3 Reasons to x-ray a stress fracture from running.

Dear MyRunningDoc, 

I have been ramping up my mileage as part of my marathon training. My foot has been sore and aching when I run. Someone told me that stress fractures don't normally show up on an x-ray until they start healing. If this is true, is there really any point to getting an x-ray if I think I did get a stress fracture from running too much?  

Adam J.

Houston, TX

Answer:

Great question!  This is a question I often hear from runners in San Francisco and Houston. Most runners are busy and don't wont to waste their time going to a podiatry office getting an x-ray of their foot unless they really think the x-ray will change what they need to do to get the foot to stop aching and  heal. (And of course, get back to running and training). But when you suspect a stress fracture, there are good reasons to get an xray.

3 reasons to get an x-ray of your foot if you think that you have a stress fracture.

The 1st reason to get an xray of your foot is to make sure that the metatarsal has not actually cracked all the way through the bone or broken into pieces. 

The 2nd reason is to confirm that the metatarsal, if it is broken, is still in a good position that will heal correctly. If the bone is moved out of place after it has broken that it will not heal correctly and will result in what doctors call a “malunion.” When the metatarsal bone heals in an abnormal position it will alter the way that forces are distributed across the ball of the foot. An unnatural distribution of forces across the ball of the foot will put other metatarsals at risk of problems later. It can also increase the chances of nerve compression that can lead to a neuroma. 

The 3rd reason to get an xray of your foot when you suspect you have a stress fracture is for peace of mind. Having an x-ray confirms that the bone is not actually broken and will not likely get worse if you are walking on the foot as it heals. A fracture walking boot is made to protect a stress fracture and allow you to walk while the bone heals.  if you have had an xray of the foot and confirmed that the bone is not completely broken, and you suspect that it is just a stress fracture, then you can treat it as such and feel confident you’re not going to make things significantly worse if you walk on the foot while protected in a fracture walking boot.

Dr. Christopher Segler, D.P.M. is board certified, American Board of Podiatric Medicine. Because he is an active marathon runner and 10-time Ironman triathlon finisher, his practice focuses exclusively on helping runners get back to running as quickly as possible. He travels back and forth between San Francisco, Houston, and Hawaii so he can often to help Texas and California patients with running injuries.  He also provides web consultations via Skype for injured runners who who are too busy to drive to a podiatry office. If you are in San Francisco and have a question about a running injury, you can reach him directly at 415-308-0833. If you live in Houston and think you have a stress fracture, your can call him at 713-489-7674. Visit our Houston Doc On The Run Practice. Learn more about stress fractures here.