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.
Discuss this article
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 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
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
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
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
|
|
