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.
Metatarsal Stress Fracture Rehab Guide >>
Free Download [PDF]
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!
Resistance Band (Hip) Exercises:
Balance & Proprioception Work:
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.
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
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. 🙂
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.
I have 2 boys now who have suffered from Lisfranc fractures in the past year. Both athletes one in the NFL And one in college on a PAC-12 team. BOTH were wearing the same Under Armor shoes because they were required to as Under Armor sponsors their teams. I am looking for information about metatarsal support necessary for not just running but more for turning and pivoting and planting ones feet on artificial turf. Taking into consideration that these boys are 6’4″ and 240 and 260 lbs. there have been several Lisfrancs in the NFL and in college and on my sons team! Incredible to me that shoes can be required to be worn that do not provide proper support and could open the door for career ending injuries all in the name of speed and $$ sales for the brand. I need information from a professional and opinions, and whatever else I can find to keep these types of shoes off of playersbwfore they become permanently disabled as one of my sons might be unless we can get another surgery to fuse those metatarsal bones together to alleviate the pain and give the foot strength again. These boys were excellent athletes who played for 10 years on grass and turf never having foot injuries until the new super light trend hit. Please advise or refer me to someone or some information, anything would be greatly appreciated …thank you
James i broke fifth metatarsal in November running hit a sinkhole. It has no signs of healing as of February. I purchased a bone stimulator, and no loner have the boot as of 1month ago. My question is how long should or could i be on my foot daily, and is it a good idea to use a light tensor to help with the discomfort?
Thank you for your work, James! I can’t seem to figure out how to download the rehab guide? *Hugs*