Bodyworks: March Fracture

How to recognise it, how to overcome it


Posted: 5 June 2000
by Patrick Milroy

Symptoms
This is a stress fracture of the second (or sometimes third) metatarsal. You’ll feel pain in the middle of the long bone(s) of your foot, which will slowly increase with distance, reaching a crescendo as you end your run. The pain will return earlier during the next session and become severe sooner, forcing a premature finish. This pattern will continue.

Signs
You may be able to feel or see a little swelling around an established stress fracture, though an early one may simply be painful if stressed by pressure, or when you move the fractured halves in opposition to each other.

Medical investigations
When pain alone is the symptom, a bone scan may be the only way to convince the athlete that a stress fracture exists. X-rays will show healing callus in an injury which is more than four weeks old, while doubters may respond to ultrasound testing by a physiotherapist – it causes real discomfort if positive!

What else could it be?
Few injuries show crescendo pain apart from a stress fracture. Muscle injuries and strains may occur between the bones, but you can often run with them, unlike a stress fracture.

Self-treatment
Rest! You may be able to swim or cycle as long as it doesn’t provoke pain, but running – which caused the injury – is out.

Medical treatment
This is as much psychological as physical – you need constant reassurance that time (probably about six weeks) will heal the injury. A plaster cast is rarely required. Biomechanical gait analysis may prevent further injury, though recurrence of a stress fracture at the original site is very uncommon.

Can you run through it?
No. Full stop.

Recovery time
Five per cent of stress fractures fail to heal as expected and some form of malunion occurs. A very small percentage need bone grafting.


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Discuss this article

I had trouble with a march fracture about 14 years ago which seemed to take forever to heal. I'm pretty sure I've got the same symtoms again and feel totally frustrated at the prospect of no running and then having to get back up to fitness again. I'd just got up to running 3 to 4 times a week for 5 to 7 km, usually off road and was really enjoying running, I'd even done my first race. This doesn't seem in the least excessive to cause the fracture. I also have flat feet and wondered if this has anything to do with getting the march fratures? Has anyone got any advice for getting over a march fracture (I know rest is the only way but wondered if anyone knew of something a bit more inspiring?) and how to prevent them in the future?
Posted: 12/05/2003 at 16:02

I think I may be suffering with a similar problem. I am well into a training schedule and have just increased my weekly mileage to approx 30. The last couple of runs ended with a local pain on the top of my foot adjacent to my big toe. I treated it with ice and brufen then ran a couple of days later, the same happened. Having given my foot another couple of days rest and ice, I ran a short distance only to find the onset of pain sooner and more severe. I have decided to give myself a couple of weeks off to see if I can clear it!? Any thoughts?
Posted: 12/12/2003 at 17:13

Sounds very familiar I'm afraid. Especially the onset of more pain sooner on subsequent runs. Back in May I simply had to resign myself to 6 weeks of not running. To ease the frustration I did lots of swimming and cycling instead to try to maintain some fitness, though I did find even the pressure of the water agrevated it a bit and had to peddle slightly differently too. After 6 weeks I started running again and fortunately had no problems.
A physio friend had a look and could identify tight and loose muscle areas but said it was too swollen to work on. She said my foot was quite splayed and the fracture may have been caused through compensation.
I also thought very carefully about my footware and identified a pair of ordinary shoes that I think may have aggrevated things.
Unfortunatley other than the article on this site 'Bodyworks:March Fracture' I could find very little about it. Rest really does seem to be the only answer I'm afraid.
Good luck!
Posted: 24/12/2003 at 09:35

Thanks Lynn, I'm glad to say that a lay off over christmas (with plenty of turkey and pudding) seem to have done the trick. I'm only just catching up with my training as I also suffered a cold!! It can be so frustrating when all you want to do is run and a seemingly tiny problem can prevent you from doing so.
Posted: 19/01/2004 at 10:51

If it feels the same, and doesent reduce in pain after 5 days of rest and ice then it may well be.
And if its the second met, then 'flat feet' overload the 2nd met shaft/head, as a result if this is the case then has a biomechanical been advised?
Posted: 19/01/2004 at 22:45

nooooooo! the day I get my FLM acceptance I decide I need to get new shoes and would you believe it I get injured. Stress fracture of the 3rd metatarsal. Well there goes my 3:30 marathon time. Anyone got advice for dealing with this physically or mentally? (i've tried the obvious, going to the pub.)
Posted: 04/12/2004 at 20:20

Just diagnosed with same problem. X-ray today confirmed stress fracture of 3rd metatarsal, been unable to run for 2.5 weeks now although cycling 30-50 miles a day 3 times a week doesn't cause any pain (running would be agony). I thought training for April's FLM (1st marathon)was going so well, anyone got any advice as to how long this takes to heal before one can sensibly start running again and any tips as to helping it heal properly. rgds.
Posted: 03/02/2005 at 21:34

just picking up on this thread, i have been diagnosed with a stress fracture of the 3rd metatarsal and am now in plaster for 6 weeks.

the plaster will make it impossible to swim for obvious reasons but i am going to try and cycle once i can put enough pressure on.

its only been 7 days and its driving me mad.

did you all recover fully and how long did it take to get back into full training ?
Posted: 20/08/2006 at 11:13

Welcome to the 3rd MT stress fracture club - a club you'd rather not be a member of! I share your frustration. I did mine 6 weeks ago today(not that I'm counting!) badly enough to stop me 2 miles into a run but not severe enough to need plaster.
I was pain free at 2 weeks post fracture but have not run since doing it. I have been cycling a fair bit and swimming A LOT. (Only good thing about this enforced lay-off is that I have taught myself to swim front crawl!) I have also started using step machine at gym and have done some short bursts of "jogging" on it without adverse effect - I know it's putting weight through the bones but at least it's without the impact of real running. Like some of the other forumites who have been through this, I intend to start back at 8 weeks post fracture with walk/run on treadmill (with emphasis on walk initially). I think any return to running should be gradual to reduce the risk of doing it all again. Good Luck
Posted: 21/08/2006 at 09:34

I read on the internet that once the bone heals (after 6 weeks) it is very unlikely it will break again.

I am 8 days post fracture and can walk very slowly and am thinking of doing light cycling in the next few days.

My plaster comes off 27.09 and am already counting down the days.
Posted: 21/08/2006 at 10:33

I think I'm getting a similar problem. Been running 20+ miles a week. Had a bit of knee / ITB problem a few months back and had my gait analysed and got new trainers and orthotics.

But for a while now I've noticed a bit of pain on the top of my foot 2nd / 3rd toe after running. Thing is it's not been too bad, just a dull ache , so I thought I could run through it. Did a short x country 4 miler on Sunday, and very painful last couple of days.

Supposed to do a 1/2 marathon on 8th June. Looks like that might be out of the window

Anything else it could be ? 


Posted: 20/05/2008 at 08:50

I fractured my 2nd metartarsal in my right foot 5 weeks ago whilst running. It is a complete mystery as to why and how it happened. As I started the run I had a dull ache at the top of my foot which I ignored and carried on running. By mile 5 the pain was so severe I had to stop.

My advice is that even if you have a very small pain in your foot stop immediately as you can worsen the break.

I still use crutches 5 weeks on but have been told I can introduce gradual weight bearing. The pain does not seem as bad.

I really sympathise with anyone who has this. It has driven me mad and still is and is the most frustrating thing to go from exerciing reguarly to doing nothing at all.

I also advise that you rest your foot as much as possible until you go back for an x-ray after 5 weeks.

I'm going to start cycling and swimming which are supposed to be very good to maintain fitness. I would also recommend going for walks on your crutches in the first 5 weeks with keeping your injured foot completely off the ground. When you get used to this introduce a hill. This is certainly a workout in itself and is better than no exercise at all. Getting the blood flowing is supposed to aid the healing of bone.



Posted: 18/06/2008 at 21:52

Regretably I am now a member of the stress fracture club, took a while for me to discover this, last week i did a pb for a half marathon with no pain at all during the race, however once over the finish line after a few mins i could barley walk. Seemed ok after a few days, raced again the following sunday and only got to 6 miles and pain started again, pulled up a mile or so later unable to carry on. Went straight a A&E who after x-ray confirmed stress fracture on 2nd metatarsal. They advise at least 6 week rest i'm afraid. So frustrating when you get these injuries when your running seems to be coming togeather.


Posted: 26/01/2009 at 19:06

I think i'm a member of the stress fracture club too  RUBBISH! Had an xray today and waiting for the results to be sent to my gp. Dunno why they didn't tell me there and then but they didn't, anyhow i reckon it's deffo is a stress fracture to my 3rd met cos i have total text book signs and symptoms.

It was a week ago now so 1 down 5 to go, gonna try have a swim 2moz and on thursday do some other non impact gym stuff. Shit though isn't it not been able run? I love it and i don't get that same buzz from anything else.  I was just getting to a right good level of stamina and speed i'm gutted.   


Posted: 26/01/2009 at 21:24

Hey Jenni and David..feeling your pain (literally!)...i've a suspected tibial stress fracture...gutted because I was entered for my 1st marathon in April. Going for an x-ray this week, but it's so frustrating because I know all I'll be told is to rest..i think only other runners (and probably only those who've had to sit it out for a while too) understand how awful it feels not to be able to run. Seriously missing those endorphins!! Speedy healing to you both..
Posted: 28/01/2009 at 08:43

Sorry to hear jennie B and Ruby77 are suffering similar injuries as myself, however do take some comfort in knowing that its not only me who is affected by this shitty injury.  People think your mad when you get frustrated that you cant run or do any decent training for 6 weeks, but i think only us 'mentalists'  who really understand the feeling you get when your out of action for a good while. I'm only into my first week of rest and have been swimming everyday, but to be honest i'm bored out of my brains with that already. Thinking of going to the gym next week and even trying some light work on the cross trainer to see if i can get a decent sweat on, do you think i'm pushing it or should i just stick to the swimming.

Wish you's both a good and full recovery. 

  


Posted: 28/01/2009 at 19:38

Hi David, 

i've done nowt for a week now and i'm writing off this week too so my foot has had 2 good weeks off except for walking on it. And i've decided that next week i too am gonna go the gym and give the cross trainer a go and see how i get on with it, but any pain however slight and i'm off, i don't wanna push it. Yes swimming is boring but it'll have to do, along with the execise bike. 

I need to try and hang on to whatever fitness i can!   I wish a full recovery to every stress fracture sufferer out there!!!!


Posted: 28/01/2009 at 20:23

Hey David and Jenni,

I went to the gym last night - did 19 miles on the bike and worked up a good sweat...maybe different for me cause i's my tibia..but felt ok biking..a wee bit sore just after and today...was so tempted by the treadmill before anyone officially tells me to stop, but couldn't break into a jog without it hurting so not the cleverest idea...not to be reccommended!

I'm not a god swimmer - can only do breaststroke..but they do adult lessons, so might actually try to learn front crawl..i've always had a dream of doing a triathlon, so this might be a good time to learn!

Take care both of you.


Posted: 29/01/2009 at 07:36

Hi Jeni and Ruby, thanks for the reply, nice to know someone out there actually reads these threads, Thats the same advise i have heard and i think its spot on, if you feel any pain during any exercise whist suffering this injury it probably isnt a good idea, and to stop straight away. Wish i could have a full two weeks off but i've worked really hard over christmas to get to a good level of fitness & dont want to just let it all slip by totally reasting. (although i know its the right thing to do),  however as for 19 miles on the exercise bike i'm really impressed you must be some type of machine !


Posted: 29/01/2009 at 18:27

Kind of reasurring that there are fellow sufferers out there! Have been training hard since beginning of January for Rome and London spring marathons. Built up through 3 half marathon races in Feb - going well with a couple of 18 mile slow training runs. At the end of the Brighton half felt a burning in the sole of my right foot radiating towards big toe. Thought better rest up and had 5 days off before a 4 mile run which felt fine. Had entered the Thanet 20, a run few days ago, as my final long one before Rome in 3 weeks. No probs for 16 miles then the pain started and got progressively worse but ran through it to end. Unable to weight bear 30 mins after finish. Sleepless night then XRs show mid shaft fracture of 2nd metatarsal. Like the posters above - gutted to get so far along the training schedule before its all been taken away.

Will take it all very easy with my aircast removable splint (advised POP unnecessary) for the next 3 weeks and hope all OK to ski on then. Will aim to start cross training and cycling on return then gently reinstate the running - fingers crossed for an autumn marathon. At least I can defer London to next year - that's if the body holds up.

 Best of luck with healing to you guys posting above!  J-the-E


Posted: 04/03/2009 at 21:06

Sorry to hear someone else is suffering as well as us, from the thread above you sound like you know what your talking about, wondered if you could give me a bit of advice, i was diagnosed with stress fracture in 2nd metatarsal after a half marathon on 25th Jan, since then i've totally rested it apart from the odd light bike ride and lots of swimming. Yesterday tried a gentle 15mins on treadmill, although no direct pain, it didnt feel as strong as my other foot. Is this natrural or am i just being paranoid ? Foot feels fine today, Come this sunday i wll of had a full six weeks from running. Is this enough time for this injury to have healed properly ?

Appreciate any comments you may have, and best of luck with your healing process. 


Posted: 05/03/2009 at 13:06

Hey Johnny - sorry to hear you've had to join our wee group - it is so frustrating - especially this time of year when it feels like spring is on it's way - perfect running conditions! I'm aiming for an autumn marathon instead now...you're right to take it easy - i've had serious warnings from physio and club members (think if i even dared try running just now there'd be spies on street corners waiting to give me a b*****ing! At least your body gets a break from running for a bit - hopefully we'll come back fresher and keener than ever!

 David - mine is my tibia, but reckon the healing time might be similar..my physio might have been over cautious, but she said to give it a full 12 weeks..gp also said this..to me this feels too long. I did mine the week before you, but when i try a wee jog when I'm walking the dog I  feel it on about the 4th stride..so going to wait another couple of weeks.. From what I've read about stress #, if you feel no pain, it should be ok, but I'd take it real easy..and build up v.v gradually..would be such a shame to do any more damage.


Posted: 05/03/2009 at 16:38

Thanks very much Ruby for your advice,  even though i dont like to admit it i think your probably spot on regards to having 12 weeks off. This sunday with be six weeks since my injury was confirmed and to be honest my foot still feels really week.

Appreciate yout comments, hope you make a full recovery.

  


Posted: 06/03/2009 at 19:06

Hi guys - David - an undisplaced stress fracture of a metatarsal should be completely healed in 6 weeks (I am a doctor myself but still didn't stop me completely overtraining looking back at my running log now!). However I think it is right to be cautious. Gentle running on a treadmill is a good idea as there is an element of cushioning and you wont find yourself too far from home if discomfort starts. They always says listen to your body - it will take time for both feet to feel the same and I am sure there is a psychological element to restarting the running also. If you are concerned have a chat with your GP. It might be worth repeating a plain foot X-ray to ensure complete bony healing (or callous formation / remodelling at least) if the foot still doesn't feel right before too long. This may give you the reassurrance you need to commence training.

Ruby - the advice you have been given is right - 12 weeks - sorry to hear - take it easy.

Even though I had the March fracture confirmed 5 days ago I've been off the painkillers for 3 days now but have an impressive limp. If anyone else calls me 'hop along' or says 'I always knew exercise was bad for you'...............Have ordered a push bike for low impact exercise and got a cross-trainer already and deferred FLM place to next year. Getting some grief at home along the lines that marathon training puts too much stress on the body,etc,etc, and that FLM next year will be my swansong but quietly planning my summer / autumn races. Did the Nice_Cannes marathon last November and may well take a look at this one again.

Good healing guys - J-the-E


Posted: 07/03/2009 at 11:59

Thanks jonny for your comments and taken them on board, am booked in to see my gp this week and i'll see what he suggests.

Thks again.


Posted: 08/03/2009 at 17:16

Devastated that I may have to join the club.

Training for my first marathon (London) and everything has been going great. 10 mins knocked off my HM PB and three 22 milers under my belt with no issues until...

The top of my foot felt a little sore last week. I thought nothing of it as I thought it was just a case of tieing my laces too tight. No bruising or anything just a small bruise type feeling. Went out and did my last 22 miler of my FLM training plan on Sunday (whilst looking forward to the taper!) and although I could feel the "bruise" it didn't stop me running at all and managed an easy 3:17. That night noticed a bruise start to appear over the 3rd metatarsal area and very slight swelling. Woke up this morning and swelling is worse and the bruise has turned into one of those "this is from the inside" pale red types.

Although I've been in denial all day, everything I've read points to a stress fracture. If it's still sore tomorrow then I'm off to A&E to see what they say.

I've never worked so hard, with such focus, than I have training for this and for it to be taken away from me at this late stage is soul destroying... 


Posted: 30/03/2009 at 23:24

Absolutely gutted for you mate, i done the FLM last year and i know exactly how much time, training and commitment it takes to get in decent shape. I"ve been suffering from the same injury since mid jan this year and am still not back in full training. Hope you get some good news from A & E.

 Fingers crossed.


Posted: 31/03/2009 at 18:21

Thanks Dave.

 Went to A&E this morning and played the "running a marathon for charity" card. I had 3 doctors and a radiographer analysing the X-Rays. The conclusion from this and my symptoms was that they were pretty sure it's extensor tendonitis.

Advice was to rest and ice it for 2 weeks (I can swim) and I might have a chance of running it.

It's a small window of hope but I'm going to cling to it!

I plan to ice and do nothing for the moment and see if the swelling goes down by Sunday. I might try some gentle exercise (swimming/ gentle cycle) next week if it's looking good and then limit myself to a couple of gentle test jogs before the FLM. I'm hoping I've got most the the training already under my belt...

Spent most of tonight staring at it willing the swelling to go down! 


Posted: 31/03/2009 at 19:37

Good luck mate, hope you get to run the FLM, dont know if you've done it before but its an incredible experience, dont know why but i got all emotional at the end, crying the lot, think its cause i blasted round the first 20 then really felt the pain for the last six. (a mistake i'll never make again). Even if you cant get round in your prefered time, if you manage just to trot round at least you will have the experience of doing one of the best marathons around. 

 Hope you get to run it mate. 


Posted: 01/04/2009 at 17:33

Hi guys and girls,

I'm new to this forum stuff. Out of sheer desperation I've started crusing this web site looking for fellow stress fracture sufferers ...... and here you all are!  Did my  last run on 18th March (only an 8 miler), got shin pain +++++. Bone scan confirmed tibial stress fracure. Have to wait til 21st April to see a consultant. Blessed bone will be healed by then???? Or is that wishful thinking?

Its reassuring to know i'm not the only one turning into a fruit loop, trying to get their happy hormone fix from swimming and cycling.

I wish you all well, especially  those hoping to do FLM.


Posted: 02/04/2009 at 21:45

Goo luck SD.

 Went out and cycled 22 miles today. I'm in some pain though - luckily it's my @rse! First time I've been in the saddle for 2 hrs since I was 14...

Foot seems to of coped OK. No swelling anymore and what I'm left with is a slightly "crunching" feeling in my tendons some time. I'm massaging tiger balm into the foot and that seems to stop it. I reckon the tendons are still a little inflamed and that's whats causing the "crunching" sensation. Gonna give it a few more days of just cycling and maybe a swim. Hopefully I'll get a run in next weekend so I can test that all is well for the FLM.

Cheers 


Posted: 05/04/2009 at 20:43

Am really hoping Im not going to be a member of this group but have some pain over my fourth metatarsal. Is it posible to have a stress fracture here? Its not an acute pain but a pain that builds up after any impact, I walked home from work today and this prduced the pain also. Its a little red and hurts under my foot too. Any thoughts from all your experience??
Posted: 06/04/2009 at 21:49

Hi all,

er i am hoping i will not become a member if honest, ive ran 3 marathons already in the last 2 years and many halfs, un-injured...so maybe ive been lucky too lucky..im booked in for the Paris Marathon in April 2010, and just of late i have pain above my left foot big toe, a dull ache..

I can run and do, i can walk and im digging up my garden and all of that is fine....when i test the toe it has less movement than its brother on the other foot when moving up and down either supported or alone when bent to its max it hurts....not had an x ray...was hoping to run through it...i mean i can bend it and it has movement so im assuming it cant be that bad....

what do you think i should do, i also cannot get my 3:30 at Paris with 6 weeks out no way...

cheers.

 Haggis


Posted: 02/12/2009 at 17:38

Isn't 'march fracture' a more old-school term used as a general term for all stress fractures?

Either way, here's my 2p's worth:

- Had a femoral stress fracture diagnosed end of April this year (over-training, 1 week after Marathon then BANG out for 2/3 months)

- Healed naturally - no need for operation.

- On crutches for 2/3 weeks then gently started weight bearing again

- Swimming and biking, like lots of people on this thread, kept me sane

- Took codine/paracetamol exclusively - NO IBUPROFENS - CAN DELAY BONE HEALING!

- Also have near flat-feet and supinate heavily

- Sometimes get a dull ache but never pain in the area now. Have ran a HM & FM since

- Worried about it happening again though...

In general, what are the weights of people on this thread i.e. low/medium/slightly overweight? I've always been of slender build, was underweight for a short peiod of time in my teens (7 years ago) but generally weigh between 9 - 9 stone 4 now (5'5)

Was wondering whether weight had any impact - I know sometimes people say about getting bad knees because they carry too much weight above them or something?

Also, how much does everyone train? I usually rack up 40 - 50 miles a week at the moment but will run more when Marathon training obviously. I also run consistently - take a day off a week to swim or rest completely, but other than that I pretty much run every night and have done for a number of years.


Posted: 02/12/2009 at 21:34

The term March fracture is normally just used for stress fractures of the 2nd and 3rd metatarsals - a 'traditional' injury of soldiers going on long marches (surprisingly!) in boots.

Haggis - A stress fracture of the 1st metatarsal (bone going up to big toe) occurs very rarely indeed as this bone is relatively free to move compared to the 2nd / 3rd metatarsals which are more rigidly confined in the foot arch and thus subjected to repetitive strain forces. So your big toe problem is likely to be something else.

A bit early for stress fractures just yet - everyone normally comes out of the woodwork when ramping up the miles in Feb / March when Spring marathons loom large.


Posted: 03/12/2009 at 20:37

Haggis - I have exactly the same pain, in my left foot, big toe. Have been running through it as not too bad, but worried it has not gone away.

Should I book a doctors appointment or go to A&E to get it checked out asap?

It will be my first ever marathon - London 2010, training going really well at the moment, really don't want it to be hampered by injury.

Any advice much appreciated!


Posted: 13/12/2009 at 22:15

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