The Author

Steve Gonser DPT

Steve Gonser graduated with his Doctorate in Physical Therapy from Daemen College, instantly applying his knowledge of human movement and functional anatomy to his passion for running. Steve is a 2x Ironman, including a 10:41 finish in Lake Placid and a Sub-3 hour marathoner.

Stay Connected

Avoiding the Boot: Stress Fractures and Running

It’s the middle of summer and you’re lugging around a nasty over sized boot on your right/left foot. It’s not the latest fashion trend, nor is it comfortable. You’re in a walking boot because you have a stress fracture.

Most, if not all, stress fractures occur over weeks to months. Sure, you started feeling it in your foot during a specific run, but you should realize that stress fractures don’t happen over night. This thing has been building over each run you have completed and your pain hits when the bone finally reaches it’s breaking point…literally. Understanding if you have a stress fracture can be tricky, but here are some classic signs of a stress fracture:

  1. Pain with high impact activity (jumping, running)
  2. Pain will subside with rest
  3. Walking or cycling may not reproduce your symptoms
  4. Pain will onset within first mile of your run and persist/worsen
  5. Pain will not “work itself out” while you run and will get worse with the longer you push

Most runners are suspect of stress fracture when they have foot pain, but often state that their pain starts early in their run, gets better mid run, and worsens at the end. This is not a stress fracture, you can back away from the ledge. These symptoms are usually related to a tendinitis of some sort.

So if you meet the criteria above, what should you do? I would start with scheduling an appointment with your doctor, which would result in an MRI or Bone Scan of your foot.

The bone scan is actually pretty neat. The doctor will inject a radioactive substance (you will not turn into spiderman or the hulk) into your vein. The substance is attracted to areas of high bone growth or formation. So if your foot is trying to heal from a fracture, there will be a “hot spot” from the substance being attracted to the site of the stress fracture.

Run Specific Workouts

Get Stronger and Faster from Home. Trial for Free

The picture to the left identifies a stress fracture in the second metatarsal of the foot. Although it’s tough to see the foot as as a whole, it makes it pretty easy to identify a stress fracture.

So you get the results of the test and your fears become a reality… you have a stress fracture. So where to go from here? Depending on severity, you may be able to ride a bike or swim; however, for all weight bearing activities you will be lugging around the aforementioned “walking boot”. For those of you haven’t seen one of these things, their neither comfortable or stylish. It takes a bone 6-8 weeks to heal, so adjust your training schedule and race schedule accordingly. There’s no cheating that time frame, only extending it by being stubborn.

Walking Boot
So now that you know you’re going to be in this hideous thing mentioned above, you’re probably wondering how do I stop this from happening in the first place. There a couple factors that can contribute to stress fractures, including bone density, vitamin D, and training volume. Due to it’s length to girth ratio (long and thin), most of your foot stress fractures reside in the second metatarsal of the foot.

So the research study listed above investigated the effect of muscular fatigue on loading to the second metatarsal. In short, the study found significantly higher loading rates to the second metatarsal when specific muscle groups were not stimulated during loading. The muscle groups were foot and ankle stabilizers (flexor digitorum longus, flexor hallucis longus, peroneus brevis, peroneus longus, and posterior tibialis). The take home message of the study was that, in the presence of fatigue, there are significantly higher bending forces applied to the second metatarsal. The repetitive and consistent bending of the bone causes the stress fracture.

The keyword here is fatigue. In the presence of fatigue, there are higher bending forces applied to the second metatarsal. This speaks to training volume and rest/recovery. If you have had a stress fracture in the past, there’s a good chance that your training approach was flawed… either too much, too fast, too soon, not enough recovery, etc.

The good news is that this is preventable and doesn’t happen over night. It takes weeks to months for these errors in training to culminate. Strengthening of select muscle groups can be found in our Members Area can not only help prevent fatigue in these muscle groups, but can help treat/prevent further injuries. Start your Free Membership Trial today!

Keep yourself out of the boot!

Sharkey, N. A.; Ferris, L.; Smith, T. S.; Matthews, D. K. Strain and Loading of the Second Metatarsal During Heel-Lift. The Journal of Bone and Joint Surgery. 1995;(77):1050-1057.

We need your help! Be part of our grassroots movement to provide useful, non-regurgitated running info. If you found this useful, please share!

Share Your Thoughts