Fibula Stress Fracture.....other proximity pain

[Mattlock]

(sorry, couldnt get image to paste into post)



5 weeks ago I was diagnosed with a Fibula stress fracture located about 2 inches above the akle bone (black spot). In addition to the pain distinctly associated with that spot I also have another distinct pain assoicated about an inch around towards the back of my ankle (red spot). The red spot actually is more sensitive and painful to the touch than the actual fracture site. This feels more like a very sore muscle/tendon that hurts substantially to massage or press on it.

Again it is located at the same height as the stress fracture just around towards the back. My podiatrist (actually the PA, (second visit) said it would be caused by the callus forming and irritating the tendon. Does that sound reasonalble?

Overall the pain(s) are improving but last night I rubbed/massage the (red) area more than usual and today it has been much more sore and more swollen than usual.

I know an MRI would clear up the issue but quite frankly the treatment (rest, no running) is probably not going to change.

thanks for any feedback.







Matt

 

[Barefoot TJ]

  Here's your picture from



Here's your picture from "that other forum." All you have to do is to copy and paste it here. As long as an image already exists on the net somewhere, a quick copy and paste will place it here.

We're trying to get the Ask the Docs forum up and running, I hope this week. Hopefully, one of them will be able to answer your question.

 

[Mattlock]

thanks BF TJ for the pic post

thanks BF TJ for the pic post

 

[paraganek]

Matt,this sounds exactly

Matt,

this sounds exactly like what I had some 3 months ago. :sad:

Those two spots on the picture (red, black) you are indicating are also exactly what I felt.

I was not officially "diagnosed" with a Fibula stress fracture because there was no indication of a stress fracture on my bone scan images so my diagnosis was more like a stress reaction.

It took me 6 weeks of resting to recover and start running again.

You can read more here http://barefootrunners.org/forum-topic/trails-back-pavement-recipe-disaster

Anyway good luck and I wish you speedy recovery :smile:

 

[Dr. Mark]

Matt, The stress fracture

Matt,



The stress fracture is concerning in that it identifies there is something really important you need to correct. it could be many things. these injuries should not happen if you have good barefoot technique, be progressive, and listen to any discomfort. One of the findings in the literature is the relation of the impact transient and loading rates on bone injury. It would be real important to see how you land. The red spot could be Achilles tendonitis. Would need to assess the pain on loading the specific tendons. Rarely does the precise anatomic diagnosis matter though. more important to identify the imbalance, weakness, gait issue contributing.



Find someone strong in your area to do a full functional assessment before returning to running.





All the best in recovery,



Dr. Mark

 

[shoeless shaw]

"Find someone strong in your

"Find someone strong in your area to do a full functional assessment..."

Any tips on how to go about that and assess their competence? About 6 months ago, I paid $200 for what I thought was a full analysis, only to find that it was filled with generalities, and the physio was really only using it as a method to get me to use his firm for consults & treatment. I don't really know what a "full functional assessment" would look like or what information it would give me.

Thanks in advance!

d.

 

[Mattlock]

shoeless shaw wrote:"Find

"Find someone strong in your area to do a full functional assessment..."

Any tips on how to go about that and assess their competence? About 6 months ago, I paid $200 for what I thought was a full analysis, only to find that it was filled with generalities, and the physio was really only using it as a method to get me to use his firm for consults & treatment. I don't really know what a "full functional assessment" would look like or what information it would give me.

Thanks in advance!

d.

I second that.....how do I find someone "strong in my area". btw...secondary pain has totally disappeared and now primary area is getting better...hope to be back to some running in a week or so...



I really would be interested in having an assesment done. Maybe I'll just video tap myself and post in one of the forums here...

 

[Neil_D]

G'day Matt,What you need to

G'day Matt,

What you need to do to cure your tendinitis are eccentric calf drops.

I have had had lots of people over the years ask me about how to get rid of tendon problems. I tried all sorts of things over the years, most of the doctors I saw didn't have a clue and just want to get you into stable shoes or some other crap.

These will work, you will have to do 3 sets of 15 each day for around 3 weeks and you will find the pain will gradually diminish.

Read the article.

http://www.carletonsportsmed.com/chronic_achilles_tendinitis.htm

If you can search for the original Swedish article that describes it better.



Regards



Neil

 

[Mattlock]

I wanted to ask the Doc or

I wanted to ask the Doc or anyone else with experience for some general feedback.



It's been about 10 weeks now and while my SFX is improving it is coming along slower than I hoped for. I can run maybe a mile a time without much pain but it still feels "weak" and I can definitely feel some "discomfort" when I press on the spot pretty hard.



The "callus" is very noticeable where the healing is occuring. I still have noticeable swelling at the end of each day around the ankle bone which usually goes down overnight. None of the swollen areas is painful at all but I assume this is normal. Looking in a mirror my injured ankle looks larger (diameter) than my other ankle by a little bit.



Again, when the podiatrist told me 4-6 weeks he also said "but you really need to go by feel" I wonder if he was just being nice knowing that it would be signfificantly longer. Seems like the last metatarsal SFX I had took something like 10-12 weeks also to heal. Maybe I am just a slow healer. I did get my Vitamin D level checked an it was 65 which is great per my PA.



Oh well, just looking for some general thoughts. I also wonder if I should just not run at all for another week or so rather than just short distances around the track which is all I have been doing.



thanks

Matt

 

[swoggis]

Hi, Mattlock.When my fibular

Hi, Mattlock.

When my fibular stress fracture was finally diagnosed in January via MRI, it required 10 weeks of NO running to completely heal: At Week 3, I had no pain at all and would have started running if I was treating "by feel". At Week 6, a follow-up MRI showed nearly complete, but not 100%, healing so my doc told me to lay off for another 4 weeks to be sure. I've been ramping back up since the end of March without recurrence of pain in that spot, and aside from one instance of scary ankle pain that turned out to be nothing, I haven't had any other injuries (knocks on wood).



My point is, that if you've been 'testing' your SFX by running on it every week for a mile here and there, then you may just be prolonging the injury.

 

[Mattlock]

swoggis wrote:Hi,

Hi, Mattlock.

When my fibular stress fracture was finally diagnosed in January via MRI, it required 10 weeks of NO running to completely heal: At Week 3, I had no pain at all and would have started running if I was treating "by feel". At Week 6, a follow-up MRI showed nearly complete, but not 100%, healing so my doc told me to lay off for another 4 weeks to be sure. I've been ramping back up since the end of March without recurrence of pain in that spot, and aside from one instance of scary ankle pain that turned out to be nothing, I haven't had any other injuries (knocks on wood).



My point is, that if you've been 'testing' your SFX by running on it every week for a mile here and there, then you may just be prolonging the injury.

thanks swoggis... let me clarify that I didnt start testing until 9 weeks into the healing... I think sat i did a little too much and felt weird after so i am taking a break.... good points ....thanks

 

[Mattlock]

swoggis wrote:Hi,

Hi, Mattlock.

When my fibular stress fracture was finally diagnosed in January via MRI, it required 10 weeks of NO running to completely heal: At Week 3, I had no pain at all and would have started running if I was treating "by feel". At Week 6, a follow-up MRI showed nearly complete, but not 100%, healing so my doc told me to lay off for another 4 weeks to be sure. I've been ramping back up since the end of March without recurrence of pain in that spot, and aside from one instance of scary ankle pain that turned out to be nothing, I haven't had any other injuries (knocks on wood).



My point is, that if you've been 'testing' your SFX by running on it every week for a mile here and there, then you may just be prolonging the injury.

thanks swoggis... let me clarify that I didnt start testing until 9 weeks into the healing... I think sat i did a little too much and felt weird after so i am taking a break.... good points ....thanks

 

[swoggis]

Ah. TMTS would have been the

Ah. TMTS would have been the easier explanation on why you still have discomfort. If you're still getting swelling in the ankle after 9 weeks off from running, that just seems odd for SFX. Let's see what the docs say.

 

[Barefoot TJ]

Have you been wearing a

Have you been wearing a boot? I think that would be the best possible thing to do to help speed healing.

Also, your Vit D levels are great, but what about your calcium levels? They must have checked that too. I guess you were okay there too?

Doc, can we take extra calcium without causing harm to our bodies, and if so, how long after taking at least the recommended daily dose do the bones actually start getting stronger? Will the extra calcium be of benefit or just a waste?

 

[Mattlock]

Barefoot TJ wrote:Have you

Have you been wearing a boot? I think that would be the best possible thing to do to help speed healing.

Also, your Vit D levels are great, but what about your calcium levels? They must have checked that too. I guess you were okay there too?

Doc, can we take extra calcium without causing harm to our bodies, and if so, how long after taking at least the recommended daily dose do the bones actually start getting stronger? Will the extra calcium be of benefit or just a waste?

TJ,

I havent had my calcium levels checked in a long time but 10 years ago (an prior) I had a history of kidney stones and was diagnosed with hyper calciurea or (over efficient use of calcium). I realize that could have changed in the past 10 years so I should have it checked again.



ps. just found a recent blood test and serum calcium looks normal.

 

[Barefoot TJ]

That's good that your calcium

That's good that your calcium levels are normal. I had surgery to remove a tumor on one of my parathyroids (hyperparathyroidectomy). The tumor was causing my body to not absorb calcium, so when my calcium blood level was checked, my level showed dangerously high, meaning too much calcium in my blood, not enough in my bones and elsewhere needed, as I passed it, as the parathyroid hormone dictated. In the meantime, I developed osteoporosis. Two and four years after the surgery, I had my bone density checked. I am no longer in the osteoporosis category, but have moved to the ostepenia category, which is much better, but because of my age, I will never be back in the normal bone density category. That's why I asked about your calcium levels.

 

[Dr. Mark]

Interesting discussion and as

Interesting discussion and as always it is hard to give clear recommendation with doing assessment on potential causes.



In general for stress fracture recovery once there is healing and callous in place (4-6 wks for non weight bearing bone like fibula) it is optimal to add some mechanical stress with very short running distances. A minute of running and then 5 minutes of walking at first. See how the discomfort is after a half hour. Gradually progess with the minute of running alternate with walking.



Many folks go out and do a mile or two…that is 1000’s of reps. Not good for the first phase of recovery.



Dr. Mark