Treating a stress fracture

I'm trying to be as aggressive as I can with treating this stress fracture. Until a week and a half ago, I was solely relying on the RICE formula with some anti-inflammatories. Now I'm basically throwing everything but the kitchen sink at my foot.

Ideally I'd like to get back to running as soon as I can, but I'm going to force myself to wait as long as possible. I'm still hopeful that 8 weeks will be the magic number, which puts me at around Christmas time before I can roll again.

Here's the run down of my current regimen:

1) Rest. I really can't do a whole ton right now, as my foots still very sore - though the soreness has shifted from being very localized on the 2nd metatarsal to spreading across the entire foot. Basically I've put myself on complete shut down for at least another week. I've accepted that November is a bust. December will probably have me getting back into swimming and some cycling. This will be the most rest I've taken in probably 5 years. I'm sure it's much needed too, since I've been pounding away for so long without much of a break (except when I've been injured).

2) Das Boot! In German, that means "the boat". I'd agree. It's a boat. A giant canoe strapped to my foot at all times. I hate it. I can't help but complain about it. The only time I'm not wearing is when I'm sleeping or showering. Basically a plastic removable cast with a stiff bottom and cushioned support + compression. The goal is to remove flexibility and the risk of putting too much pressure onto the metatarsal heads and toes. I acquired this wonderful piece of equipment a week and a half ago.

I have to rant for a second: What amazes me is that the medical community is willing accept these things as a means of treatment. Sure, it does offer pain relief while walking, but at a huge cost. My left foot is propped up at least 1 1/2 inches higher than my right foot. I'm totally off kilter. Walking, let alone even standing in the boot throws everything off in my body. It's killing my knees, my hips, my back, my posture... all in an effort to stabilize a few small bones and joints. This thing is horrible. A monkey could designed something better. Unfortunately, most doctors are so narrow minded and fixated on their areas of "expertise" that they fail to recognize the damage that something like this causes elsewhere in the body.

So much for the months and months of strengthening my hips and feet to get me to where I was. I feel like a week in this boot has trashed it all!

On the flip side, I've read that cycling shoes can be used instead of das Boot. I've tested this theory by walking around in my shiny Pearl Izumi's, and I think this could be a good substitute. I'm not willing to ruin my babies though, so this weekend I'll try to look for a decent pair of mountain biking shoes. The key is, the soles will need to be ultra stiff. Probably fiberglass or a composite material instead of a flexible plastic/rubber. There can't be any give if I'm gonna sink das Boot.

3) Icing. Still doing this at least once a day, 10 minutes on 10 off, 10 on again. I was icing a lot more, but there really isn't much swelling or inflammation at this point.

4) Pill popping. Calcium supplements. I need as much as I can get. I believe it's recommended that the body gets 1000 mg a day, upwards to 1500. I'm taking 1000 mg twice a day, combined with Magnesium and Vitamin D to help with the to absorption. I'm also taking some Chinese herbs to promote the healing of "traumatic bone injuries." I honestly really don't know what they are, but I'll take my acupuncturist's word for it.
I was taking Motrin/Aleve to help with the initial inflammation and pain, but I abandoned that a couple weeks ago after I read that anti-inflammitories actually can slow the healing process.

5) The Exogen 4000 Ultrasound Bone Healing System. It's a beauty! Long story short - as the name says, it's an ultrasound device promotes the healing of bone injuries. Apparently it's proven in phased studies and FDA approved. I've seen a number of articles and forums that suggest it can reduce the overall time required to heal by well over 30% with a very significant success rate (like 75%+).

Thanks to our awesome medical system in America, they're typically $3,500-4,000 new! Of course, the only people who actually buy the things are those with big PHat insurance plans to help pay for them. They then resell the devices on Craigslist or eBay after they're finished with their treatments. I was able to snag one on eBay that was barely used for $350. The battery life can get 300+ uses at 20 minutes per use; mine's only been used 8 times! Not a bad deal.

Anyway, it's purpose is to significantly speed up the recovery process. If that's the case, then it's well worth the $350! Recommended use is for 20 minutes, once a day. I'm going twice a day. So far it seems to be helping.

6) At least once a week, I'm getting acupuncture. I'm slowly starting to believe more and more in Eastern medicine. Acupuncture helped probably more than anything else when I was treating my hip back in the spring. I'll go out on a limb here and say that I'm seeing similar results with my foot. I've had 3 sessions recently. It's like a flood of fresh blood and energy through the foot, and all the muscles totally chill out. Even if the effects only last for a day, afterwords the foot feels great.

8) Moxa therapy once a day. Also recommended by my acupuncturist. It's a treatment with heat to get fresh blood, oxygen... energy... and qi all into and out of the foot using a burning cigar looking stick - called Moxibustion. It totally relaxes and loosens things up down there. Not sure how much it's helping, but it feels good.


SO - Like I said, I'm basically throwing everything I can at this thing. It's been a little over two weeks since I believe I officially broke my foot (technically about a month since I first incurred the stress reaction). I haven't seen much improvement yet, but I have a feeling I'm starting to turn the corner.

2nd Metatarsal Stress Fracture

It's official. Results back the other day confirmed my fears via a MRI. I have a stress fracture in the second metatarsal of my left foot.

Think of bending a pencil... it may not necessarily break, but it does receive small cracks along the surface. One of those cracks would be akin to a stress fracture. The pain is very acute and has been very localized to a specific point along the top of my foot (approx where the arrow is in picture). It is at it's worst when I apply pressure to the ball of my foot, thereby putting upward pressure on the break.



In the mean time, I'll be in das Boot for at least the next 3-4 weeks. I'm already attempted to swim a little, but in moderation. No kicking, flip turns, or pushing off the wall... in otherwords, lame. Otherwise I don't anticipate much physical activity until I feel more comfortable on my foot.

Bummer.

Hitting Bottom

It's been 2 weeks since that fateful rainy night, when I first experienced a mysterious pain on the top of my foot.

I'm honestly still not sure where I actually went wrong. I can only speculate that I must have mis-stepped somewhere late in the run while going around puddles.

I've been told by many people that this injury should be obvious:
I ran about 55 miles in my Vibram Five-Fingers over the course of 3 weeks... POST MARATHON. I over did it using a new training technique.

OK, not the smartest thing to do in the world, but I was going off a percent of base mileage. So if I typically would've run about 200+ miles in those 3 weeks, then 25% in VFF's shouldn't seem all that far-fetched - especially when I've spend months strengthening my stride and feet by consistently running in racing flats and occasionally in Newtons.

I was also basing this off the sage rule: Listen to your body. I most certainly was listening to my body - My feet had never felt better in my life!... or at least until the 9th mile of my October 27th run. My cuboid pain had eased up significantly, my shin splits finally went away, my ITB and hip even felt better. These are things that have plagued me for YEARS!!

Something I did not consider with my VFF's:
Both feet have very small bunions. Nothing ridiculous, but big enough. I believe this has been caused by some of my dress shoes being too tight around the toe box. The resulting effect of the bunion is the second metatarsal actually gets forced upwards slightly. The foot muscles adjust and atrophy accordingly.
While running, there is then an increased force on my 2nd metatarsal, particularly when running more on my forefoot - and especially if my toes are forced to be separated (like in the VFF's). Typically this wouldn't be a problem for me in normal cushioned shoes.

SO, remove all cushion, separate my toes and there's absolutely no protection to that 2nd metatarsal head when striking on the ball of my foot. Add 55 miles and jumping around a bunch of puddles for a few weeks in one of the rainiest Octobers that Chicago has ever seen... and I have the makings of my own catastrophe. It appears that the muscles in my feet were simply not built up enough to handle the work load.

So much for listening to my body. This was a complete blind siding injury. Absolutely no prior indications that I was having a problem. No prior symptoms. No warnings. No way I could have recognized that my second metatarsal was bearing too much of the blow.

Hence I strongly feel that I couldn’t prevent it. In hind sight I don’t think I would have changed anything, except for what I've done since then. I clearly should not have run another step. I did a track workout the following day (when it still didn't feel too bad), then took 10 days off, then ran 5 easy last Friday per the recommendation of my doctor. Those were both not wise moves.


I have to accept this. The pain at this point is undeniable and not going away. I need to move on and concentrate on fixing it.

As of Sunday, I'm self-diagnosing this as a Stress Fracture of my 2nd metatarsal - in spite of my doctor telling me that it wasn’t on 2 separate occasions, and in spite of much research on numerous barefooting/VFF blogs (where people claim the exact same pains were soft-tissue related).

I had a MRI yesterday. It was a very sobering experience. I hit bottom. I'll see Dr Baker again on Friday for confirmation of the results. Unless some miracle occurs and he sees something that he can manually fix (ie, some sort of dislocation or pinched muscle/tendon) - then treatment for a stress fracture will take about 8 weeks. Doing the math from my diagnosis: that means I'm laid up until basically New Years Day.

A complete travesty, considering I was in the best shape of my life 2 weeks ago. Now I could only dream to walk without a limp. I will certainly lose fitness from here.

Instead I have to work on healing it, and as meticulously as possible so I can return without any trace or potential for relapse.

It remains to be seen how this may affect my plans for the London Marathon in April, 2010.