San Francisco Podiatry Video

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Saturday, January 31, 2015

Can I run a marathon with a metatarsal stress fracture?

Hello Running Doc,

I have been training for my first marathon for the last four months. I have been following an online training plan and my mileage has been increasing steadily. After overcoming all of the initial soreness with the periods of increased distance, I have been doing well. Until recently…

I started having this aching pain in the ball of my foot. At first it was only when I was running. I iced it and kept training. Eventually I started having aching pain and throbbing on the top of my foot as well. I went to see my primary care doctor and I was told that I have a metatarsal stress fracture. My doctor told me I had to stop running for 6 weeks and skip the marathon.

Is it possible for me to still run the marathon, even though I have a metatarsal stress fracture?

Thanks for any advice!
Erin M.
Oakland, CA



Metatarsal stress fractures are one of the most common causes of pain in the ball of the foot in runners. It is also one of the most common reasons that a marathon runner is forced to stop training and skip a race like a marathon.

The short answer is, yes, you could probably still run the marathon. However, that depends on several factors.

The doctor’s job is not to tell whether or not you can run. The actual job of the of a sports medicine podiatrist is to explain all the risks and benefits of a given course of action. It is then of course up to you to decide what is best for you given your circumstances.

Metatarsal stress fractures come in a full range of trouble. In the very early stages it is actually a stress response, that is affecting the metatarsal bone and causing the pain. In many cases of the stress response the metatarsal calms down and heals quickly. If you did not remove the stress that is being applied to the metatarsal (i.e. training) then the metatarsal stress response can get worse and a tiny little crack forms and the bone. This is a metatarsal stress fracture.

If you have a metatarsal stress fracture and you continue to ramp up your training it is possible that the tiny little crack can form a complete break in the bone. This is when the real trouble begins.

The first thing for you determine is whether or not you actually have a true metatarsal stress fracture or just a metatarsal stress response. If it is only a metatarsal stress response, you could substitute running for some other activities that apply less stressed to the metatarsal, maintain your fitness and then resume your training in time to run the marathon.

But if you have a true metatarsal stress fracture and you're not careful about which activities you choose, it is possible that the metatarsal stress fracture could turn into a completely broken bone that requires surgery for repair.

It is indeed possible that you could continue to train, with the appropriate direction, and then run your race. However, it is a dangerous game to play if you're not certain about the exact condition that is causing the pain in the ball of your foot.

You must work with a sports medicine podiatrist who specializes in the treatment of runners to guide you through the alternative activities so you can maintain your running fitness while decreasing the risk of making the stress fracture worse.


Dr. Christopher Segler is a runner,  sports medicine podiatrist and 14-time Ironman triathlon finisher. His practice focuses on the rapid treatment of running injuries, and a rapid return to running for his patients in the San Francisco, Oakland, and San Jose. He also does remote consultations via Skype for runners and triathletes overseas. If you have a question about metatarsal stress fracture that it is affecting your ability to run, you can reach him directly at 415–308-0833. You can also learn more about metatarsal stress fracture surgery for runners at DocOnTheRun.com and learn more about metatarsal stress fractures at AnkleCenter.com 


All content copyright 2015, Dr. Christopher Segler, Doc On The Run.

Thursday, January 29, 2015

Should a Runner Have Morton's Neuroma Surgery?

Hello Running Doc!

I am a life-long time runner who has done many marathons. About a year and a half ago I started developing tingling and pain in the ball of my foot about. The pain gradually got worse. I saw a podiatrist and learned that I had a Morton’s neuroma.  I was given some neuroma pads to try to take the pressure off it, but it still continued to bother me after I would run. Eventually I went to the doctor again and I was told that I would have to stop running.

I really don't want to stop running. For this reason I went and got a second opinion from an orthopedic surgeon. He recommended that I have surgery on my foot to remove the Morton's neuroma. I'm still not sure if this is the right approach because I am concerned that surgery can alter my foot in someway that might change my running biomechanics. Is that something I should really be concerned about?

Thanks!
Henry B.
San Jose, CA


A painful Morton's neuroma certainly can disrupt your ability to run. The swollen nerve on the bottom of the foot can cause tingling and burning pain. But in addition this pain can get worse. In the initial stages of the development of then neuroma, many patients will say that they have tingling foot pain that is intermittent and only happens following long runs.

But over time, the continual irritation of the neuroma makes the nerve swell and the pain becomes more frequent. The nerve endings in the painful neuroma become over active. Then you start to have pain when you're simply sitting in a chair, driving your car, or even while relaxing reading a book.

Surgery can be an effective treatment for a Morton's neuroma that is keeping a runner from running. Basically the nerve is removed and you get numbness in the area where you previously had pain. That is the biggest concern is explained by surgeons before you have surgery.

But there are other risks to surgery. The one that is particularly relevant to your concerns is that in order to remove the neuroma the most common surgical approach involves cutting of the intermetatarsal ligament that stabilizes the forefoot. This ligament is not sewn back together once the nerve has been removed.

Because you have essentially removed a ligament in the ball of the foot, you can have a small amount of foot instability that was not present prior to surgery. This is not a “surgical complication” but is just a consequence of the surgery as it is normally performed. The only other alternative is to place a surgical incision on the bottom of the foot. However a painful surgical scar on the bottom of the foot can be even more disruptive to your capacity to run than the Morton’s neuroma.

If you are really considering having surgery in order to surgically remove the Morton’s neuroma, you have to make sure that you discuss your running activity in great detail with your sports medicine surgeon. You have to make sure that your surgeon understands how much you run, which surfaces you prefer to run on and, for what distances. As long as you understand the biomechanical implications of the surgery and you and your surgeon agree that it is the best option for you, it may be appropriate to proceed with surgery to remove the neuroma. If you're not convinced that neuroma surgery is right for you then you should try all of the other alternatives to surgery to make sure that you have tried the less invasive options that can better preserve your ability to run.

Dr. Christopher Segler is a sports medicine surgeon and runner. He is 14-time Ironman triathlon finisher. His practice focuses on the rapid treatment of running injuries, and a rapid return to running for his patients in the San Francisco Bay Area.  If you have a question about a painful neuroma that it is affecting your ability to run, you can reach him directly at 415–308-0833. You can also learn more about Morton’s neuroma at AnkleCenter.com and alternatives to neuroma surgery at DocOnTheRun.com