Adventures in healing

Today marks the 8 week anniversary of my perplexingly stubborn foot injury. Had I known back in February that I would still be unable to run today, I likely would have resigned myself to a period of springtime hibernation. But every day brings new reasons for optimism and I can now confidently report having entered a stage of progressive recovery. In retrospect, the unpredictable ups, downs and surprises of this frustrating period have also been immensely character-building.

Like many runners, I tend to have an inflated sense of how in touch I am with my body; I am thus continually humbled by how poorly I sometimes interpret its messages! If you read my last post, you’ll recall that I initially self-diagnosed my top-of-foot pain as extensor digitorum longus tendonitis. However, after 6 looooong weeks of unsuccessfully treating for tendonitis, I began to suspect a more serious injury … could it be a dreaded metatarsal stress fracture? An MRI revealed no clear fracture line, but showed “abnormal signal intensity” throughout the foot, reflecting edema in the bone marrow, consistent with a diffuse stress reaction (for a great review of stress fractures and reactions in athletes, see Fullem, 2012). Oddly enough, this finding came as a huge relief, finally providing an explanation for my excruciatingly slow healing. No surprise that treating weakened bones for tendonitis would be completely ineffective!

At the same time, this diagnosis taught me a critical lesson. Equally important as listening to your body and heeding signs of incipient injury is accepting you don’t always have the answer, and remaining open to all potential causes of a problem. My symptoms appeared perfectly consistent with tendonitis, and perfectly inconsistent with a fracture: aching that moved around along the path of the tendon from shin to ankle to top of foot, but no swelling or pain upon pressing the metatarsals. With an athletic history void of fractures yet scattered with tendon issues, I was convinced this was just more of the same. But to my surprise, under the combined stressors of marathon training and aggressive transitioning to minimalist running, my metatarsals gave out before my tendons.

Over the last 2 weeks I’ve conducted extensive research which has led me to incorporate several new treatments. Although it’s impossible to attribute improvements to any one intervention, together the following appear to have been highly effective at promoting healing in my stressed metatarsals:

During injury recovery, the body requires additional nutritional support beyond the demands of normal maintenance to ensure active repair of damaged tissue. For bones, this support includes excess calcium, with vitamin D, magnesium and vitamin K, all of which are essential for building strong bones. Silica has also been shown to promote bone health (Carlisle, 1981Jugdaohsingh et al, 2004; Seaborn & Nielsen, 2002) and as a nice side effect, purportedly also improves hair, nails and skin (although I have yet to notice newly lush locks or a vibrant complexion!). In addition, I’ve been supplementing with glucosamine-chondroitin and omega-3’s for joint support and inflammation control, respectively. I’ve also become rather obsessive about maintaining a balanced diet rich in vitamins, minerals and protein.

Bone stimulation
There’s considerable evidence that stimulating fractures with ultrasound can accelerate bone healing (Heckman et al, 1994; Nolte et al, 2001). I purchased a bone stimulator (Exogen 4000) a week ago and – coincidentally or not – have experienced the most marked improvement yet over this past week. Such devices are relatively pricey and not easy to track down (I found mine on Ebay), but are user-friendly, FDA approved and scientifically validated.

Comfrey, or Symphytum officinale, is commonly referred to as “knitbone” due to reports of its phenomenal ability to heal bone fractures. I have been applying a comfrey salve topically to the foot as well as taking a homeopathic dose of symphytum multiple times a day.

The traditional prescription for stress fractures or reactions is complete rest from all forms of weight-bearing activity, often including a boot for walking. For later stages of recovery I’ve seen conflicting advice, with some therapists suggesting the incorporation of pain-free weight-bearing exercise to encourage strength building. As a firm believer that our bodies are more resilient than we’re often aware and under some circumstances are most nourished by active healing, I have opted for the less conservative course. Granted, during the first 6 weeks, my decision to use the elliptical machine, walk and hike (barefoot of course!) was based entirely on a misdiagnosis of tendonitis. Now knowing the state of my bones at this early post-injury stage, I suspect this excessive activity almost certainly delayed my healing. Since my foot has advanced beyond its original highly vulnerable state, I currently follow a simple guideline: engage in any activity that does not cause discomfort. Given my high pain tolerance, I set my threshold at discomfort rather than pain. Running through “discomfort” is what triggered this injury in the first place! This approach currently permits me to walk, do the elliptical and one other secret indulgence to be shared in a coming post (intrigued, aren’t you?)!

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9 thoughts on “Adventures in healing

  1. Reblogged this on Science-based Homeopathy and commented:
    Effects of the Arnica 30X on 1995 Oslo marathon runners

  2. Breanna says:

    Hi Emilie. I enjoyed reading your post about your stress fractures/ reactions and your recovery and I had a question for you. I am a runner myself, graduated this past may after competing in XC/track & field at my college for four years and now I am a College running coach. I was recently diagnosed with a stress reaction in the neck of my femur (I’ve had two stress fractures in my femurs prior to this) and I have been trying to research what kind of exercise I could do while I wait to run again because the doc told me that I cant do anything with my lower body, only some core and upper body. I was just wondering if you had any thoughts since I can’t cross train? I have to wait another 2-4 weeks before I can start to do any kind of exercise on my legs again; I haven’t ran in 6 weeks already so I’m going crazy! I’m also afraid that when I go back to the doc that he will say before I can run again I have to start with cross training. Any thoughts on getting back from a stress reaction safely? I’ve done the recovery from stress fractures before but this is different and I don’t know how to go about this. Any thoughts would be great! Thanks!

    • Emilie Reas says:

      Hi Bre,
      I’m so sorry to hear about your struggles with your femur. I’m surprised your doctor ruled out all lower body exercise for just a stress reaction, as that seems a bit extreme. During my recovery from my stress fractures, I found that very easy stress on the foot (particularly a few weeks into recovery when some healing had started) actually helped stimulate healing. I’d listen to your doctor before me, but I will say that some doctors can be overly conservative in their activity restrictions. My rule was that discomfort was acceptable, but pain was not. Following these guidelines, being as active as I could without causing pain, I healed remarkably fast … my doctor told me he’d never seen a fracture heal so quickly. For cross-training I did the Alter-G treadmill (which I HIGHLY recommend if you can find one near you), water jogging and the elliptical. They all engage the lower body, so if they cause you pain, I’d suggest swimming or simply upper-body strength work. Best wishes for a fast recovery and happy trails!

  3. […] to 2012 and 2013, during which I respectively lost five months and five weeks to metatarsal stress reactions and fractures, I took no time off from a running injury in 2014. Compare the erratic green and […]

  4. Jeff says:

    Hi, Emilie,
    Thanks for your postings–they are a ray of hope. I think I got my stress fracture (2nd right metatarsal) about 6 weeks ago on a barefoot run. For 4-5 weeks I treated it like tendinitis, even had my primary doc and chiro look at it and reach that same conclusion. For those 4-5 weeks I couldn’t run much, but did a bit, walked a lot, biked a lot, and still the pain didn’t subside. X-rays at a podiatrist last week confirmed the stress fracture with a significant bone callus, indicating healing and reinjury over those weeks. Now I’m in a surgical shoe/boot/crutches combo, trying to rest but also trying to maintain sanity by hobbling around, walking dogs, cooking, etc. My question is at this point, probably 5-6 weeks from initial injury, should I be completely sedentary or can I walk around as long as I wear the boot and/or use crutches. Podiatrist said to stay off as much as possible, but your posts suggest movement is good. I don’t want to undo my healing–is the boot able to keep the foot stable enough to handle normal short (10-15 min) walks? I’m taking your suggestion regarding vitamin & mineral supplements, and hope that insurance will cover the exogen. Thanks,

    • Emilie Reas says:

      Hi Jeff,

      Your case is a bit tricky, if you did indeed reinjure it during your recovery period. I think it depends a lot on the severity of your fracture and how much it’s actually healed. I really can only first tell you to listen to your doctor, and then share what worked for me 🙂 I moved as much as possible as long as it did NOT hurt – and that is critical. Activity can stimulate healing, but pain indicates further damage. It’s a delicate balance. If you can’t walk without pain, then yes, stay in the boot/crutches. If you can walk 10-15 min without pain, then you’re probably not doing any harm and may actually help expedite bone remodeling. I fractured my foot twice and – avoiding the boot and staying as active as possible – healed in record time. Good luck! You’ll be back out there before you know it!

  5. Tariq says:

    Your history and delay in Diagnosis is exactly what occurred in my situation . The plain XR and the CT foot were NORMAL . I was Dx with post fall Tendonitis and given an ACE bandage to use as needed . Foot pain persisted and after about 3 weeks I requested / insisted to have the MRI that showed clear cut Stress Fracture of the tarsal bone i.e. NAVICULAR FRACTURE. I have now been given a Cam Boot . On my own I purchased an US Bone Healing System ( EXOGEN ) by Biovdntus .
    My Ortho is luke warm about the low level US healing mechanism. Being a very busy Cardiologist , I’m extremely concerned about the delay in DX / RX and worry about potential Nonunion and Chronic Pain syndrome …
    My question is ; for how many weeks did you use the US system . Thank you for your immensely informative post .

    • Emilie Reas says:

      Hi Tariq,
      I’m sorry to hear about your navicular fracture! I hope your healing is well on its way and that the Exogen is helping. I don’t recall exactly how long I used the Exogen, but I would guess a few weeks. I believe I stopped once I was able to begin running on it. Good luck!

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