Can You Run With a Stress Fracture? My Experience + Recovery
Bone stress injuries (BSIs), often called a stress fracture or stress reaction, are one of runners’ most-feared injuries. While soft-tissue injuries can usually resolve themselves with a couple weeks of rest and rehab, BSIs often take a couple months or longer to resolve.
I’m a long-time runner and marathoner, and I’ve had two bone stress injuries in my foot. In this post, I’ll go over the basics of BSIs (focusing on those in the foot), the typical recovery timeline, and my experience dealing with this injury.
Disclaimer: I am not a medical professional. This post does not constitute medical advice and is for educational purposes only. Please consult your doctor or another medical professional about your specific situation, and don’t disregard professional medical advice or delay in seeking it because of this post.
What is a Bone Stress Injury (BSI)?
A bone stress injury happens when your bone becomes inflamed from repetitive loading. In some cases, there may even be a tiny fissure in the bone (hence the name “stress fracture”).
Our bones are constantly breaking down and rebuilding themselves. When the load you place on them is too great, the bones end up breaking down faster than they rebuild, leading to a bone stress injury.
Most runners get bone stress injuries in the feet, specifically in the metatarsal/toe bones. The most telltale symptom of a bone stress injury is tenderness when you press a specific point on the top of your foot. You may also experience pain during activity that goes away at rest, and sometimes swelling.
Why Do Bone Stress Injuries Occur?
BSIs can happen for many different reasons, and several factors may have contributed to your injury. Some common causes of BSIs include:
- Increasing mileage or intensity too quickly
- Bad running form
- Old or poorly-fitting shoes
- Underfueling (lack of protein or calories)
- Lack of vitamin D or calcium
- Weak hips
If you have irregular periods, that is also a risk factor for bone stress injuries, as this could indicate underfueling or a hormonal imbalance.
How Are Bone Stress Injuries Diagnosed?
Two-thirds of BSIs don’t show up on an X-ray because there may not even be a fracture, and if there is one, it’s very small. They may only appear on X-rays when they start to heal, as the bone creates a callus.
MRIs can show minute inflammation of the bone and pick up findings missed by X-ray, but they’re very expensive and not necessary to diagnose BSIs, though they may be ordered if your injury is in a high-risk area.
Doctors may also use ultrasound to evaluate soft tissue inflammation around the site of the injury.
How Long Does It Take for BSIs to Heal?
Typical healing time is 6-8 weeks, as that’s the amount of time it takes for regenerate and repair itself. Your healing time will depend on the severity and location of the stress injury, however.
For example, the fifth metatarsal is known for being a higher-risk stress injury because its blood supply is often compromised in the course of an injury.
If you have a high-risk or higher-grade stress injury, you should expect your recovery timeline to be even longer. Your doctor should be able to tell you if your injury is low- or high-risk, and how severe it is.
Keep in mind that recovery often isn’t passive. To address any strength imbalances that may have led to your injury, your doctor or physical therapist may give you do daily rehab exercises. For a BSI in my foot, I was given ankle- and foot-strengthening exercises, as well as hip-strengthening exercises.
Can You Run with a Bone Stress Injury?
While the healing process generally takes 1.5-2 months for low-risk BSIs, this doesn’t mean you’ll have to stop running for that entire time. If your BSI is low-risk and low-grade, you may be able start a return to running plan after shorter period of time off.
Previously, many doctors put runners with BSIs in a walking boot for a month and told them no running for at least 2 months. In 2014, however, SJ Warden et al. published a paper in the Journal of Orthopaedic & Sports Physical Therapy on a new way to manage low-risk bone stress injuries. This paper recommended following a symptom-based approach rather than specific timelines.
Warden et al. recommended that athletes get back to “unassisted pain-free gait” as soon as possible, rather than putting all athletes in a boot (which alters your gait and can cause other imbalances). If it hurt to walk, athletes could consider a stiff-soled shoe (for BSIs in the foot), walking boot, or non-weight bearing until they could walk normally.
Once the runner was pain-free during regular activities, they could start a return-to-running program. There is again no specific protocol, but many plans recommend that a runner is pain-free for a week before starting the plan.
The plan referenced in the paper then has runners run/walk every other day for 30 minutes with increasing intervals of running, as long as they don’t experience any pain during or after the workout. By the end of 2 weeks, they’re running 30 minutes continuously at a slower pace. From there, they can increase their speed over the next two weeks before increasing the duration of their runs.
Of course, recovery from injury is not usually linear. If runners experience pain during the workout, the plan says to stop immediately, take a rest day, and go back to the previous step where you had no pain.
I’ve made a calendar of this plan below, with the last week at the bottom since it wouldn’t fit. If you’re on your phone, zoom in to read the details.
Of course, this is all dependent on your symptoms and the severity of your BSI. That’s why it’s important to see a doctor, as they may recommend no running at all for a certain duration if you have a higher-grade BSI.
When I got a BSI on my second metatarsal, it initially hurt to walk for about a week. I was able to start a return to running plan after 4 weeks off, when my symptoms finally settled down (I was able to bike during that time off from running).
My Recovery Timeline + Experience with BSIs
I’ve had a bone stress injury twice in my left foot. The first time was in 2015 on the fourth metatarsal, and the second time was in 2023 on the second metatarsal.
First Stress Reaction in 2015 (4th metatarsal)
The first time, I remember the pain coming on pretty suddenly. I believe I just started having pain in left foot after my run one day, and I was especially tender over the fourth toe bones. When I squeezed my foot, I also felt pain.
I saw the athletic trainers at my college, and they ordered an X-ray that found no evidence of a fracture. They told me I could keep running as much as I could tolerate. Weirdly, I was still able to run without much pain for a couple weeks after and even did a 20-mile run (my first!). My toes tingled a little during that run, but it didn’t bother me much.
Either immediately after that run or a few days later, I was in too much pain to even walk. I was put in a walking boot and crutches for a week or two, and the sports med doctor ordered an MRI. (Looking back, this was unnecessary; it should’ve just been treated as a bone stress injury to save me money and time—it ended up being $500+ after insurance).
I was diagnosed with a stress reaction and was told not to even bike for a couple weeks. I turned to arm bikes and swimming to keep up my cardio (I may have even been told to use a buoy to reduce leg movement while swimming for a bit).
I was told no running for 2 months and that I needed to wear the walking boot for 1 month. This injury really pushed me to cross-train, and it was the reason I picked up swimming and triathlons.
Once the 2 months was up, I think I probably did some run/walking for a couple weeks until I could run a couple miles continuously. I believe I only ran twice per week and added one mile to my “longer” run each week. I took one rest day and swam or biked the other days.
I was able to do a sprint triathlon (with a 5k run) about one month after returning to running. Three months after my return, I did a half marathon and ran a 5-minute PR (1:44). I’m almost certain it was the cross-training that really improved my fitness, as swimming is such a good full-body workout. I was also teaching an indoor cycling class that summer, so I ended up working out twice a day for a few days per week (I’d often do a run or swim later on, and about once per week for a month, I did a “practice” triathlon in the gym).
I continued to cross-train pretty heavily until 2020, when I started running more (I didn’t really have a choice because of the pandemic). You can read more about my triathlon-style training for a marathon if you’re curious.
One thing that helped me immensely during recovery was seeing a physical therapist for a gait analysis. He was able to evaluate my form and give me feedback, as well as test my muscles for any imbalances.
I was given a set of exercises to strengthen my hips, knees, and feet. He told me to make sure my knees don’t angle in when I run and to keep my cadence at around 180 strides per minute. I continued doing a lot of these exercises for years and was injury-free until around 2019 (when I got an injury not from running but from skiing).
Second Stress Reaction in 2023 (2nd metatarsal)
This injury also came on pretty suddenly after a regular run. My foot felt kind of weird during the run and the next day, it felt weird while walking as well. Then, I started to have pain while walking.
I had noticed that the top of my foot had felt slightly tender for about a month before, but I thought it was from my new shoes—they’d actually previously rubbed my skin raw in a spot on the top of my foot.
When I pressed above my second toe, that area as well as the outside of my foot hurt. It was a weird, deep pain on the outside of my foot. I also felt some tingling in the toes when walking.
I saw a sports med doctor who took an X-ray and found nothing. He told me to reduce my mileage, but that I could even keep running once per week if it didn’t hurt. To build back up, I could keep adding one run per week if it didn’t hurt.
It hurt to walk, so that was out of the question for me.
He told me that I needed to eat more protein and strength train (I hadn’t been great about doing my old exercises and hadn’t been going to the gym). He also gave me some rehab exercises to do. The doctor recommended eating 1 gram of protein per pound of body weight per day, but when I did some research, I found that it should actually be .5-.9g per pound of body weight per day.
The day after I saw the doctor, I started going to the gym to bike and strength train a few times for week. (Strength training is known to increase bone density). I would do abductors/adductors, resistance ball hamstring work, some light arm work, and my rehab exercises.
I wore a walking boot for a few days, but then felt good enough to walk without it. I even went on some easy 2-4 mile hikes about 1.5-2 weeks after my injury.
About 3-4 weeks in, my pain/tenderness seemed to flare up again, and I wore a walking boot again for a few days. It was weird since this was about a week after I’d gone hiking, and I hadn’t been doing much walking around since then. The sensitivity settled down towards the end of week 4 and the beginning of week 5.
At the end of week 4, I scheduled an appointment with a physical therapist, who gave me more specific rehab exercises. She told me I could start a run/walk routine since it didn’t seem like I was in much pain.
I made sure I could walk 20 minutes pain-free before doing a 20 minute walk/run with 8 minutes of walking and 2 minutes of running. Then, I did 7 minutes of walking and 3 minutes of running for 30 minutes two days later, and I progressed down the plan referenced in the paper before getting back to 30 minutes of full jogging. It took about 6 weeks to get to this point, and 2 weeks after I started run/walking again.
It was also around the six-week mark that my foot no longer had pinpoint tenderness above the second metatarsal. If I was on my feet a lot during the day though, I would still have a small amount of sensitivity in my foot though week 7.
Seven weeks after my injury, and three weeks after starting the return to running plan, I raced a 5k. This was definitely a bit earlier than the plan recommended to do speedwork, but I’d signed up for this race before my injury, and had already switched from the half marathon to the 5k. The 5k wasn’t at full speed either—I basically stuck to my regular running pace for the first 2 miles and raced the last mile.
I’m still in the process of getting back to my regular mileage, but I’ll definitely update this post as things develop.
Having a long-term injury like a BSI can be really upsetting, so I hope this post helps you visualize what your recovery might be like, and offers some encouragement to you.
Have you ever had a BSI? What was your recovery like?
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