuries, dietary and nutritional considerations, and hormonal imbalances all will affect how you move. More on gait.
Speaking of nutrition and its affect on muscle balance and gait, nutrition also plays an important role in the health of your bones and joints. Therefore, poor nutrition can result in a stress fracture. This is especially true when a stress fracture develops in a major bone such as the femur – unfortunately all too common in female distance runners who often don’t eat well or suffer from anorexia or bulimia. Many think that because a bone density scan showed a good result means they have healthy bones. But that test measures only quantity of bone in certain areas tested, not quality of bone or quality of health.
How about specific nutrients to heal?
There’s a lot more to bone than just calcium and vitamin D, though both are definitely important here as well as overall health. Probably the most important nutrient that is overlooked for bone health is the mineral manganese (Mn). Your body needs a lot of Mn when bone is injured; I sometimes give a patient 50-100mg of Mn a day for a couple weeks if they have a bone injury. Other nutrients like magnesium, copper, zinc, and silicon are also important for bone health. Most people don’t need more calcium, but rather they need to stop stealing it from their bones. Many think their calcium level is good because they take a supplement or the level is normal in their blood, but they could be robbing the mineral from bones. The body pulls calcium from bones when the blood and tissues are too acidic, which happens when a diet is high in caffeine and/or refined carbohydrates, as well as when there is too much of the stress hormone cortisol. Elevated cortisol is a result of training too hard (anaerobically), not resting enough, or too many other high stressors in life that you’re unable to deal with. So rarely do I see a need to give a calcium supplement to a patient with a stress fracture but often I see a need to address diet and lifestyle.
GAGs synthesis is all about how we all keep our joints and connective tissue strong and healthy. Read more about that joint and tissue repair as it’s an important consideration when it comes to preventing or healing stress fractures (fast!).
How about that diagnosis “stress reaction”?
Basically, I think “stress reaction” is a pathetic diagnosis and one given by a physician who doesn’t know why the patient has the problem they’ve presented with. All it means is that you’ve suffered some trauma/injury in an area because your body was unable to handle the amount of stress you dealt upon that area. Stress reactions mean nothing – they don’t tell you what exactly is wrong, how you got injured, and they sure don’t give any insight in how to correct it. A brace (tape or orthotic) might be prescribed as well as anti-inflammatory or pain meds, but they’re not going to address the source of the problem.
In a stress reaction, much like when there is a stress fracture, you’re not dispersing impact correctly throughout the proper areas of the body (typically the foot), so you’re isolating the impact when you walk/run to a specific area or areas causing trauma. So a stress reaction occurs for the same reasons that many other injuries occur, including stress fractures. Gait imbalances, improper footwear, and dietary and lifestyle considerations top the list when dealing with a “stress reaction.” We all react to stress, it’s the type and amount of stress as well as how we react to and recover from that stress that is going to determine whether we remain unaffected, become more fit, or break down with an injury.
Dr. Stephen Gangemi "Sock Doc"
I'm a board-certified chiropractic physician and clinical nutritionist with a passion for true natural health care. I implement dietary & nutritional therapies, exercise & movement practices, and lifestyle changes along with manual therapy techniques to help the body heal and prevent illness and injuries.
Cody says
You mention caffeine and processed carbohydrates cause your blood to be too acidic. I heard eating too much meat will do this also. Is this true?
Sock Doc says
I don’t believe so. Although eating a lot of grain fed (meats) and processed proteins (hydrolyzed & isolates) in high amounts can be very acidic, eating healthy grass fed meats, free range eggs, and undenatured whey protein will not. And stick to the general recommendation of 1-2g/kg bodyweight for protein intake. In general, vegetables and fruits are more basic while proteins and carbs are more acidic (fats are neutral) but that is oversimplified chemistry and doesn’t take into account quality and quantity.
Cynthia says
I dont agree with your thoughts about a stress reaction. I think osteoporosis is not apparent on many cases where patients are young, so if you begin to do more activity than usual, the bone starts to weaken and the beginning stages are a stress reaction. If not given a chance to heal, it will turn into a fracture because eventually the bone will start to crack. I dont think its a fake diagnosis, its a sign that you need to take a break.
Sam Hight says
Through coaching a lot of teenagers and young adults over the last 5 or so years, I’ve found that a lot of what they think are stress fractures are actually muscle imbalances or overtraining. I’ve only ever come across this in the “shins” though – that’s the nature of parkour really. MovNat is possibly gentler due to a greater emphasis on safe and steady progression.
This was actually the same situation for my first attempt to self-diagnose and rehab some of my own aches. I was totally blown away when the pain disappeared immediately with some muscle activation exercises and that I discovered somewhere. Possibly from Thomas Kurz.
Cynthia Silverthorn says
Over Thanksgiving, I went on a trail run using shoes with a 3mm drop. I ran 4 miles of trails…no problems. I didn’t trip or twist my foot or anything. I felt fine. A couple of hours after running, the top of my foot was really sore and as the day progressed, I couldn’t put any pressure on it. I iced and took Ibuprophen thinking it would go away in a day or so. Here we are in January. The top of my foot still hurts. I can stand with no problem, but when I go to walk, the top of my foot hurts. The point of pain is at the middle of the 2nd, 3rd & 4th metatarsal of the foot. You can’t get a stress fracture on the top of your foot, can you? I can turn my foot, even bend at the toes. I can’t run, though, and walking is painful. Tennis shoes are bearable, dress shoes cause pain. Any ideas on what this might be?
Sock Doc says
Could be a stress fracture, sure you can get them in those bones. Actually I believe the 2nd met is the most common place to get one. Impossible, of course, to say that’s what it is w/o a film. You should get a X-Ray to rule it out (or in). It would show up now most likely since the healing of the bone will be visible on the film; sometimes stress fractures don’t show up when they first occur. If not that, it could be a stress reaction, or muscles imbalances within the foot or lower leg, and following the advice in this post as well as the “Tendonitis/Bursitis” might help too.
But get an X-Ray – it’s been over six weeks. Bones typically heal within six weeks. See what that says and go from there. Feel free to keep us updated here.
Cynthia Silverthorn says
Thanks for the input. My PC did an xray about 3 weeks ago and thought he saw a tiny fracture, but said because it was so small and in an odd place, he couldn’t be sure it was a fracture. He gave me a shot for inflamation and told me to come back if it still bothers me and he might do an MRI. I’m trying to get back in to see him. I’ll keep you informed.
Sock Doc says
Interesting but typically another X-Ray would be warranted first in this case since a fracture that might have been slow to heal should be visible now. Not sure of the point of a MRI here – that’s more for soft tissue, and you had an anti-inflam shot. And even if it is, there’s not much they know to do about it other than more anti-inflams & orthotics. Bone bruise possible too, which would show on MRI, but similar treatment.
Sam says
.hi
I’ve been having problems with both my feet for the past year or so nw. I am not an athlete nor do I do training or exercises, I havnt had any injuries that I’m aware of, however, i have these aches and pains and a burning feeling mainly under the foot; and is causing increasing pain wen walking and even when resting I have the same symptoms. My feet become numb at times when resting. I have recently had an mRI scan of my feet and today received the results of my mRI. The scan showed stress reaction in The base of the third metatarsal bone of the right foot. (Even tho i feel the symptoms are same in both feet.) What stress reaction in the metatarsal bone mean and What could be the possible causes and cure for this. I would be so grateful for your advice and expertise.
Dr. Stephen Gangemi "Sock Doc" says
Hi Sam, something like this I’d need to see to figure out. But hopefully the general article advice helps as well as the other articles – sometimes improper footwear can cause the issues you’re having.
Cynthia Silverthorn says
Another comment … I just read Part I of your post about gait. You bring out a good point. Last summer I had a hamstring injury that I’m still struggling with even today. It’s on the same leg as my foot injury is now. I’m thinking my gait may be off because of the hamstring which may be part of the reason for the foot injury I sustained 6 weeks ago. Now I need to address the foot injury, the lingering hamstring injury and possibly a gait problem. Sounds like I need to go to a sports physician, not my PC.
Sock Doc says
Yes, injuries often stay an “haunt” you even once the pain is gone. If you email me where you live maybe I know someone close to you. But hard to find someone who looks at the entire body.
carrie23 says
Hi,
I have some pain on the bottom of the outer part of my foot. I went to the doctor today because I was worried the pain might be or develop into a stress reaction. He took x-rays and doesn’t believe there is a fracture (the pain began about 2.5 weeks ago so probably wouldn’t show up anyways) but because it doesn’t hurt when he applied pressure to it, he doesn’t believe it has progressed to a fracture. I am waitressing right now so I am on my feet a lot. When I’m not at work, I have been staying off it as much as possible (not running or doing yoga or even cycling). He suggested heel inserts which seem to give some temporary relief, and wants me to come back in two weeks for orthotics. The pain is not excruciating but I am nervous about aggravating the injury if I work without the inserts.
I really felt like he was just trying to sell me orthotics and didn’t address what weaknesses led to the pain in the first place. Would you mind if I asked for a referral to see another doctor in my area?
PS I begin med school this fall and I have been really excited to see the way you approach health and wellness, it is really inspiring!
Sock Doc says
Sounds like a peroneus brevis insertion problem. You can look for trigger points along that muscle (easy to find an anatomy page on-line) and see if that helps. Of course I would never use orthotics for this type of problem. Sure you can email me and I’ll let you know if I know someone in your area.
Jan says
After a knee-injury, I decided it was time to take action with my running and started the switch to natural running. For 3 weeks I’ve been running barefoot now, following a very conservative schedule (3x a week, 5x 1min running with 1 min rest in between in week 1, 8x 1/1 in week 2 and 4×2/2 in week 3… no traditional running at all). I’ve developed a slight (so far) burning sensation on the top part of the inside of my right foot. My anatomy chart tells me that would be the first metatarsal.
If this is indeed the metatarsal, what can I do to prevent this now small annoyance to develop into a full blown injury?
Sock Doc says
If you’re feeling any pain ANYWHERE (not just a metatarsal) then it’s your cue that you’re switching to barefoot too quickly. Please read the last section on how to do so properly here: https://sock-doc.com/2012/03/healthy-people-barefoot-people/
Kate says
I am just getting off of a stress fracture (I had about 3 cracks in one foot and evidence of a past one in the other) for which I was off for about 12 weeks. I have just now been able to start running again, and have complimented it with cross training, and am trying to build up slow (5% a week is what they say?). When I run, I no longer have the tell tale pain that comes to be visible during the run, becomes less apparent due to endorphins, and which comes back when I’m done. I do however, feel a slight pain upon starting, which is around my ankle area. I think that this is due to the fact that I have not done the motion for some time. Today, when running, I got a bit of burning sensation in the balls of my feet. I remember that I did feel the same thing when I bought the shoes that I have now, but that I perhaps got used to it (they are the asics cumulus 13).I only felt it during quite long runs (14-15km) Could this be a shoe problem or a body issue? I do have high arches, but am told that I have a “fallen arch” on one foot. I have a pair of lighter (more minimalist) adidas that I use on off days/speed days. I would like to fully transition to them, but am not sure if now is the right time and whether I should try to fully transition to them after a few months of being back running. Do you have any advice? Thanks.
Sock Doc says
Hi Kate – hard to say where your problem is coming from. You could try some of the foot strengthening exercises I show in the videos and also check out the post I just put up “Lose Your Shoes” to make sure you’re properly transitioning into the min-type shoes.
Oscar Salvendy says
Hi,
I rolled my ankle (outwards) while running in the winter. I felt a very sharp pain, but within minutes it subsided, so continued running. It really didn’t swell up much, but I developed stiffness in the ankle. Since then, I’ve found what I thought was a trigger point (right above the bony ankle protrusion) but it actually got worse from massage (I tried for at least a week). It doesn’t really feel like a trigger point, more like a sharp, needle pain. Do you think I’ve torn a ligament? I can still run/walk pain free, but range of motion is limited and there’s slight swelling. Thanks.
Sock Doc says
Hard to say; can’t diagnose that over the internet. But either way (torn or not), as I explain in the recent post on trigger point therapy – you almost never should be looking for a trigger point in the actual injured area, especially around ligaments/tendons. Look deep in the muscle, in this case the calf muscles. Whether it’s torn or not – that’s where you check, and if treatment there doesn’t help, then you should have it looked into.
Oscar says
Thanks. A bone scan result says its “suggestive of fracture of the cuboid.” Would you say this might be confused with cuboid syndrome? Would you recommend a therapist do the “cuboid whip?” Massaging the top of the cuboid seems to temporarily relieve symptoms (not sure if trigger points exist there?). Lastly, if indeed its fractured, is 50-100mg ok to take? I’ve read the daily intake shouldn’t exceed 11mg. Thanks again.
Sock Doc says
I can’t recommend specific advice or therapies here since you’re not a patient of mine. But I can say that typically when a see a fracture in patients I do use that much Mn, but it is individualized so sometimes a bit more, sometimes less. I also always recommend staying OFF the injured area and I don’t know what a cuboid whip is.
Deanna says
I am a runner, play sports often and work out at the gym. About 4 weeks ago I started to have pain in my right foot that I never had before. It was on the top of my foot above the metarsals in the cuneiform area. I went to get xrays done (likely too early because it had only been a week at that point), was told not to put any weight on it at all for one week so I got crutches and took a week off work, then was referred to a specialist who ordered 2 more x-rays, did some pressing on my foot and told me to ditch the crutches and start easing back into activity. My foot doesn’t hurt at all now. I can walk on it normally and pain free. I have it taped with kinesiology tape and keep a padding on the top of my foot so there’s not so much pressure on it from my sneaker. It does hurt slightly when I press down on the “knuckle” of my 2nd metatarsal but hurts more if I press down in the area of my intermediate cuneiform bone. Do you think this would be a stress fracture or a bruised bone from sneaker pressure? And since it doesn’t hurt to walk or run on it given the location of the pain, would it be okay to listen to the specialist and start easing back into some light jogging? I would appreciate your insights on this- thanks!
Sock Doc says
Well as you know sometimes stress fractures don’t show up immediately – you have to wait until they start healing and then it can been seen on a film. Funny you ask this (a lot of people as me about TOFP – Top Of Foot Pain) – I just shot a video of this and other foot problems such as Morton’s Neuroma over the weekend. It’ll be up in a couple weeks. Really the problem is from the bottom of your foot and you definitely don’t bruise a bone from sneaker pressure. Follow the advice I give in the Plantar Fasciitis Video (treat the Tibialis Posterior muscle) even though you don’t have PF. I think it’s okay to exercise if you don’t have pain – listen to your body.
Lisa Darak-Druck says
I am recovering from a fracture of the navicular bone in my right foot – diagnosed 1/30 & put into a hard cast with no weight-bearing for 7 weeks, used a walking boot for the next 3 weeks, then transitioned to a Brooks running shoe with Lynco OTC orthotics, which I used for about 2 weeks. During that time, I began researching barefoot living because I sensed the heavily padded, orthotic shoes were not working for me. I ordered some Vivobarefoot shoes, which I started wearing every day (before the cast, I walked around the house totally barefoot most evenings/mornings, and I also started PT with lots of foot strengthening exercises while I was still in the boot, so I did not experience any muscle soreness from the transition to minimalist shoes). Unfortunately around that same time (@3 weeks ago), I was walking around on cobblestones & began feeling pain along the right side of the same foot, which has been persistent. I had a CT scan yesterday & appt w/my sports medicine specialist today for follow-up on my navicular fracture, which thankfully is healing well, BUT I was also diagnosed with a slight hairline fracture in my 5th metatarsal. Ugh! So now I am looking for advice regarding the continued transition to barefoot. I showed my doc my Vivobarefoots, and she didn’t say that I couldn’t wear them, but she said that metatarsals tend to do better with a stiffer sole. In my heart, I want to continue walking minimalist & barefoot as much as possible. What do you think? Oh, the radiologist also said that the bones in my foot seem osteopenic. I’m 42, still menstruating, but did test positive for osteoporosis in my spine but not hips after the fracture – further blood tests have not shown any reason for the early osteoporosis. I have upped my calcium supplements to 1,000 mg, vitamin D to 4,000 IU, started taking 50g of manganese (for the last week & 1/2 after reading about it here), & take magnesium (but I don’t have the dosage handy). I’m moving toward a more paleo diet & eat lots of veggies, although I can’t yet let go of a little something sweet each night. Another thing is that i definitely feel like my gait is improving since being in less footwear. I walk with a much softer knee, i focus on sort of rolling though my step & pushing off my toes (although when I started I was pushing off sort of diagonally out over all my toes). Maybe that was all too much info, but I want to do what is best for my body, and I would really like professional advice about my desire to be barefoot.
Sock Doc says
“Metatarsals do better in a stiffer sole” – I always wonder where some of these docs come up with these things. What do they mean by “better”? Because if they’re referring to less mobility and more support – better in their minds – then that is clearly a problem. Healthy People = Barefoot People will guide you on how to transition properly. Maybe the transition to the Vivo’s was too much, too quickly…
If you’re truly osteoporotic, (not osteopenic), especially at age 42, then there is seriously something going on nutritionally/hormonally. I’ve never had a patient take over 600mg of calcium a day. I can’t tell you what to take or not to take since you’re not a patient, but don’t think more is better. Your body cannot absorb high doses of calcium at one time, especially if it is in the carbonate form. And with manganese – that’s 50mg (not grams).
Lisa Darak-Druck says
Thanks for the quick response! Yes, you are correct on the actual manganese dosage I am taking! ;-). Do you have any recommendations for where or to whom to turn to pursue the nutritional/hormonal issues? Do you know anyone near Portland, ME by chance? I did have blood tests for thyroid function, parathyroid, calcium levels & one I can’t remember the specific name but basically it tested for multiple myeloma. All these tests came back normal. I have been overweight most of my life, but my diet has greatly improved over the last year (& I’ve lost @100 pounds). Again, thank you so much.
Sock Doc says
It’s great to hear that you’ve lost 100 pounds! Wow.
I don’t know anyone up there, sorry. You can check out my consult page for more info if you’re interested” https://sock-doc.com/consult-with-sockdoc/
Michelle Romo says
I had a question for you. It has been 8 weeks sense I injured my 2nd metatorsial. I have a stress fracture. I know bones typically heal between 6 to 8 weeks. My foot is still sore with a dull ache and I was wondering if you think that is normal after 8 weeks. I took 6 full weeks off from running or working out. I eat VERY healthy and take a good multivitamin. I am 35 years old and not menopausal. I ice it many times a day and I just don’t know why it’s taking so long to heal. How long can it take to completly heal? Thank you
I also wanted to add that I am back to running. I took 6 weeks off (that is what my doctor recommended) I was told by my physical therapist and my doctor that I can return to the sport I love..which is running. It dosent bother me when I run…thank god..so I was told that I can keep doing it. Do you think that Is why my foot is not 100% healed yet because I keep running? I am a stubborn runner and have a HARD time NOT running. LOL 🙂 ))
Sock Doc says
No that’s not “normal” after 8 weeks. Maybe the ice is making it worse (this will be discussed staring this Thrs July 19th in a 4 part SD series). Most likely it is the muscle imbalances causing your pain now and no longer then fracture. Check out the Foot Video. https://sock-doc.com/2012/05/foot-injuries/
PS – unless your multi is a whole food fruits/veges multi then it’s not good. There’s no such thing as a “good” multivitamin.
Michelle Romo says
Thank you for your reply. I will check the video out. I never thought about the ice making it worse. I will have to look into that. Yes my multivitamin is a “good” one….Actually it’s a “great” one.I only ingest healthy foods and supplements. It Is a whole foods fruit and vegetable multi that I get from my natural doctor. Thank you for the reply 🙂
Heather says
hello! interesting article thanks for sharing, would love some insight. Back in sept-november I was running a lot. I ran 3 half marathons in 22 days, and started having pain on the top of my foot in the metatarsal bones (3rd more specifically) It got so bad I was in a lot of pain. Took two weeks off on my own, still pain so finally saw an orthopedic dr. who took an xray and it was clean. he put me in a boot for 4 weeks. I followed orders to a T and wore it everywhere. went back in, still had slight pain when he pressed on it (although I could jump up an down no pain). he took another x ray at that time, it was clean. and I was in it for 2 more weeks, then I took an additional 2 weeks of no running just walking. Changed shoes from my old adidas to some newtons, gradually built back up, no foot pain and ran great for several months. took some time off at beginning of summer to rest then slowly started ramping miles back up mid june. Nothing crazy, like 20 miles a week tops. Pain very slowly returned. I feel achy on top of my foot, more so when barefoot than when wearing running shoes. It doesn’t hurt badly at all, just slight pressure/dull ache but enough for me to notice and stop running. I wanted to note I do have scoliosis, and one shoulder is noticably higher than the other, as with one hip. I am wondering if leg length descripency is causing my problem, and my bigger question, how do I solve it? But a lift in the opposite shoe to even out my hips? I am at a loss. I am afraid to go back to the dr. and be put in a boot again but not really solve the problem. Any advice would be wonderful. I dont want to miss another racing season!
Sock Doc says
Check out a couple articles in the “start here” box on the home page specifically the one on orthotics (heel lifts) as well as Healthy People = Barefoot People. Other than that I’d say you’re probably wasting your time with a foot doc like you’ve been seeing. Look for someone who doesn’t just look at the problem (your foot) but the entire body and how it affects the foot. That could be a PT, chiropractor, rolfer, etc…
And I’ve seen some problems with Newtons so you might consider a different type of minimalist shoe.
Jacob says
I recently (a month ago) got the go ahead from the doc to start running again after a terrible stress fracture. I leave soon for Army BCT, and got the fracture in the first place by running down my road and upping my mileage from 2 to 4 miles way too quickly. I now run only two miles at a dirt track, with some nice running shoes. i stretch before and after as well. My question is what are the chances of getting a stress fracture again? I’m so scared to that i totally limit my excersise potential, which is not good considering i want to earn my Us Army Ranger tab one day. I guess my question is realistically, how worried should i be? i have little to no pain after runs or during my rest days, btw.
Sock Doc says
That depends on what caused the stress fracture which as you have read can be anything from the shoes you were wearing to muscle imbalances to diet. So although I’d love to ease your mind, it would be a guess on my part since I can’t actually see you. And I don’t like to guess 🙂
* Note stretching sure won’t help though. And “nice” running shoes may be viewed by some (me) as terrible if they’re thick and over-supportive.
Jacob says
Wow doc, your article about not stretching was amazing i must say. and i think my only real problem with my injury is because i rushed into it on hard concrete with old shoes. i wear Nike Air Alvord9’s, which are a bit on the thick side, but they aren’t too bad (especially since in the Army we wear combat boots). i prefer them over my other Nike free runs, which were a tad bit too unsupportive. thanks for everything! I’m done stretching that’s for sure.
Kat says
Hi,
I’m going into my seventh year of getting bilateral tibial (and often fibula) stress fractures every season I run. I know this isn’t natural and I want to fix it. I keep to very low mileage (some seasons I only cross train and race), always cross train, and often supplement with lifting. I have a healthy diet and have never been diagnosed with an eating disorder. All of my DEXA scans come back normally. I pronate, and have tried to correct by using orthotics or supportive shoes, but I’ve also tried a minimalist approach with VFFs. Neither has been beneficial yet, but I am now planning on primarily focusing on training barefoot. I take a calcium supplement, and will now try taking Mn.
I’m 22 years old and would consider myself healthy and in great physical condition otherwise. I just can’t run without getting stress fractures. I’ve managed to get stress fractures after running 9mi/week. I’m currently taking a year off in hopes that a prolonged healing time will make a difference. I used to be quite quick, especially considering I spend over half my time training in the deep end of the pool. I want to get back to racing, and one day I want to try marathons and ultras. But when I can’t get through a 5k or 3k steeple training program, those goals seem pretty unfathomable.
Do you have any suggestions of why I seem to keep getting them or what I can do to stop it? My last doctor called me a medical mystery, and now I don’t know where else to turn.
Sock Doc says
Hi Kat – reading the first paragraph you had me thinking you were in your 40s, yet you are half that age. Not that a stress fx is ever normal, but every season for seven?
As I often say to people – “Sometimes you just gotta be treated by a doc or therapist who looks at the entire body from a structural, nutritional, and emotional perspective and understands how everything is interrelated and attributing to a health issue or injury.” Although there’s not a lot of “us” out there, that’s your best bet – you need to be treated. You’re of course welcome to come see me for a couple days or ask around where you live for someone who looks beyond your injury (and taking calcium for a stress fracture – often unnecessary).
Kat says
Thanks for the quick reply Doc…
Do you have any recommendations for doctors in the greater DC area? I’ve had some really lousy experiences in the past. Generally after they find I don’t have an eating disorder and am already using orthotics (recently quit – thanks to your website! (and the lack of success after five years – boy, you would have thought I’d give up on them sooner…)), they tell me they don’t know what to do with me and send me on my not-so-merry way.
I’m already starting to experience some shin pain again…and all I’ve been doing since track season ended in May is biking, deep water running, and swimming. I’m more than a little frightened by this. Accepting that I can’t run is one thing (and certainly not one that I’ve even come close to), but now I’m starting to imagine a life without any strenuous physical activity, and I don’t think I could ever handle that.
Thanks for the advice and quick reply. I really appreciate it.
Sock Doc says
Sorry I don’t know anyone up there. Call and put your name on my wait-list. You’re only 4hrs from my office. 🙂
Julie Bergfeld says
I have been struggling with a calcaneal stress fracture since June. I was first mis-diagnosed, then reinjured it and have since takend 8 weeks off of running, with pool running, elliptical and some walking as exercise. I went back to the doc this week and he tells me two more weeks. He did take an xray too. I have no pain on palpation nor hopping. What can show up on a xray that could cause this? Is this a normal rate of progression? Seems awfully long.
Sock Doc says
Not sure what he may have seen to think you need a couple more weeks. Maybe he was comparing it to the original film. Yes that’s very slow. Ideally you should be back in <6 weeks - but ideally you shouldn't have had a stress fx in the first place.
Diane L. says
I am 57 and have been on Boniva for Osteoporosis (now improved to Osteopenia) for 5 yrs. I have fibromyalgia/fatigue and am not very active although I do work part time at a desk job. For 3 weeks I have had a sore/ache on the top of my right foot- feels like I dropped a shampoo bottle on it, but didn’t, but it feels like a bruise, no discoloration but occasional burning feeling. I don’t wear heels ever, usually flats. It is not too painful, just annoying ache but finally went to Orthopaedic dr, took xrays, saw nothing but did see soft tissue swelling. He wants me to have a bone scan on foot to determine a stress fx, or said possible tendon issues. He told me to wear sneakers. Do you feel it is necessary for me to go through a bone scan for a stress fx, can’t I just treat it as if it is that or should I be definite what it is? I’m not sure what he will do for me even if it is. I was considering looking into orthotics for support but read on your site here that those might hurt, not help? I am somewhat confused and not sure how to proceed? Thanks in advance for any advice you may be able to give me.
Sock Doc says
If you’re on Boniva and have fibromyalgia then you have some serious health issues that need to addressed. So a problem like you’re having in the foot is just part of this overall musculo-skeletal distress. Because of that, it’s impossible for me to give you any good advice.
MissyC says
I am 35 y.o. Cauc. Female. I began running November 2011. I ran my first half in May 2012. While training I had bilat shin splints left greater than right and IT band pain on left leg. Lowered my training to three days/week and it alleviated the problem. Rested, ran a little for a couple of weeks after the race and then started training for my second half (Oct. 2012). No real problems (noticed slight left heel pain/tightness initially when starting up). Ran my 9 miles on a Saturday felt great, 3 on Tuesday and had to get in the car that day and travel 13 hrs. Thursday went out for 5 miles, had slight groin pain in left groin but was able to keep paced. Hurt worse after run so I rested for 5 days. Went back out on the Tuesday for a 5 mile run, got 2 miles out and was in severe pain. But I was running an out and back in the country so I had to run back. By the time I got home, I was limping severely and running 2.5 minutes slower/mile. Rested. Saw ortho the following eek. X-ray negative. Traveled 13 hrs by car home, saw another ortho a week and a half later. MRI. Ortho dx stress reaction femur on lesser trochanter. Crutches x4 weeks. By my own admission…I used crutches for first week religiously, second and third week when outside my house, and last week, hardly at all. (Terrible I know). Had another funeral to go to, traveled 13 hrs again. felt pain twice, both times when getting up from a couch. Now, after the car ride home, it flared up.. I follow up again on Thursday. Why would sitting make it worse? I feel like I should be doing more to feel better, not less. Yoga? Pilates? Stretching? Weight training?? I was told I couldn’t do any exercise and for 5 weeks now I have going crazy. Should I be pushing for orthotics? I supinate. I want to be the most informed I can be, and I want to heal.
Sock Doc says
If I recommended orthotics and stretching then this whole site would be a lie and you’d be better off learning about health and fitness at a site from some joker who sits behind a desk and just writes books. So let’s not go there. You could be having more pain after sitting because of the pressure on your lesser trochanter. That’s where your psoas attaches too – that’s your major hip flexor and it supports your “core” while you sit. So that muscle may not be working correctly and it’s causing a problem there. As you know, I think the stress reaction dx is a joke – it’s a cop-out diagnosis when the doc can’t figure out what’s wrong. Any injury is a “stress reaction”. You also most likely have developed many compensations from the past injuries – shin splints and ITBS – and those are a factor too.
Rebrubs says
This information is so helpful! I am a distance runner usually averaging 50 miles a week and a few marathons a year. About 4 months ago I finally healed (with xray and MRI verification) from a stress fracture in my inferior pubic ramus. It took 13 months to heal after an initial incorrect diagnosis for 6 months. I started back to running real slow, with walking first and adding in light jogging, then slowly increasing pace and distance. Just last week, however, the stress fracture is has returned! Devastated! My orthopedist does not have any answers to why this happened in the first place after I have been running the same for the past 10+ years injury free (I don’t really agree with the over-doing-it explanation) or why the stress fracture came back. Any ideas what is going on? What would this come back? I am guessing it is my gate, but not sure how to really change that. Would orthotics help? I am running in a minimalist shoe already. Running is my LIFE and (as one doctor suggested) I refuse to find a new hobby! 🙂
Sock Doc says
As the article explains, it can be much more than just a gait/structural problem. Nutrition and stress play a huge role. Read the article again as well as the Sock Doc Training Principles. Since you ask about orthotics it tells me you’re very new here (that’s fine – just need to read the site more). 🙂
Alex says
Hello, I’ve recently been diagnosed with pars stress reactions on both my right and left side lumbar spine (L3). I’m in the middle of basketball season, and I’m a the captain (and senior=last year!). I’m torn if I should finish up this last month of basketball and risk further injury (stress fracture) or if i should rest because lacrosse season is coming up. I love both sport and I want to make the better choice without out wasting my opportunities. My doctor obviously took the precautionary step and said rest, but this sport means so much to me. Any insight Doc?
Alex
Sock Doc says
You know I can’t make that decision for you. You’ve got to weigh the risks vs benefits.
My insight for you is this: Training and competing with an injury is a recipe for disaster. Not only will you not perform well, but the recovery time can easily be much longer compared to the time you are able to work around the injury.
flex says
just over 4 months ago i managed to get stress fractures from running to my sacrum and left and right pubic bones. i cant really feel anything in the sacrum or right pubic bone now but if i do too much cycling (i still havent one a single step) i get an odd feeling in the left pubic bone. not overly painful but it can get a little sore for a few days after some long rides – at which point I stop for a few days again.
but i dont really know what is going on inside and fear at worst that i am refracturing it. or is it natural too have some pain and strange stuff going on down there?
Sock Doc says
Most likely the residual pain is from the muscle imbalances that occurred due to the stress fxs. Check for trigger points in the areas, but not over where the fxs were.
flex says
throughout this injury i have never really found a trigger point. the thing is, it is very close to the symphasis and feels quite close to the surface so i cant even figure out what possible muscle it could be?
Sock Doc says
Maybe there isn’t one, but highly unlikely. When I hear that someone can’t find the point it’s usually because they’re in the wrong spot or not palpating (pressing around) correctly. Check other areas of your pelvis – sides and back; it might be a bit away from the stress fx.
Tina L says
Hello!
I fractured my third metatarsal while running on December 11th of last year. A few weeks ago I was able to stop wearing a boot and start using my foot again. I continued spinning and swimming instead of running, while also consistently doing foot strengthening exercises as well as yoga. I wear vibrams, which is what caused the fracture (stepped on a large rock). I began running again a week and a half ago (still in vibrams :-)), but am now being diagnosed with a “stress reaction” in my fifth metatarsal from not distributing my weight properly, which I know was a subconscious effort to protect the fracture site. I had caught myself standing on the outside of my foot, which became a bad habit while I was injured. Since becoming conscious of this habit I stopped and begun distributing my weight evenly. Is this “stress reaction” an injury I can run through, or is it best not to push it?
Thanks so much!
-Tina
Sock Doc says
Well hard to say w/o seeing you but as I note in the article a stress reaction is simply when your body can’t withstand a certain amount of stress. I’d check out my Foot Pain Video and check the peroneus longus and tibialis posterior muscles as it sounds like the balance of your foot (and supination/pronation) still isn’t right.
Carrie says
Hi there,
Wonder if you’ve ever worked with ballerina’s. I’ve danced ballet for 12 years, stopped for 10 years, then got back into it about 4 years ago. At year #3 back, I started getting what I assumed were shin splints. I wasn’t surprised since when I got back into the groove I went full force and took up pointe again too. Therefore, I backed off for a few months, rested, stretched, did light exercise and slowly got back into it.
A few months later…bam, pain is back. Took off another 6 months and finally went to the Orthopedist, got an MRI and he said “stress reaction.” He suggested PT which was a joke since everything they did I could easily do on my own and have done many times throughout this issue. He also suggested orthotics. Once again I limited myself and slowly got back into ballet.
Yesterday, pain started again. Shin bone always feels fine but next to the bone (especially the inside) I get pain, sometimes sharp and I’m at a complete loss of what to do. Diet is very good, shoes (Asics usually) and insoles just fine, walk around barefoot often too…only thing I tend not to do is drink enough water.
Any advice?
Sock Doc says
Yes I have seen several dancers. You can see one’s testimonial here: https://sock-doc.com/athlete-testimonials/
Asics are typically terrible shoes, especially for a ballerina who is used to unrestricted movements.
Check out the videos on the site here for ways to assess and treat the trigger points in your legs & feet.
Carrie says
Wow, thanks! The shin splints video really helped me locate the trigger points.
Going to try and use some of your techniques as well as switch to a more minimalist shoe. Any suggestions on shoes? Also, you noted stretching as something that shouldn’t be done but as a ballerina it’s hard to avoid. Am I right to assume calf/shin stretching should be limited during the healing process for me? The PT I went to was all about me stretching my calves and shins constantly which I’ve done all the time since this injury started. I’m excited to try a different approach.
Sock Doc says
Yes, less stretching for now as you’re healing up. Check out the article “Lose Your Shoes” for the shoe advice.
w says
I am a serious 42 year old runner – 40-50 miles a week and I have been running and racing since high school. My last run was January 11th. (AAAARGH!) The last 2 years have been chock full of lots of trail miles, multiple ankle rolls on the same side where I have the stress fracture, and a few ultramarathons.
I was diagnosed with a navicular stress reaction on February 18th. I have been wearing a cam boot since then and am in my last week (hopefully) of wearing the dang thing. This Friday I will find out if it’s healed enough to get back to my running. Is there any official way to know it’s healed besides another expensive MRI?
Sock Doc says
No, that would be the only “official” way but most people never have a follow-up MRI, they go by pain and symptoms.
flex says
This may be an odd question. A stress reaction happens on the way to a stress fracture but when you are healing do you then go back through a stage where your bone is in a state of stress reaction?
Sock Doc says
That’s a good question. I’m not 100% sure of the answer but I’d think no it doesn’t go through that stage. During the stress reaction there is swelling, to various degrees depending on the damage, so as the fracture is healing there shouldn’t be the same amount of swelling there.
Lauren Vigliotti says
Dear Sock-Doc:
You are so kind to reply to everyone’s questions! I hope you respond to mine. Four years ago I got stress fracture of the left side of my pelvis from running, etc. I healed and have been running strong ever since. At that time, I was prescribed an Exogen Bone Healing ultrasound device. I used it and have no idea if this helped at all. What do you think of these devices?
I have increased training miles over the past couple of months on trails very successfully, with no symptoms of injury, and Saturday, out-of the blue, sustained a stress-“reaction/fracture/sever strain”) in the exact same spot on the RIGHT side, after a marathon on flat pavement.
Do you recommend soft-tissue massage around the area, heat, ice?
Thanks for everything you do!
-Lauren
Sock Doc says
Please read this; thanks!
https://sock-doc.com/sock-doc-questions-comments/
Susan Brown says
Dear Sock Doc: My daughter is 21 and although she enjoys a bit of jogging, she is hardly an avid runner. Last November she started having pain in her lower right leg. She had a bone scan that showed a stress fracture in both of her legs however the left leg was painless. Her calcium levels were good as well as her thyroid and other minerals. Her orthopedist told her it was due to bad luck and advised her to wear a boot on the right leg about 9 weeks. She is a type 1 diabetic who requires more healing time. After taking off the boot she felt much better. This past March she started having pain again and it has continued to get worse. She clearly has swollen legs and says she can feel the fractures. Some are in the same places as before and she thinks there are some additional ones. She is scheduled to see another doctor soon and will have another bone scan and most likely an MRI. She is flat footed and her right foot turns inward slightly. She has a slight curvature of the spine. I am very concerned that there is either something metabolic happening here and/or her poor gait is causing the stress fractures. Hoping I can find the answers for my daughter.
Melissa says
Hi, I was diagnosed with a stress reaction in the distal part of my femur after getting an MRI 3 1/2 weeks ago. I have been on crutches since then by doctors orders without putting any weight. The problem is that at times it still hurts around my knee. I’m worried it is not getting better. Any suggestions? Also would you recommend swimming or would it be best if I just rest it completely as I have been doing? I’m supposed to be on crutches for 3 more weeks. Help please
Sock Doc says
Sorry I can’t personally advise you. When I see someone with a stress reaction I typically have them use the area as much as they comfortably can. Motion heals, but of course not if you’re in pain and damaging the area.
Emme says
I am a freshman female college student athlete. I play D-1 lacrosse. Well I actually didn’t play my first year due to my “stress reactions.” I sat out the entire season and am home for the summer. I went for an MRI this week and there is still swollen areas in my bilateral tib fibs. I really want to be good to play when I return in Sept. Any suggestions? I am so frustrated and will do anything at this point. I am tired of hearing you need to rest. My orthopaedic Dr. said the only activity he would permit me to do is bicycle. My college sent me to see a podiatrist who treats patients with shin splints and stress fractures with shock therapy. Have you heard of Shock Therapy Treatment? A podiatrist mentioned to me that he feels it is scar tissue? So confused as to what may be the best fix for me. Any suggestions? Thanks in advance.
Sock Doc says
I have heard of it and feel that it’s a primitive treatment that personally I’d never use or recommend. I think manual therapies (trigger point) as I discuss throughout the SD site are much more beneficial.
Carole Heath says
I have been getting pain and a burning feeling in the ball of my foot (RIGHT) I RANG my local Boots consultant and I told him the problem. He said it sounds like metatarsalgia he suggested rest and pain killers and try not to put to much pressure on the foot regarding walking. If it doesn’t improve in a few days go to your GP and he may send you for a scan to see if there are any underlining problems. He also asked if I play tennis or badminton which I don’t. Was I over weight which i’m not. And what type of shoes I wear normally. I walk for miles with my dog everyday and I never suffer foot pain at all. But recently I went to a place where the streets were very cobbled could this have caused the problem at all. My foot does seem to be improving with rest so hopefully it will pass quite soon. I am 65 years old are foot problems more likely with older people anyway.
thanks
Sock Doc says
Please read this; thanks!
https://sock-doc.com/sock-doc-questions-comments/
Kat D says
Hey Sock Doc,
Have you ever seen patients with pain that mimics stress fractures? I’ve had a handful of stress fractures in my tibia before, so I know exactly what they feel like. However, I’ve also had instances where I have the exact same symptoms and pain levels, but there have been no signs of fractures on the x-rays, MRIs, or bone scans. Any thought as to what could be causing that pain?
Thanks! Love the website!
-Kat
Sock Doc says
Sure have. And I had a similar type pain when I first tried wearing VFFs. Felt like I had a stress fx in my left fifth methead. Went away after about 24 hours. These pains are from muscle imbalances and possibly irritation to the bone (or tendon attaching to the bone). In any case of pain, the muscles are not functioning correctly. So with the issues like you’re describing, there’s imbalances to account for.
Kat D says
Thanks for getting back to me! A quick follow up question…you said your pain resolved in about 24hrs. How about pain that lasts a couple months? And takes several months of rest before it fully disappears… Can that be chalked up to muscular imbalances too? The pain I’ve had has been exactly like stress fractures – pinpoint, 10/10 wake-you-up-in-the-middle-of-the-night-screaming pain on the tibia…and it doesn’t go away easily. Is that really just due to a muscle imbalance?
Sock Doc says
There will always be a muscular imbalance in a case like this, but what is causing the imbalances is the question.
Kelli says
Hi-
I have been running for about 3 years now and lead an active life, I worked as a nanny and now I own a dog walking business. Up until last September I have never had and problems associated with running. Then in September I was running(low mileage) and doing plyometrics(no shoes) and I developed bad stress “reactions” in 2 places on my tibia. When I went in for diagnoses the dr realized that my feet naturally point downward and I have a major lack of plantar flexion(5%). Around this time i also developed terrible pain in my feet. I took 5 months off of running and was in PT every week doing exercises and having graston work done on scar tissue around my shin. I have now been able to run 2 half marathons with minimal pain in shin but still some pain in feet. After first half marathon I was unable to walk. Fast forward 2 months and I am now training for my first full marathon and have been following a schedule and about 2 weeks ago I noticed that my calf and hamstrings are extremely tight. Now I am noticing a little pain on my shin bone when I press on it and my feet pain is getting worse.
Any suggestions on how to once and for all get over this stress reaction? And why after 2 years of running and 25 years of having no trouble with my feet has this problem now sprung up?
Sock Doc says
Please read this; thanks!
https://sock-doc.com/sock-doc-questions-comments/
K Turner says
Hi – My daughter and I have really gotten great information from your posts tonight. My daughter is a year round volleyball player. She is 14 and High School Tryouts are next week. She was diagnosed with a Stress Reaction last Thursday, also calling it a Mid Foot Sprain/Tendonitis. The trainers said to modify workouts to upper body only and not to run, jump or anything that would cause impact to the left foot. In doing upper body workouts today, she came home and did an ice bath off and on for a total of 8 minutes, per the trainer’s instructions. Later, she could barely walk, and we both became anxious wondering why it seemed worse than before, because she followed the trainer’s advice to the letter. So here is the question: Is the foot seemingly worse because of the strain put on it from the lifting of the weights with squats and “dead lifts”, 25 lb kettle balls, etc, or is the foot worse because of the shock of the ice bath? We appreciate your quick response.
Sock Doc says
Can’t say what it could be from – impossible to know. Could be other factors involved (well there always is with stress reactions).
CK says
Hi Sock Doc,
While training for my 13 marathon and running 70 miles per week, I suffered a severe pelvic stress fracture in March 2013. I resumed running in the fall and ran during most of my pregnancy in 2014, including a half at 27 weeks pregnant. In January 2015 I had a baby and resumed running 8 weeks post partum. I did a half in June. Occasionally I felt a slight ache on the former fracture location. Recently I’ve been increasing my mileage from 40 to 50 miles per week as I plan to start marathon training in September. I ran a strong tempo on Wednesday. Two days later I did my usual 8 mile run and felt the ache throughout most of the run and during the rest of the day. What would cause this ache? Is the old stress fracture location sensitive? Would pregnancy and birth make me more vulnerable? Should I be worried? Thanks!
nona says
If you are still on here. Doesn’t appear you are. I have a question. I have had pain on the outside of my foot for 6 months when I walk or stand even 10 min. Had xray said all they saw was soft tissue swelling. Gave Me anti inflammatory and wrap said elevate and ice. I think they are missing the issue.
Brianna says
Hi,
I’m a collegiate D1 mid distance runner. Last year I had issues knee I had pes ansine bursitis (not sure if spelt that correctly) with that bursa sac in my right knee. Before I got that I realized that my muscle was extremely tight tight along my tibia on the inside in my right lower leg. I was not able to race often last year because of it. This year was going super well with no issues until just before thanksgiving when I started having some mild pain here and there and near my right knee began getting a little stiff with dull pain as well as my muscles becoming tight to the inside of my tibia like last year. After thanksgiving I realized that some of the pain was coming from a spot on my tibia right below the bursa sac that was inflamed last year so I went to the athletic doctor at my school. There was no pain when I hopped on it, rarely any pain when running on it only at random times when I would wake up or after my runs. The pain was just an annoying dull paint by didn’t seem to be caused my the immediate impact. I took a week off and only biked a little that week. I saw him again (last week) and he gave me the clear to run a little again but I had to be cautious and run inly every other day lightly. I followed his instructions but last week on Wednesday I ran three miles which I admit was at a way faster pace than I should have been running and it became irritated again. I ran again on Friday and Sunday. I took Monday and Tuesday off from running and proceeded to run today with no pain while running just a little pain after my run today. Icing definitely is helping and bringing the irritation down. It’s hard to tell where the pain is starting from after my runs now because the spot on my shin was where pain was coming from but my knee also feels very tight after as well as the tendons leading to my bursa sac I injured last year are a little inflamed. Being that I rarely have any pain running would you say to continue with my training plan running every other day lightly and then increase when the pain is nonexistent after running?
Sock Doc says
I typically advise my patients to continue moving as much as they can when they are injured as long as it’s not “bad pain”. As an athlete, I’m sure you know the difference. Check out this article too: https://sock-doc.com/tendonitis_bursitis/
Roxy says
Hello,
I love your website!such great info!
Now, I’m at my wit’s end with this injury.
I ran my 3rd marathon 25th Nov and decided to rest and take it easy so haven don’t much running, did some cross training and walking. As I was about to start marathon training again, a piece of metal falls on top of my foot, it bruises, so I rest my foot, ice it, no running for just over a week. I did Pilates instead. So 2 weeks ago I try to start running, did 1 mile, then 2 miles. Then a long walk(but I kept twistin mg my ankle-the boots I was wearing and the west cobbles didn’t help). I rested a couple of days and then I another 2 mile followed by a 3 mile partial trail run, where I do believe I twisted my ankle again. I got back home, took shoes off and the pain I had on the outside of my left foot just kept going..went to a&e a few days later as I was worried about a fracture, nothing showed up, so I was told possible stress fracture and no exercise for 3 weeks. 1 week on, pain is still there, imve only been walking.
Pain is in weird places-sometimes in the 5th metatarsal under my little toe, sometimes over my cuboid, sometimes where the 5th metatarsal starts. And also, when I touch my tibia above my ankle bone is a bit sore. I’m losing my mind with what it could be as the a&e didn’t help that much, I’m seeing a podiatrist on Wednesday, but I can’t help worrying. I’m 30. I have started using hokas as my running shoes.
Also, 4 years ago, I ha d a bunion removed from this foot and I have a wire and 2 screws in that bone.
Sock Doc says
Sounds like you need to find a therapist to go through all those ankle and foot muscles to correct the imbalances there.
Pete says
Hey Doc,
5 weeks out from a marathon. 5 days ago when I was about 3/4 way through my long run (20 miles), I started to feel a little discomfort on bottom of foot just below base of little toe. Prior to that, training was going extremely well, body (including feet) felt great and no problems. No recent ramp up in miles, gradually moved up from normal mid forties per week to mid fifties per week starting last November. One thing that did change is I used a new pair of shoes for that long run. I had run a couple easy, short runs in them prior with no issues, liked them, and thought I’d try them out on a long training run as they were a potential candidate for race day shoes. So different brand of shoe, and basically a racing flat.
The pain is at what seems to be an unusual spot, at the head of the 5th metatarsal, right under the plantar plate. Saw an orthopedist yesterday, Xray’s negative, the orthopedist suspects stress reaction, although she had to admit, she’d never seen an injury at that location before–plenty on the shaft and base of 5th metatarsal, but none at the head. Prescribed an orthotic which does allow me to walk pain free. Pain is very localized and can be elicited by direct pressure on the exact spot, or by weight bearing directly on the area as well.
So I feel a bit in no mans land of maybe with some rest, and dialing back for a bit, this thing could heal enough to allow me to run the race. But if I’m forced to take too much time off, I’d probably skip the race–just not interested in trying to race at subpar fitness.
So interested in your thoughts. Have you seen injuries at this location before? Do you think the shoes are the culprit, or do you think it’s something that would have been inevitable regardless of shoes, i.e. a slow buildup over time that this last long run finally pushed things over the edge. My coach and Dr. think shoes, but I don’t know. Last, if this ends up being more on the superficial end of the spectrum, do you have an opinion as to healing time–i.e. is there a chance I can still maintain fitness (meaning back to running pretty soon) and race?
Thanks
Sock Doc says
That is definitely an interesting spot. Hopefully you’re not wearing those shoes anymore, unless it was just a coincidence; you could have just over-reached in your training too much. With something like that if it’s not fractured (sometimes those won’t show up on an X-Ray for several days), I’d run if I wasn’t uncomfortable. Most likely your tibialis posterior fatigued and this over-worked your peroneus muscles resulting in the little toe issue. So check for issues in the tib posterior just as I note in the videos/posts on this site. Good luck!
bek says
My daughter suffered a fib stress fracture in November and had been wearing stiff inserts for arch support for the past 4 years. The foot doc believed the inserts were too rigid for her and recommended she get rid of them. Ironically, he was the one who prescribed them, but her feet and body has changed since she was in 7th grade. She is an elite runner for the high school. She is just getting back to running light mileage and hasn’t had any pain but we aren’t sure what type of insert would be good for her. She also has experienced mild discomfort yesterday in the ball of her right foot. Any advice?
Sock Doc says
Well my advice is to wean off the inserts so one can regain the strength in their feet again. See: https://sock-doc.com/barefoot-minimalist-walking-shoes/
Jeromy says
My daughter plays basketball. She is having burning and pain on outside of foot. Mri was negative. rested for 4 weeks started back up and still burning and pain. Doctor checked for tendon damage, was none.
Robert says
I am a 20 year old decathlete and do not do much mileage at all. I do more 400 training and jumping along with the throws. I was diagnosed with a stage 3 stress reaction and am wondering how this could have happened and how I can prevent this in the future. I have always been in great health and my training is great at my university. I am 6-5 and weigh 200 pounds and my legs are incredibly strong. Is it possible I have a deficiency in my diet or could it be from over training?
Dr. Stephen Gangemi "Sock Doc" says
Could be from overtraining, or from dietary/nutritional inadequacy. Could also be from some gait imbalance causing more force to be focused on an area rather than properly displaced, resulting in an injury.
Daniel says
About two years ago I got a fibular stress reaction, doc gave me orthotics. I was able to run with no pain with them, but then I decided to try to get rid of them and go more minimalist. But every time I try, I end up getting medial shin splints, (mainly same leg) and they start to get bad- so bad that I’m afraid I’m developing tibial stress reaction/fracture. Could it be I’m jumping into it too quickly? Should I spend a month walking around more barefoot and in minimal shoes to develop strength?
Thanks,
Dan
Dr. Stephen Gangemi "Sock Doc" says
Might be too fast or you have to directly deal with the muscle imbalances as I describe in some of the videos.
Danny says
So some tibialis anterior strengthening exercises may help? As well as some tib. Posterior massaging?
Dr. Stephen Gangemi "Sock Doc" says
See the info on trigger points, and all the info I share in the foot and ankle videos. The tib post is discussed often.
Layarni says
I’m 17 and I was diagnosed with a stress reaction in my navicular after having an MRI 18 months ago. My main sport is surf life saving beach events which is basically sprinting on the sand, I also play netball. I’ve been in and out of a boot many times and been to many different physios but none of them can help and they all just say it’s going to take time. I’ve hardly done any sport since march 2015, I’ve given up netball but I really want to get back to doing sand sprinting this summer (in Australia). Is it normal for a stress reaction to take this long to heal like the physios keep telling me.
Galina Alexandrova says
Our Daughter is 18 years of age and a professional ballet dancer with a major ballet company. She has recently been diagnosed with a stress reaction on her tibea by the doctors who work with the company. This pain has been an on and off problem over the past several years. She is usually able to dance through it until she is able to give it enough rest to calm for a while. Her latest diagnosis was given four weeks ago. She has been doing physical therapy and dancing with it and has for the most part been avoiding jumping which is what irritates her most. After four weeks of this she recently tried jumping again, but still experienced pain. We feel like tis is a never ending problem. Do you have any advice for her?
Dr. Stephen Gangemi "Sock Doc" says
Most likely there are a lot of muscle imbalance in that leg that are not getting corrected so the stress is focused on the bone. This really requires some bodywork to sort through all the past injuries, muscle imbalance, and compensations so the stress is no longer focused to one area.
Melissa says
My name is Melissa and I am a cross country and track and field athlete for Colorado Mesa University. Currently, I am a sophomore in college and have been dealing with multiple stress fractures throughout my 2 years in college. Last year in around November I was given the news that I had a femoral stress fracture in my upper diaphysis. With hearing this news my blood levels were checked and everything came back normal. I was on crutches for 8 weeks and after made a slow recovery back to running starting with 1 minute of running on a track and slowly progressed back to normal. Again, I begin training this season however, I had a lower mileage training plan and avoided concrete as much as I could. Again, halfway through my season around October I started to experience the same pains in the same spot in my femur. I again went back to the doctor where I got another MRI. The MRI resulted in a stress reaction in my femur in the same spot. Throughout the past 5 months I have noticed my hair to change both in texture and in volume. Because of this we had my thyroids check and that resulted normal along with not being anemic. I am currently on crutches with 50% weight for 8 weeks. I have done tons of research and I don’t believe I fall into the female triad because I have a regular period due to birth control and I eat healthy and regularly. Does anyone have any ideas of what could be the cause to a repeat femoral stress fracture?
Pooja Soni says
Hello dr. I have been suffering from stress reaction from last 7-8 months and after I run about 10-20 min my side calf start paining , I am a footballer and it feels very bad to see your teammates practicing and you sit out.. please advise.. I had my MRI it shows little swelling near itband..
Dr. Stephen Gangemi "Sock Doc" says
Stress reactions are too complex to give advice on-line; the best I can give you is what’s in the article.
Jenny says
Hello,
I am a runner. I felt some pain in the top of my left foot while running a couple of days ago. I stopped running because it reminded me of how my foot felt about 8 years ago when I had a stress fracture. I do not want to go through that again. I will stop running until the pain is completely gone. I stopped wearing my orthotics about 2 months ago. I feel fine without them. However, the orthotics provided some extra support to my second metatarsal where I previously had the stress fracture. I have a significant bunion in that same foot which puts stress on the second metatarsal. I would greatly appreciate your advice.
Do you think I should reconsider going without the orthotics due to the bunion?
What do you suggest I do now to help myself heal without my foot getting worse? I have not seen a doctor because it ha only been a couple days, and I am hoping that the pain will go away fast with no runnning. Thank you so much.
Rick says
Hey guys my name is Rick. I run track in college but I’ve been out with no running at all for six weeks with an injury to my right tibia and it still hurts. I had a MRI and it said I had cortical thickening with tibial periosteal bone marrow edema posteriorly could be related to stress reaction. Do any of you know what this means and also do any of you know how much longer I have to sit out ?
Dr. Stephen Gangemi "Sock Doc" says
It’s a common diagnosis and finding with a MRI. Hard to say how long to heal up as well as how much it’s actually contributing to your pain/problem.
Diana says
I’ve been running on roads and trails in minimal shoes for about 5 years. I’ve also run as much as 7 miles on bare feet.
I was recently on a road run and stepped half on/half off the asphalt curb, rolling my ankle/foot.
After an x-ray showing an avulsion fracture in the fifth metatarsal. I am in a boot for 6 weeks, with 8-10 weeks before returning to running.
My question is, what will be the best way to rehab the foot?
I have noticed it’s shape has changed so my gait will (naturally) be effected. I was forming a bunion on the same foot that looks like it is straightening out, perhaps from the pronation of trying to keep weight off the outside edge of my foot.
Any advice? I do go barefoot in the house and minimal outside as well.
Dr. Stephen Gangemi "Sock Doc" says
Check out the rehab videos on this site please!
roel says
Hello,
I still have a stress reaction in my 2nd metatarsal and it just doesn’t want to go away. I’ve done 2 mri’s which showed that the stress reaction got less in 4 months. However, whenever I start running again, it just keeps coming back. Do you have any advice. Currently I am also recovering from a fasciotomy I had done last week.
Dr. Stephen Gangemi "Sock Doc" says
Typically with issues like this it’s an entire gait problem – not just local to where the symptoms are; so your body creates an injury pattern over and over again. Best to find a good doc or therapist to sort it out.
Caroline says
Hey! So I had my accessory navicular bone removed in December. I was slowly trying to build up my muscle, and we went back to the doctor last week and he said to be more aggressive in physical therapy. I went to one session that was really difficult, and it didn’t hurt while I was doing the exercise, but it hurt a day later. The pain got unbearable, so I went back tot he doctor and he diagnosed me with a stress reaction and told me to drink more milk and take vitamin D. I’m wondering if this could turn into something worse? Should I do light exercise or none? Thank you for all of your help!
Dr. Stephen Gangemi "Sock Doc" says
Sorry I can’t give such personal advice on-line for something like this. I’d suggest you see a therapist who can work on that area for you – not just a doctor who puts their faith in milk. 🙂
Nancy S. says
Bless your heart for saying those heavy structuredshoes can be bad news and that being barefoot can be good. I suffered a minimally displaced fracture of the distal fibula on 6/3 from doing something stupid and falling with my lower leg under me. I went to the ER and was put in a Breg J-Walker Plus until 7/6 when Ortho told me I was healed??? Really? I am 71 and osteopenic and I find it hard to believe. However, she mandated that I not walk around barefoot or in socks and wear my supportive sandals ( Aravon Katy) every waking hour. After three days doing so, the pain in my foot was so severe I could barely walk. I took the shoes off and went barefoot and with 36 hours the pain subsided. Every time I put those shoes on since the fall, the same wretched pain returns. However, if I wear my Dearform ballet type slippers – no pain at all. I hate not doing what she says, but my foot cannot take it. I spent 5 weeks basicslly walking on my heel and now she wants me in a shoe that places my foot in a completely oppostive direction, making the inner aspect of the sole into the ankle scream in pain. I think I will buy a new pair of New Balance sneaks that have stitching like Tretorns and are lightweight and almost flat. I will be much more comfortable but the Ortho will be mad. I have spent most of my life barefoot when at homeand I guess at 71, my feet are not interested in changing. Thanks so much for this article. I could bore you with details of how an Ortho destroyed my left foot doing bunion surgery so rhe mechanics of that foot are bad to begin with. Now that I have developed MGUS, I doubt anyone will be willing to try to repair it.
Dianne says
What about bone inflammation along with labral tears, joint effusions and a cyst with that lovely stress reaction?? I can’t walk. The pain is intense. Based on your article, I’m guess gait issues due to ME/CFS possibly caused this? What is your recommendation on fixing this?
At the same time, thank you. This is the most informative article i’ve read so far. Not one doctor has given me instructions or follow up but simply shoved me out the door with “rest” as their solution but not how much or how long or weight baring or not so obviously Dr. Google is hard at work since the medical system left me behind.
I will start flooding my body with nutrients as a start though. Good info.
Dr. Stephen Gangemi "Sock Doc" says
Hope the article helps – I can’t give individualized advice on your specific case. Realize that many people with tears and chronic injuries typically need to see a qualified practitioner to help them resolve their issues.
Alex says
Hi Sock Doc, thanks for all you do. Your articles have helped me recover from knee pain and foot pain and avoid further injury. 🙂
I ran a 50k (in barefoot shoes) 10 days ago and have had minor but nagging midfoot pain ever since. I suspect a navicular stress fracture. Do you have any recommendations on how to help it heal? Is rest the only thing that works for stress fractures, or can compression / trigger point therapy / other exercises help?
Dr. Stephen Gangemi "Sock Doc" says
Active recovery still applies to the point of discomfort. Manganese is vital to heal bones and ligaments too, more than any other nutrient.