Stress Fracture, the Two Words a Runner Does Not Want to Hear

by | Sep 15, 2015 | Blog | 0 comments

The life of a runner who happens to be a doctor. I am not just any doctor, I am an orthopedic surgeon. It sometimes has its privileges. Well, not lately when it comes to my injuries. I have been battling a foot injury for over a year. It started as plantar fasciitis of my right foot, as I mentioned in a previous blog. I continued to run. I made a great marathon come back times two- Berlin and Chicago. They were my first marathons since I had right arthroscopic knee surgery in 2013. My foot got better for a while after resting after my marathons, but the pain returned.  It not only returned, but my other foot started to bother me also. The breaking point, the day that caused me to  actually shut down was 5/10/2015 after Susan G Komen 10k race. Following the race it hurt to walk. I knew I had to stop running, so I could run again another day.

I started treating myself. I wore a boot for almost two weeks to relieve pressure on my foot.  I went back to physical therapy. My foot improved, but it never was one hundred percent. I had plateaued.  I decided to stop treating myself and see another orthopedic surgeon. I traveled to the suburbs and saw a foot and ankle orthopedic surgeon. He ordered x-rays of both my feet which were negative for any broken bones. I thought crazy me, why had I not gotten x-rays of my feet. When I see any patient I always get x-rays prior to treatment. He injected both my feet with cortisone; and they improved.

I started slowly running. The first few runs did not hurt. I did intervals to work my way back into running.  I would run four minutes and walk 2 minutes.  I gradually increased this until I could run about forty minutes. I got up to about three miles. I had a little pain at the end, but what was ironic was my left foot was now bothering more than my right. I initially thought, maybe my foot was getting use to the insert that my physical therapist has recommended. So I continued to run, and gradually increased my time.

I had signed up for a 10K for my birthday as part of my weekend celebration. While I had not made it up to six miles on my own, my plan was to run what I could. I could always stop if I was not complete the distance.  I ran five minutes to one minute intervals for the10k race. I had to finish in time to make it to my birthday brunch.  I was able to run the six miles without any difficulty. I was so happy, I was able to  race ago, or so I thought. Again my left foot hurt after the race. It was not excruciating pain; it was more of a nuisance. I only ran once the week after the race. I did not want to over do it. I continued five minutes run to one minute walk intervals. I figured if I could run a 10k I could step it up. I wanted to get back into marathon shape. It still had that annoying pain on my left foot. The following week I did my usually five to one intervals but my foot hurt a little more than it did previously. It still was not excruciating. I thought to myself maybe I am still recovering from the race so I only ran once that week. I tried to run the following week but my foot hurt, so I decided to rest and only run once that week. I opted to go more biking instead. My foot was a little better later in the week, so I tried to run, but could only run twenty minutes. My left foot was hurting so I stopped.

I knew I had two bike rides over the weekend so I would “get it in” then. On that Friday night I rode 23 miles. My foot ached some which was unusual. My foot usually does not hurt after bike rides. I figured it was related to my run in the week. That Sunday I did a 36 mile bike ride. After the ride I was playing around and I jumped. I felt this sharp pain in my left foot that did not immediately go away. My foot was bothering me the next day at work.

I get a call from doctor’s office that Monday, about my appoint with another foot and ankle surgeon. I had made two appointments initially, and decided to opt with the one who could get me the earliest appointment. I decided to keep the other one just in case. I was still hurting so I decided to go. As I told him my story it hit me, this maybe a stress fracture. It had been in the back of my mind, but maybe I did not want that to be my reality. He ordered a bone scan, because I had symptoms in both feet versus getting two MRIs.

Briefly a bone scan is a test that can find damage to bones. A radioactive substance called a tracer is injected into a vein in the arm. The tracer travels through the bloodstream and into the bones. Then a special camera takes pictures of the tracer in the bones. Areas that absorb little or no amount of tracer appear as dark or “cold” spots. This means that there is lack of blood supply to the bone, and can indicate certain cancers. Areas of fast bone growth or repair absorb more tracer and show up as bright or “hot” spots in the pictures. Hot spots may point to problems such as arthritis, a tumor, a fracture, or an infection.machine

In my case if there was increased uptake it would indicated a stress reaction or stress fracture. The treatment would be the rest, and recovery. An MRI would show a fracture, but is a lot more expensive especially with two. While I have good medical coverage. I still have to pay a percentage out of pocket, so we decided to do the bone scan.

So I got a bone scan. It was quite a unique experience. I have ordered plenty of bone scans, looked at many myself, but it was different actually going through the experience. I arrived, and they injected the tracer  into a vein in my arm. They then took pictures of my feet. I had to stay still on a table for about 20 minutes.

11975504_10154117646074881_219541229_o 11938880_10154117644634881_2036359356_n After they took pictures,I had to wait about two hours. The tracer had to circulate through my blood system. I was happy I had the study where I worked. I left and did some work, then I returned. They then scanned my whole body, and took more foot pictures It took another 45 minutes.

The results revealed that I had a stress fracture of my left foot.

bone scan

It was bitter sweet. I knew why my foot was not getting any better, but this also meant that I had to rest. No running, I had to totally shut down. I actually shed a few tears, then I got myself together. Things happen for a reason, so my focus is now on recovery. I can still work out, but nothing that puts significant pressure on my foot. I have been doing stationary biking and working on losing more weight, so I will be faster when I return. I will be back and better than ever.

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