Feet Don't Fail Me Now - Page 3
Metatarsal Stress Fracture
Overpronation can cause stress on the other metatarsal bones (the Jones Fracture described above affects only the fifth metatarsal). Early recognition of discomfort and subsequent adjustment with an orthotic can prevent a full-blown metatarsal stress fracture and an eight- to 12-week layoff. Water-running therapy (jogging in water deep enough that your feet don’t touch the bottom; also called “aqua therapy”) during the healing process is not as fun as being on the trails, so early attention to any metatarsal distress is important.
If you do have a stress fracture, all weight-bearing exercise—including cycling—must cease. You may be given an Exogen bone stimulator; you won’t feel the current from the bone stimulator which in certain cases can accelerate the healing process considerably.
Quick Guide Metatarsal Stress Fracture
Symptoms: Pain over metatarsal.
How it occurred: Chronic overpronation or supination.
What the doctor may do: Palpate area. Gait analysis. X-ray. MRI.
Likely treatment: Orthotic or orthotic adjustment. Cushioned shoe. Exogen bone stimulation. No weight-bearing exercise for eight to 12 weeks. Note: Platelet-Rich Plasma (PRP) shows promise in speeding healing.
Cuboid Pad and Cuboid Bone
Cuboid syndrome is a subluxation (partial dislocation) of the cuboid bone in the foot. The cuboid bone essentially moves out of place due to ligaments weakened from repetitive inversion (the foot repeatedly turning inward while running).
The pain is directly under the arch. It mimics plantar fasciitis but does not go away with standard treatments. X-rays and MRIs are usually not helpful because they will appear normal. An examination revealing tenderness on this bone makes the diagnosis. Treatment is conservative, normally involving manipulation and then strapping with tape and/or employing an orthotic with a cuboid pad to hold the bone in place as the ligaments heal. Maximum downtime is six weeks; if a runner is in a hurry, I have seen Platelet-Rich Plasma (PRP) injected into the ligaments to speed healing while the runner wears the strap or orthotic.
In 2009, pro-football quarterback Eli Manning was reported to have a different cuboid condition. News outlets reported that he had a “stress syndrome” of his cuboid bone. Here, the bone becomes stressed from repetitive inversion, and the condition, if not corrected, will lead to a stress fracture. The pain is exactly the same as that of plantar fasciitis, but there is usually less or no pain with palpation of the bone. This is not ligamentous and is easily seen on an MRI. Rest, an orthotic to protect from more inversion and a bone stimulator are useful in healing and preventing a stress fracture. Recovery time varies with the severity, and all bets are off for a quick fix if the syndrome becomes a stress fracture.
Quick Guide Cuboid Syndrome
Symptoms: Pain in arch, which mimics plantar fasciitis, but pain not usually seen with first step in the morning.
How it occurred: Repetitive inversion.
What the doctor may do: Physical exam. Palpation. Manipulation during physical exam should show relief of pain. Gait analysis.
Likely treatment: Cuboid pad and no running for six weeks. Repeat manipulation of bone back into place weekly. Orthotic or orthotic adjustment. Platelet-Rich Plasma (PRP) speeds healing of the ligament.
Excerpted with VeloPress’ permission from Running Doc’s Guide to Healthy Running: How to Fix Injuries, Stay Active, and Run Pain-Free, by Lewis G. Maharam, MD (www.velopress.com/runningdoc).