For runners experiencing pain on the top of their feet, the likely cause is a metatarsal stress fracture. An injury that develops progressively, metatarsal stress fractures can spell the end of training for months. Understanding the signs and potential causes of this injury may mean the difference between an early return to training or an extended period of time off your feet.
Definition
The five metatarsal bones of the foot connect to the base of your toes, the proximal phalanges, and to the cuneiform bones at the mid-foot. Stress fractures are small cracks that may appear in these bones and, unlike a normal fracture, are created over a prolonged period of repeated impact.
Symptoms
Symptoms of this injury are limited. First, pain will be limited initially but will increase with continued training. Mild swelling or redness may appear. More serious stages will witness pain while running and decreased pain while at rest. In severe stages, pain will persist even when relaxing and pressing the top of the foot in the affected area will likely cause you much discomfort.
Causes
Metatarsal stress fractures can be caused in different ways, all of which are the result of bone fatigue. After any impact-heavy exercise, your body naturally produces bone cells while you are at rest to repair and strengthen your bones. When too much stress is continually placed on the metatarsals, the body can’t repair the bones quickly enough. If you are a track runner or ultra marathoner, you will be more susceptible to this injury. If you haven’t exercised for some time and then suddenly begin training at a high level of intensity, you are also more susceptible. Other possible causes may include osteoporosis, runners with flat feet or stiff arches and females whose periods are either abnormal or absent.
Treatment
Healing time for a metatarsal stress fracture will take time. Healing may take 12 weeks or more. A visit to the doctor for X-rays, an MRI or a bone scan should be considered to determine the severity of the injury. Rest, icing the affected area and a decrease in load bearing activity is the ideal place to start. For pain, take acetaminophen. Avoid non-steroidal anti-inflammatory medications such as ibuprofen, aspirin and naproxen. In more severe cases an immobilization boot may be necessary. Surgery is rarely performed.
Prevention
Lessen the chances of this injury occurring by implementing a few simple changes into your training program. Avoid performing the same exercise daily. Incorporate low intensity cross-training exercises to lessen impact stress on the feet. Consider your foot type; if you over pronate, for example, be sure to use appropriate footwear. When increasing the tempo or load of a training plan, do so slowly and keep sessions short in duration.
