What a massive relief that was!!! 20km (4 laps of Queenscliff to Shelly Beach and return) holding sub-4:00 minute/km pace feeling great! This was on the back of a horrible day previously as the cynic in myself predicted a worse case scenario of a right-sided fourth metatarsal stress fracture. I could barely walk following Tuesday's run, the dorsal surface of my outer foot was swollen like a balloon, and I had focal point tenderness right on top of the bony shaft of the metatarsal. Experience tells me that one way to differentially diagnose between a metarsal stress fracture vs. a lower grade bone stress response or metatarsalgia is to determine how the symptoms play out up one attempting to run. If the pain 'warms-up' and improves as the run progresses, the latter is more likely. Alternatively, if the pain deteriorates, a stress fracture could be 'on the cards.' Luckily for me today, the pain on my right foot disappeared (almost) completely after the first 5km. Surprisingly, I was limping less post run than on Tuesday - which is encouraging.
However, like any overuse injury - the essence is to determine the underlying cause - or the 'culprit.' If you have been following my blog, you would note that I have recently completed the majority of my speed work around an anti-clockwise circuit at Passmore Reserve. This means that for the majority of these sessions, my stride length is longer on my right side. This, I believe, put an excessive amount of stress through my peroneal muscles (the muscles on the outside of your lower leg and ankle). In a subconscious attempt to unload these tender muscles, which are responsible for subtalar eversion (i.e. turning your ankle to the side so that the sole of your foot faces away from your body) - and therefore allow you to push off the ball of your foot when running ideally off your first and/or second metatarsal (i.e. closer to the big toe) - my central nervous system compensated by forcing myself to push off on the outside of my foot to propel myself forward. This would likely cause a significant increase in stress towards the outside of the ball of my forefoot - leading to a likely bone stress reaction through my fourth metatarsal bone.
Now that I am aware of this, I ensured that I resumed to the ideal biomechanics of pushing off through the inside of the ball of my right forefoot (like how I always have, and similar to my left side). This obviously relieved the excessive loading through my poor fourth metatarsal!
Who said running related injuries are boring! No two injuries are ever the same, and this is why it is vital to take a comprehensive patient history backed up by a thorough physical examination that considers every single factor that may have played a part in the current clinical presentation.
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