Stress Fractures vs Foot Sprains Sioux City
It is not uncommon for a runner to complain of foot pain. Runners are especially concerned with pain that ramps up along with their training schedule and weekly mileage. Perhaps their first marathon is a few weeks away, and they have spent twelve weeks preparing. In such circumstances, their biggest fear is that they’ve developed a stress fracture that will force them to miss the marathon; their great hope is that they’ve merely suffered a small tendon sprain across their foot.
Stress fractures are characterized by constant pain in the forefoot, especially when standing. Often, this pain is first noticed after the patient has begun to increase her running mileage. Even experienced runners can develop a stress fracture if they increase their mileage too fast, or change their routes to run on harder surfaces. The chances of developing a stress fracture also increase if the runner wears old, worn-out running shoes, or has begun a plyometric strength training program.
Bone goes through a continual remodeling process. Every day, we apply pounding force to our bones. As we rest, our body builds stronger bones to absorb that level of force, and repairs any damage. When we properly increase our running mileage, the body has a chance to recover from each day’s run. However, if we increase our mileage too fast, the body cannot keep up with the physical demands placed upon it, and stress fractures develop. In these cases, the second metatarsal bone is the most commonly affected, bone because of its length and position. The second toe serves as a mechanical axis in the foot during our gait cycle, and the force we exert on it can quickly increase when we are tired and “pound the pavement”.
Once symptoms have developed, the bone may or may not be tender to the touch. Pain is usually increased when the foot is squeezed together. X-rays are usually taken if a stress fracture is suspected; however, a small stress fracture will often not show up on an x-ray. A bone scan is a more definitive tool for detecting subtle stress fractures in the foot. A scan is highly sensitive and shows the structural integrity of the bone in great detail. Conversely, an MRI is better to use when evaluating sprains, strains, and joint damage.
Unfortunately, a runner will probably need to take several weeks off from running in order to let a stress fracture heal properly. They may need to walk in a walking cast or boot in order to keep weight off the affected bone. Crutches may be necessary if the pain does not subside with limited walking. For many nonathletes, a stiff shoe or regular orthotic may reduce the stress on the foot enough to avoid the need for a cast.
Every runner who comes into the office is hoping for the tendon sprain instead. There are many small muscles and tendons that run across the top and bottom of the foot towards the toes. We actively use these muscles with every step we take, and the tendons connecting to them can become inflamed when we increase our mileage too fast, change shoes, or alter the type of surfaces we run on. Sprains and strains are very frequent, and occur commonly if you begin running steep hills, for instance, or start to include speed work in your training.
Sprains and strains usually hurt most with the first few steps. After a short distance, the pain subsides and we are able to run with minimal difficulty. If we stop for a prolonged period of time we notice stiffening, and an increased intensity of pain in the damaged tendons. The pain is lessened when we stop, rest, or apply ice to the area. Sprains and strains respond very well to rest, ice, and reduced running for several weeks. In most cases modifying our running mileage and routes, combined with therapy, is enough to keep us running and improving at the same time.
Mild sprains can be successfully treated with running modifications and home treatments. Moderate sprains may require in-office treatment and further mileage modifications. Severe sprains usually require some type of rest and minimizing running until the pain subsides.
Therapeutic treatment goals are to decrease pain, inflammation, and edema in the injured tissue. Ice, heat, electric, ultrasound, or cold laser therapy are common therapeutic modalities for sprains and strains. Many times, stretches for the Achilles, calf, tibialis anterior, quadriceps, hamstrings, IT Band, and hip flexors are incorporated into treatment plans. Treatment will also look at your foot strength and proprioceptive muscle patterns. Weakness issues should be addressed, in order to reduce excessive stress and pounding on the body, as well as to enhance efficiency of your running gait.
Long-term, we would all like to run smoother and with less of the pounding that can cause potential stress fractures or sprains in our feet. Most of us are not highly efficient and smooth runners, and consequently need to manage our running miles, intensity, footwear, and running surfaces on a weekly basis. Increasing training by more than 10% results in a higher risk of foot stress fractures or sprains.
Sprains and stress fractures are treated differently at home and in the office. Diagnosis is very important to prevent further damage. We have seen many runners who try and minimize their injuries. They do not want to admit they have signs of a stress fracture, and continue running. This can cause mild fractures to develop into severe fractures, requiring months of healing and therapy. It is better to be safe rather than sorry: go for a proper evaluation rather than risk serious injury.