Metatarsal Stress Fracture: Rehab & Return to Running

I've been where you probably are right now... It sucks.

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 full-time, I suffered from not one metatarsal stress fracture but four (yes four!) in six seasons.

This experience is one of the many reasons why I've become such a running technique nerd in my role as a running coach and rehab specialist! - With no recurrence of the problem... thank goodness!

But enough about me...

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 stress reaction. This in many cases, if left untreated, is the early stages of a full-on metatarsal stress fracture.

I'm going to write this article as a guide for rehabilitating the worst case scenario - a metatarsal 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

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 95% 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.

Metatarsal Stress Fracture Exercises

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

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 Exercises

Foot Strength Exercises

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 running position, aim for a midfoot strike.
• Aim for a footstrike beneath a flexing knee 

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