Metatarsal Stress Fractures: Rehab & Return to Running

Oct 8, 2012   //   by James Dunne   //   Injury & Rehab Information  //  6 Comments  //  Affiliate Disclosure  

Metatarsal Stress Fracture Rehab Exercises

runners_knee_exercises

 

Of all the blog posts I’ve written to date, this piece on Metatarsal Stress Fracture injuries is probably the closest to my heart. For good reason.

Back in the days when I was playing Rugby Union full-time, I suffered from not one Metatarsal Stress Fracture but four (yes, 4!) in six seasons.

Each Metatarsal Stress Fracture came towards the end of pre-season – lots of running in studded boots, on hard ground. My foot biomechanics (very stiff midfoot, US size 15, carrying 240lbs at the time!) proved to be less than up to the task!

This experience is one of the many reasons why I’ve become such a technique geek in my role as a running coach and rehab specialist! – With no recurrence of the problem… thank goodness!

Enough About My Injuries…

I’ve been asked by a Professional Ironman Triathlete (who will remain anonymous) to offer some advice / support, as he’s been diagnosed with a Metatarsal (MT) Stress Reaction. This in many cases, if left untreated, is the early stages of a full-on MT Stress Fracture.

I’m going to write this article as a guide for rehabilitating the worst case scenario – a MT Stress Fracture – enabling a successful return to running.

I’m not going to go into the signs and symptoms of a Metatarsal Stress Fracture or Stress Reaction. The internet is full of that sort of  info… The meaty (and useful) information, is what to do once diagnosed!

Metatarsal Stress Fracture Rehab Process

FREE DOWNLOAD: MT Stress Fracture Rehab Guide [PDF]

Phase 1: Reduced-Weight-Bearing Period

Regardless of the severity of your Stress Fracture / Reaction, you will have been told to rest the foot, and minimise loading while the bone settles and heals. Sometimes you may be given an orthopaedic boot and crutches to minimise loading.

That means rest the foot – NOT the other 90% of your body! 

Look at this period as a time to get stronger in the weak areas you don’t normally have time to focus on.

With a number of weeks without running, you will suddenly have time to get in the gym, on the bike, and in the pool. For triathletes, this often means spending more time cycling (avoid big gear work) and swimming and aqua-jogging to maintain general fitness, and work on technique.

But don’t neglect the gym work! This is your opportunity to come back a stronger athlete.

There are so many exercises you can perform during this reduced-weight-bearing period.

Depending on the severity of your injury, and stage of healing, you may find some exercises more appropriate than others. Let discomfort be your guide. If it hurts AT ALL, stop!

Metatarsal Stress Fracture Rehab Exercises

Core Exercises:

Resistance Band (Hip) Exercises:

Balance & Proprioception Work:

Remember!!

As with any period when you stop running, you will lose a degree running specific strength and around the foot and ankle. In addition, you may well experience increased stiffness of joints and soft tissues in the foot and ankle.

If you don’t work on maintaining the strength and mobility around the foot and ankle, your return to running may be inhibited – when the time comes.

There are some measures are some measures you can take to minimise these foot and ankle specific issues. Here are some ideas:

Foot Mobility:

Foot Strength:

Phases 2 & 3: Return to Loading, Then Running  

Very Important! Don’t try loading and running again until you get the “green light” from your Physiotherapist or Sports Doctor. Even if it feels good. You’ll only find out that you weren’t ready, when it’s too late… setting you back weeks!

Once ready to start loading again, do so in a progressive manner. Even if your aerobic system is fit to complete big milage – your foot / ankle / calf won’t be!

I often suggest that you begin using a progressive set of jumps and hops – jumping rope is great for this – but only a little at a time (otherwise you’ll be on a fast-track to tight calfs!). Jumping rope teaches you to become lighter on your feet and improves dynamic core control.

Start with 5 x 20 seconds, double leg jumps. If you have no reaction, build the volume gradually.

The Jump-Rope Options Are Endless:

When your physio tells you it’s time to begin to gradually start running once again, take the same approach… Very low volume to start with, working on technique, then build volume gradually.

Here’s the return to running programme I usually give my injured runners.

Running Technique

Try to focus on these key running technique points:

  • Increase running cadence (reduce contact time)
  • Don’t land in too much of a forefoot position, aim for a midfoot strike.
  • Land closer to under your hips 

Learn more about stress fractures in runners here: Stress Fractures: The Ultimate Runner’s Guide

FREE DOWNLOAD: MT Stress Fracture Rehab Guide [PDF]

About The Author

James has an academic background in Sport Rehabilitation and a special interest in Applied Biomechanics. He currently coaches a large number of Runners and Triathletes across all levels of ability and performance. He's grown a strong reputation for enabling athletes to improve their running performance and overcome running injuries through improving their Running Technique and developing Running Specific Strength.

 

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6 Comments

  • Hi James.Many thanks for this article as it was very informative.I have done Triathlon for a couple years in the past, but lately I am only cycling and swimming.Mainly because I for once don’t enjoy the run part as much as I do the other 2.However, I was just wondering if you have ever heard of this.2 years ago,I start suffering from some discomfort on my left foot, near the side along the metatarsal.The discomfort pain was usually after a long day of work in the office and never after cycling or even running.At one point I’ve decided to book a doctor’s appointment and after an Xray and one MRI my Orthopaedic doctor diagnosed a extra bone at the end of the metatarsal.This can clearly be seeing on the Xray so it is fact there.My doctor advised me that this wasn’t uncommon but he was not sure why I have only start suffering from pain/discomfort now.BTW i’m 40 years old.He than, suggested me to go for a asteroid injection and the area was inflamed and to setup some biometrical assessment.I have completed the first step which I wasn’t pleased and quite frankly I am having more pain now than before.It’s now 8 weeks since the injection and my doctor also suggested I may need an surgery to shave off the extra bone, however this mean be on crutches for 2/3 months.I still can do everything and a simple change of shoes have helped a lot.I will probably arrange to see another doctor, but wondering if you ever heard of similar cases.Many thanks for your support.

  • A great realistic article for recovery and return to running James. Some really good tips there that I shall certainly put into practice as I struggle through the last frustrating period of my MT SF!!

  • Hi James… Very intersting article and this is the exact information i need. In fact i broke my 5th metatarsal foot 3 months ago and now i am back to training but when running my ankle hurts a lot but not where i broke it. I dono if it’s because i was in a cast for 10 weeks and my ankle hurts because of the immobilisation process. i’ve been running for 2 weeks and the pain didn’t go away… is it normal or i need to see a doctor? does the joints take a lot of time to be back to normal or there is something else?
    thanks for your help James. :)

  • […] Metatarsal Stress Fractures: Rehab and Return to Running […]

  • Great article, James. I found this answer to my first obvious question…

    **Stress reaction versus stress fracture**
    Excessive and repetitive loading on weight-bearing bones can cause “fatigue damage”. Stress reactions – the less severe of these diagnoses – are bony abnormalities that are evident with diagnostic testing but do not entail disruption of the cortex, the outer shell. In contrast, stress fractures progress from Stage 1 to Stage 3, and in each the degree of cortical cracking becomes more extensive leading ultimately to failure. Simple x-rays often do not reveal evidence of stress injuries until healing is well underway and the calcification “lights up” the area. That is why MRI’s and bone scans are so helpful. Earlier diagnosis – as soon as symptoms appear – along with rest and treatment can prevent a stress reaction from progressing to a stress fracture.

  • […] fracture under repetitive stress, in much the same way as muscles strain and tear when overloaded. Metatarsal stress fractures, tibial stress fractures and stress fractures of the hip are not at all uncommon […]

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