How Can I Tell if My Foot is Broken?

Hi My Running Doc,

A couple of days ago I accidentally kicked the wall with my right foot. My foot still hurts and it is bruised.  I read on your website that bruising can be a sign of a metatarsal fracture. How can I tell if it is just bruised or if my foot is actually broken? I would love to have your expert opinion!

Thanks!

David, Houston, Texas.

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Hi David, 

Bruising is a Bad Sign

It is true that bruising is a bad sign when it comes to foot and ankle injury. When you actually fracture a bone, the bone cracks and bleeds quite a lot. That blood diffuses throughout the soft tissue under the skin. What you see is a bruise. That is part of the reason that a bruise can be so concerning for a fracture in the foot. 

In fact the sort of bruising pattern that the picture of your foot shows is often indicative of a fracture or broken bone in the foot. Given your pattern of bruising it is more likely that you have a metatarsal fracture or a fracture in one of the bones in the little toe such as the proximal phalanx phone.

Myths about Foot Fractures

1.  If you can walk on the foot, it can’t be broken.  FALSE!

This may be one of the most widely perpetuated myths about foot injury on the Internet. I have seen many patients with serious fractures that are walking on the foot. Some patients are limping and obviously in a tremendous amount of pain while other patients with fractures or broken bones barely feel any discomfort at all. This is not a reliable indicator of whether or not you have a broken bone in your foot.

2.  There is nothing you can do for a broken toe.  FALSE!

This is also absolutely not true. While it is true that most fractures in the toe will heal uneventfully, there are things you can do to speed healing and decrease your risk of complications. Fractures of the bones in the toe can move if not properly stabilized. Certain shoes will speed healing. Taping the toes to provide stability and immobilize the fracture will also help. But some toes should never be taped together. 

Without the proper treatment of a broken toe, the fracture can fail to heal leading to what physicians refer to as a nonunion. A fracture that never heals correctly can lead to pain, disability and interfere with your ability to run or even walk without pain.  Occasionally patients that take the approach that “nothing can be done for fractured toe” just end up in surgery later.  For the most part this is avoidable if the toe treated correctly.

Diagnosis and Treatment Options

If you are suspicious that there might be a broken bone in your foot (or in one of your toes) it is best to figure out whether or not it is actually broken.  The best option is to have an in-person evaluation by a sports medicine specialist such as a sports podiatrist.  The second option is to have a remote consultation with a sports podiatrist via webcam. A third option is an attempt at self-diagnosis. This video on YouTube can show you how to perform self-diagnosis of metatarsal stress fractures. This same video would apply in your case if the pain is located where you’re bruising is in the foot.

If you see a physician in person or via webcam or you perform your own self-diagnosis and think that you probably have a fracture then you should get x-rays. X-rays will not only confirm (or rule out) a broken bone in the foot but it will also give you an idea of the severity of the problem. There are some fractures that absolutely must be treated surgically. Others simply need a fracture walking boot in order to stabilize the fracture and allow it to heal. And occasionally it is necessary to use crutches. 

But not all fractures are the same. So if you have pain and bruising after this sort of injury and suspect that you have a fracture in your foot it is important to determine whether or not there actually is a broken bone, and treat it appropriately. As long as you treat the fracture correctly you should be able to heal and then get back to running.

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.

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.

How to Tell If You Have a Stress Fracture In the Foot by San Francisco Running Podiatrist

Last year just a few weeks before Ironman Louisville, I got an out-of-state call from a very worried triathlete. He said he had been ramping up his training for the big race. He had slowly been building milage over the past year. But then he started to get an aching foot when he ran. Slowly it turned into throbbing foot pain when he would run. And by the time he called, it was starting to hurt even while he was walking.

He was really distressed.

As a runner and prior Ironman finisher, he had been running long enough to know that a stress fracture in the foot was one of the most likely injuries that could force him to stop running. He was worried he wouldn't even be able to show up on the starting line at Ironman Louisville. The good news is that we were able to manage the stress fracture and he did complete the race without incident.

Training for any distance event (whether a half-matrathon, marathon or Ironman) can lead to a stress fracture in one of the metatarsal bones of the foot. But if your foot aches, there are some simple ways to tell how likely it is that you have a running-related stress fracture. This video explains how you can tell if you might have a stress fracture in the foot.

To learn more about stress fractures, visit the most comprehensive running injury site in San Francisco. All of the running education information has been created by San Francisco's Award-Winning Foot Specialist and Ironman Triathlete Dr. Christopher Segler. He's not just a running specialist who writes about running injuries, but he is a real runner as well.

What Happens If I Keep Running on a Stress Fracture in the Foot - San Francisco Sports Medicine Podiatrist Explains

Stress fractures in the foot are one of the most common injuries in runners. Although runners often endure many different aches and pains while training for a marathon or half marathon, an ache in the foot that is a stress fracture is one pain that shouldn't be ignored. One of the questions I get from runners on a regular basis is "what happens if I keep running and it is stress fracture."

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The short answer is that if you continue to run, the stress fracture will likely get worse and lead to a complete break in the bone.

I have seen this happen more than once. One runner was actually a triathlete. He had been rapidly increasing his milage while training for an olympic distance triathlon. He started to notice a vague aching sensation in foot one day during a run. The next day the foot was sore. By the end of that day at work it was throbbing. He took off a couple of days from running and rode his bike instead. He resumed running a couple of days later. Then he noticed the dull ache in his foot with every step during his run. When he took his shoe off he noticed some bruising of the foot as well. He kept running anyway.

When I finally saw him, he had been running on this painful, aching foot for about 5 weeks. The foot was swollen, tender and bruised. As soon as we took an x-ray of the foot, it was obvious that he had fractured the fifth metatarsal bone. He had to have foot surgery to repair the fractured bone and allow it to heal. Obviously, foot surgery is not a good start to any running or triathlon training season.

A stress fracture is a tiny (virtually invisible) crack in the bone. If you continue to apply stress to it (such as running) the tiny crack gets bigger. Continue running and the crack can lead to a complete break in the bone. Once the bone breaks, the ground essentially pushes the bone up out of the way. At that point the stress that was being applied to that bone get transfered to the bone next to it.




That is what has happened in this xray image. The pain from the 5th metatarsal stress fracture was ignored by the patient. Once the stress fracture turned into a completely broken bone, a stress fracture started to develop in the next bone over (the 4th metatarsal bone).

Generally a sore foot while running warrants attention from a sports medicine podiatrist. Particularly if you want to keep running. With early treatment, you can get it to calm down and avoid disaster. Make sure you find a podiatrist in your area who runs and understands runners. That will give you the best chance of making to the starting line and finish line of your next big race.


Dr. Christopher Segler is a Podiatrist in San Francisco. He is also an Ironman triathlete and marathon runner. He authored a chapter in the Handbook on Podiatric Sports Medicine. He has also won multiple awards from the American College of Foot and Ankle Surgeons for his research on diagnosing subtle foot fractures. He offers podiatry house call appointments for busy professionals and athletes who prefer the convenience of a house call at their home or office, instead of waiting half a day to go to the doctor. You can learn more about stress fractures in the foot at AnkleCenter.com and Doc On Th Run.com.