Stress Fracture

[Kate B]

As you all know I had a stress fracture in my 1st and 2nd metatarsals in the winter, and by the end of January, beginning of Frebruary they seemed to be on the mend.

 

I started off going back to class really slowly, just doing floor work in contemporary and floor barre and staying away from ballet class altogehter. It was fine. But for the last 4 weeks I have been going to ballet, and by the end of last week I was getting the pain back, and I went to class on Monday and had to stop because it was hurting so much.

 

And now, even just standing up hurts, even in my shoes.

 

My PT is on holiday for the next 2 weeks. She is going to be annoyed with me. I'm beginning to think I tried to go back to dancing too fast.

 

I'm not sure what to do. Should I stay away altogehter for a few months? Or just go back to floor work in contemporary? Do yoga and swimming for a while? I am so annoyed with myself.

 

Sorry, this is turning into more like a rant than a request for advice. Thanks for listening.

[Victoria Leigh]

Kate, I would say stay with only floor barre and that type of non weightbearing work until you are sure it is healed. Or at least until your therapist returns and you can get an opinion of what is happening.

[Kate B]

Thanks Ms Leigh. I know there is no quick fix. It's so annoying though!

[DreadPirateRoberts]

Hi Kate --

 

Ranting is fine... I can sympathize, because I had a stress fracture (5th metatarsal)

right at the end of May last year. I know I am the most impatient patient anyway,

and this was no exception. I was walking on my foot long before I was supposed

to, and even when it hurt, because I hated wearing the stupid plastic ski boot thingy

and hated crutches even more. My orthopedist laughed with me about it, and then said

the following, which I'll include in case it helps you. Of course, as Victoria points out,

you should check with your doctor when they return. Maybe get another xray, etc.

And, of course, I am NOT a doctor, but here's what mine told me:

 

The rates at which stress fractures heal are highly dependent on a couple of things:

- obviously, immobilization, to prevent refracturing the bone,

- obviously, making sure you are getting plenty of calcium, vitamin D, etc in your diet,

- obviously, genetics -- some people's bones are more prone to fracture, slower to heal, etc.

- obviously, your age,

and, finally, what was NOT obvious to me at all:

- the location of the fracture on the metatarsal! I learned that some areas of your toes have

much more blood flow to them, and thus heal more rapidly, and others not so much. Looking

at my xray he mentioned that I was lucky, and that healing should go really well because of the

location of the main break. However, he said that had the fracture occurred a few cm more

proximally, the healing time would have been much longer, and healing would have, in fact,

required a more severe degree of immobilization. (That would have been, I believe, referred

to as a "Jones fracture" of the 5th metatarsal, which has sometimes ended the careers of

professional football players from what I read)

 

So, it may be difficult to generalize our experiences with stress fractures because of all

these variables. But, what we CAN generalize is how rotten the experience is, and how

painful it can be, and how frustrating for active people to be immobilized. So, thanks for

writing about it. I'm sending best wishes for a speedy recovery, or re-recovery!

 

Oh -- one last thing -- I did notice that when I was being naughty and attempting to

walk when I should not have been, that I often found my muscles and tendons in the

affected foot were strained, because I was compensating in an unnatural way, quite

subconsciously, as I was walking, climbing stairs (the worst!), or even standing still.

You may find a similar thing happening to you, too. Perhaps that could be a part of

the pain that you are feeling now??

 

Anyway, I hope you're soon better!

[Guest Pigeon]

Hi "DreadPirate" --

I have to go along with the advice of the others, because I, too, had a stress fracture of the metatarsal.

The muscles and tendons in the affected foot can easily be strained, and could indeed be part of your present pain. The bad news is this: the stress fracture can take 8 months to heal! --and that is IF YOU'RE GOOD! I got through it by telling myself that each day that I rested it, I was further along to getting back to ballet.

I did find that ice helped, though, along with elevating the foot when it's tired and the pain is at its worst. You really do have to "baby it." Don't do anything on half-toe, even reaching for something.

Know, too, that we're with you, and you can complain all you want! Give us a progress report....

Pigeon

[Guest Pigeon]

Whoops! I addressed that to "DreadPirate' -- it was meant for Kate!

Sorry.

Pigeon

[Kate B]

Thank you so much, I am touched by your advice and support. I can see that a prolonged period of rest is probably going to be the best thing I can do for it, and I will talk to the PT when she comes back. As I've never had an x-ray for this (my GP just gave me painkillers and told me, vaguely, to 'rest') maybe I am going to have to push for one, as I really want to understand where the problem is and exactly what it is I am doing wrong (although I suspect it is simply a case of trying grand plies and pirouettes - demi pointe - too soon.)

 

I will let you know how things go. For the time being I am going to have to think of ways to keep my fitness up, because I find that losing fitness (as well as simply not being allowed to dance) is the most depressing thing about this injury.

[DreadPirateRoberts]

Hi Kate --

 

Please do keep us posted on how things go for you. I agree -- it is so

hard to not be able to dance, but hopefully swimming (if that is easily do-able)

will keep you fit until you're back in ballet class again!

 

I checked a couple of online medical information sources about stress fractures,

and thought I'd pass along what I found for you. Again, all the appropriate caveats

apply (I am not a doctor, I cannot vouch for the accuracy of the info, etc). But,

given that, maybe some of this will be helpful.

 

1) From the Merck Manual, see:

Merck Manual link

> However, when a stress fracture does affect the big or little toe, healing usually takes longer than

> with the other toes; the person may need to be immobile for a long time or may need surgery.

 

2) From the American Academy of Family Physicians online reference:

AAFP link

[ Treatment for] All stress fractures (conservative therapy)

- Modified rest for six to eight weeks (or until pain-free for two to

three weeks); activities of daily living and limited walking are permitted

- Nonsteroidal anti-inflammatory drugs

- Cryotherapy

- Stretching and flexibility exercises

- Cross-training (non-weight-bearing exercise)

[ Specifically] Metatarsal stress fractures

- Wood-soled shoe or casting for four to six weeks

- Special attention should be given to fifth metatarsal fractures to prevent nonunion

 

3) There is also an interesting article in the online guide to Clinical Sports Medicine, see

Clinical Sports Medicine

 

Maybe some of these will help -- Good luck, Kate, and hopefully you'll be back to full

strength before the summer is out...

[Kate B]

Thanks DreadPirate - the third article was really interesting. It looks like it will have to be complete avoidance of dance for quite a long time.

 

I have a PT appointment a week on Tuesday. I will be able to get some good advice about keeping strength and flexibility from that.

[Guest beckster]

Hi Kate, sorry to hear your foot is bad again! I am sure you can find non-weight-bearing ways to keep your fitness up in the meantime. Perhaps your physio will suggest something - swimming seems an obvious choice. And you can always stretch at home, sitting on the floor!

[Jaana Heino]

Oh, Kate, how sad. Stress fractures can really take a long time to heal. I think it is a good idea to push for an X-ray, and maybe it would be good to also get an opinion from a specialist since it's now a recurring problem?

 

To find something comforting, no matter how small a thing: you are ever so lucky to have the option of floor barre.

[Kate B]

Thanks guys.

 

I'll wait and see what PT says on Tuesday, and then see if I need to take further action - she might suggest it.