stress fractures

[Diane Pinkers]

I've been living vicariously through reading blogs of thru-hikers. A trail-ending injury that has side-lined one of the folks I follow is a stress fracture of the foot. I'm guessing, the only way to prevent that is conditioning one's feet? How do you train your feet for day after day after day mileage? Can stress fractures be prevented?

[Roger Caffin]

> How do you train your feet for day after day after day mileage
You KNOW what I am going to suggest, don't you?
Lots of day walks and weekend walks and multi-day walks.

> Can stress fractures be prevented
Um – I suggest that a 'stress fracture' is something you would only get from high impact. Not sure how you prevent that. Are there other similar forms of damage which can happen from 'ordinary use'?

Cheers

[Owen McMurrey]

Hopefully they're just off the trail temporarily.
I had a stress fracture in Airborne School a couple decades ago, and toughed it out the last week on just naproxen rather than be recycled through with another group.
Wasn't fun, and a thruhike is another thing altogether. I was much better after a couple of weeks off, though. Maybe they will be, too.
My feet were probably about as well "conditioned" as feet can get then, but like Roger said, impact. That's what we were practicing taking dozens of times per day…
Nowadays I have a "no jumping" rule.

[M B]

Stress fractures are overuse injuries. Too much mileage too soon. Bones can adapt and thicken, but it doesnt happen overnight. Takes months and probably under good nutrition conditions too.

The runners proverb…increase mileage by only 10% per week…is often cited to help to avoid injuries.

Downhills,can be brutal if you drop your weight on your leg. Its common on the Appalachian trail to have terrace like "steps" built in for trail construction , (I guess this keeps water from running downhill and making a deep rut). These "steps", are horrible for downhills. Like pounding the leg bones with a hammer with every step. After so many miles, they give and stress fractures develop. Common injury there.

The answer is to use poles, slow down, let you weight down gently onto the downhill foot.

[Adam G]

I've had a stress fracture before, thankfully while running and not on a thru hike. There were three main contributory causes

– Too many miles too quickly. Work up SLOWLY. I'd say increase a mile every few weeks for hiking or running
– Not switching out my shoes often enough. You have to replace your shoes every 500 or so miles. If you attempt to prolong their life to save a little money, you will suffer both physically and financially in the long run
– Overpronation. A little poor foot positioning over thousands of footsteps can exert stress in the same place over and over again. Unfortunately, there isn't much written on proper hiking form, which involves your entire kinetic chain from hips to toes

[Valerie E]

Sorry to hear this…

I don't want to rain on your parade, but my stress fracture of the foot took a very long time to heal completely…yours may (I hope) be less severe.

Mine manifested itself as a very sudden, very sharp stabbing pain, as though I'd stepped on the blade of a kitchen knife that was sticking up from the ground. I had no prior warning before it happened — I just took another step, and BOOM. I was 5 miles from the car over difficult terrain (in the dark, too), so I probably compounded the situation by walking out on it. Maybe if you were closer to a road, yours won't have gotten exacerbated (I hope).

My whole foot (top & bottom) was a nasty purple/yellow bruise by the time I got home, and the Ortho doctor just recommended R.I.C.E. and staying off it. If I had it to do over, I think I would go to physical therapy — so that's something you should consider.

And yeah, it wasn't my smartest hike ever — I hadn't been hiking as much as usual leading up to it; I was stuck with someone significantly slower (so I was on my feet MUCH longer than I would normally have been for the same distance); I am a mild overpronater (hey Adam, I never knew that was a factor!); and I was wearing a pair of hiking boots that I didn't much like (too stiff).

[Scott S]

I had a stress fracture in my foot a few years ago. My wife had one last year. A friend on the PCT had one. In all 3 cases, the fracture happened immediately after changing shoes either during a thru-hike or when running well over 20 miles a week. When I showed up at his office with my sfx, the first thing my sports med doctor asked me was "what did you change recently about your training?" So, my best advice would be, if you're changing shoes, give your feet a chance to get used to the new shoes before doing lots of miles.

Other than that, my doctor said to be sure to get enough calcium in your diet and take supplements if you're not.

The good news about stress fractures is that bones heal up completely in 6 weeks or so (usually–stress fractures in a few places take longer to heal), and once they heal they heal for good. I'd much rather have a stress fracture than a bad sprain or tendonitis. Those kinds of injuries can drag on forever.

[Jennifer Mitol]

Yeah, there's not a lot you can do to prevent stress fractures – except make sure your nutrition is good, you don't increase mileage too quickly, wear appropriate footwear, etc etc.

I would IMAGINE that poles would help reduce risks of lower extremity stress fractures, but that's just a theoretical statement, not one based in research.

+1 on stress fractures being WAY easier than tendinopathies, but regardless if you ever get one you should find out if you have a biomechanical fault somewhere that may be contributing to it. That's what a PT is for – not an ortho doc, not a podiatrist. Yes, I'm biased. And I freely admit it ;)

[Mike M]

I had a stress fracture in my left heel, very not fun :( Mine happened out of the blue, was going for a short run (6-ish miles) felt like my achilles was a little sore so I slowed, wasn't getting better so I walked- within 10-15 minutes I couldn't put any (any weight) on my left heel. It was extremely painful (didn't help that I had to navigate three different airports the next day). It's possible that running on cement and paved roads contributed to this, hard telling- might have happen regardless.

I did learn a few things from my experience. If you can, get a air cast/boot so there is no pressure on the stress fracture. I didn't have that luxury because of my line of work, which didn't speed up the healing process. Take Calcium while you're healing. Don't take ibuprofen, it slows bone growth (healing). You can get an xray, but the stress fracture likely won't show up until 3-4 weeks after the bone starts knitting. It really doesn't matter because the "cure" is time-the bone knitting itself.

I was able to stationary bike after 6 weeks, walk after 8 weeks and run again after 10 weeks. It's not a quick heal. The good news is that it's very rare to have a stress fracture in the same location- as the bone knitted is stronger than before. The Spetsnaz (Russian Special Forces) will have their troops jump off of high objects w/ the intention of inducing microfractures, once healed the bones are stronger. Crazy Russians :)

Good luck

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