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Possible stress fracture

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Possible stress fracture

Post  mul21 on Wed Apr 03, 2013 6:46 pm

My girlfriend has been ramping up mileage a bit to get ready for a half marathon and has been having a nagging pain on the top of her foot. It's a little tender when pushing on it with the foot elevated, but much more so when there's weight on the foot. The pain is completely localized to the area shown in the picture below. Any thoughts? Does this sound like a stress fracture or stress reaction?

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Re: Possible stress fracture

Post  carleenp on Wed Apr 03, 2013 8:36 pm

@mul21 wrote:My girlfriend has been ramping up mileage a bit to get ready for a half marathon and has been having a nagging pain on the top of her foot. It's a little tender when pushing on it with the foot elevated, but much more so when there's weight on the foot. The pain is completely localized to the area shown in the picture below. Any thoughts? Does this sound like a stress fracture or stress reaction?


Unfortunately, that seems highly likely to me. Time for an MRI.
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Re: Possible stress fracture

Post  Seth Harrison on Thu Apr 04, 2013 8:21 am

@mul21 wrote:My girlfriend has been ramping up mileage a bit to get ready for a half marathon and has been having a nagging pain on the top of her foot. It's a little tender when pushing on it with the foot elevated, but much more so when there's weight on the foot. The pain is completely localized to the area shown in the picture below. Any thoughts? Does this sound like a stress fracture or stress reaction?


Yes, it does seem like a stress reaction (but most likely not a stress fracture at this point). I've had that exact situation happen several times. I have, however, been able to train through it, and run Philly to a BQ, without it getting worse. In my case, it got pretty tender, but never got to the point where I felt I couldn't run. I remember that it wouldn't bother me too much during a run, but be more painful afterwards. The pain would subside after a little while. If i were her, I'd continue to monitor it through training. Obviously if it gets considerably worse, she'll have to have it checked out.
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Re: Possible stress fracture

Post  JohnP on Thu Apr 04, 2013 8:59 am

So hold on a minute. Has she changed shoes lately (either running shoes or work shoes or casual shoes)? I've changed shoes and had pain in various spots of my feet until they got used to them. Just a thought.
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Re: Possible stress fracture

Post  carleenp on Thu Apr 04, 2013 9:02 am

I too was thinking maybe stress reaction over fracture, but it can be hard to tell and the only way to know for sure is to get an MRI or Bone Scan. I had a stress reaction in my foot once (closer to the ankle), but was told by the doctor not to try to run through it. I pool ran for 4 weeks with mine and didn't really lose any fitness.
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Re: Possible stress fracture

Post  mul21 on Thu Apr 04, 2013 10:06 am

@JohnP wrote:So hold on a minute. Has she changed shoes lately (either running shoes or work shoes or casual shoes)? I've changed shoes and had pain in various spots of my feet until they got used to them. Just a thought.

Nope, no shoe changes of late or anything strange factoring in.

She has access to x-rays at work and had one done this morning that didn't show anything. I have her taking some NSAIDs with regularity and icing, so hopefully that combined with a day or two off will solve it.
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Re: Possible stress fracture

Post  Alex Kubacki on Thu Apr 04, 2013 10:24 am

This may be silly but if she's ramped up her running her feet might be swelling more with the increase distance, and so if she ties her shoes too tight that'll cause some really annoying pain.
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Re: Possible stress fracture

Post  fostever on Thu Apr 04, 2013 12:32 pm

One way to find out, have a real doctor examine it. If it is real pain when weight bearing and not just minor discomfort on top of the foot that's a red flag.
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Re: Possible stress fracture

Post  Mark B on Thu Apr 04, 2013 12:33 pm

One thing I have read about stress fractures us that the pain gets progressively worse as exercise continues. That might be more telling than an X-ray, which does not really show much until the SF is healing.
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Re: Possible stress fracture

Post  wrichman on Thu Apr 04, 2013 11:37 pm

@mul21 wrote:
@JohnP wrote:So hold on a minute. Has she changed shoes lately (either running shoes or work shoes or casual shoes)? I've changed shoes and had pain in various spots of my feet until they got used to them. Just a thought.

Nope, no shoe changes of late or anything strange factoring in.

She has access to x-rays at work and had one done this morning that didn't show anything. I have her taking some NSAIDs with regularity and icing, so hopefully that combined with a day or two off will solve it.

1. x-ray won't detect a new stress fracture or reaction - go see a doc. and get an MRI to know for sure
2. put an "x" with permanent marker on the spot. see if same specific spot causes pain or it moves around. specific spot is more likely stress fx.
3. can she pass the hop test? hop on one foot (the bad one). pain upon hopping is very indicative of a stress fx (or reaction - although I could jump and hop w/ stress reaction in my hip/pelvis).

seriously - if there's sharp pain when pressing on the one specific spot, and it doesn't go away after a few days then go to doc. and get MRI. demand one. with a stress fx, the sooner you rest it, the quicker the recovery
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Re: Possible stress fracture

Post  mul21 on Fri Apr 05, 2013 11:51 am

Thanks for all the advice everybody. Not something I've dealt with so I wasn't sure what direction to go.

She's passed the hop test and has decided it only hurts with certain pairs of shoes, running shoes included. She's going to give it a go with the Frees she's been breaking in and see if the softer upper on those helps since it almost seems like a bruise at this point.
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Re: Possible stress fracture

Post  T Miller on Fri Apr 05, 2013 12:00 pm

@mul21 wrote:Thanks for all the advice everybody. Not something I've dealt with so I wasn't sure what direction to go.

She's passed the hop test and has decided it only hurts with certain pairs of shoes, running shoes included. She's going to give it a go with the Frees she's been breaking in and see if the softer upper on those helps since it almost seems like a bruise at this point.

I had a similar pain, only up a little further on the foot, a couple months ago. Doc thought it was an inflamed tendon and he prescribed an anti inflammatory and it hasn't bothered me since.
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Re: Possible stress fracture

Post  mul21 on Fri Apr 05, 2013 7:14 pm

We have a diagnosis! She paid a visit to the St. Louis Marathon expo today while I was working and had a PT that was there take a look at it. Looks like she has a slight impingement of the metatarsals and it's easily fixed by getting a metatarsal pad to take some of the pressure off the top of the foot. We'll pick one up tomorrow and see how it works out.
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Re: Possible stress fracture

Post  JohnP on Sun Apr 07, 2013 7:35 pm

Jim, I saw something else on this in Runner's World this weekend. THey mentioned that if you take off your shoes without untieing them, it can cause pain in that area you mention. This could be any of the shoes she wears. Again, just another possibility as far as cause.
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