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.

2 comments:

  1. You mention - "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."

    Could you elaborate on some activity options and their relative safety level? (for example, biking, rowing, swimming...)

    Thanks so much!

    ReplyDelete
  2. Hello Beth-Ann,

    Thank you for your inquiry. The best way to add other activities and keep them at a safe level depends on what activities you enjoy the most and the specific type of metatarsal stress fracture. For example, sometimes it is possible to continue running. In October, my wife got a stress fracture in her fourth metatarsal but we are able to decrease the stress just by offloading the metatarsal enough that she could still continue to run and still heal.

    In other cases, it's better to divert to some other activities. All you have to do is decrease the stress to the metatarsal. You have to decrease the stress enough to allow it to heal.

    Obviously the most stress would be with running jumping, etc. The lowest risk activity one that does not involve any weight-bearing to the foot whatsoever. However in between both of the extremes there are full range of activities. Any activity that is not supply any stress to the metatarsal will likely be safe. But this assumes you can fully feel what is going on.

    Deepwater running is one common activity that runners use to help maintain fitness while avoiding any stress to the metatarsal. But even this activity may be risky depending on the extent of the fracture.

    Just keep in mind though to runners are alike and no stress fracture requires the same treatment as someone else in order to heal and get back to running. My approach is generally to use the highest level of activity that's possible so that you can maintain your fitness and still recover from the stress fracture.

    Make sure use discuss your desired activities with your doctor before beginning any new activity or increasing any level of activity whenever you're trying to heal a metatarsal stress fracture.

    Dr Christopher Segler
    Doc On The Run
    http://www.docontherun.com

    ReplyDelete