This series will explore the most common running injuries, their treatment, and prevention. In this entry, stress fractures. What are the most common running injuries that I see and how do I treat them ? Being a runner myself, I know the need a runner experiences to be able to run. That being said, with some lower extremity running injuries, a runner may need to stop running temporarily.  Temporarily is the key word, as my goal for any of my patients is to keep them as active as possible during treatment. This series will explore the most common running injuries that I see, as well as how to treat and prevent them. 1- Metatarsal Stress Fracture: A little crack in the bone, this is by far the most common injury that I see. Symptoms

  • Swelling top of foot
  • Pain on top of forefoot
  • Does not stop you from running. Is painful during, but especially after a run
  • No bruising
  • Gets progressively worse
  • Pain does not go away completely after 1-2 days of rest, but foot feels better

Common Causes

  • Overtraining: increasing the intensity or duration of running too rapidly
  • Bio-mechanical instability


  • X-rays – used, but we typically do not see stress fracture on x-rays
  • Ultrasound – this is a better diagnostic imaging test for stress fracture
  • Walking Boot – No hard casts are necessary, so the patient can stay more active
  • Bone stimulator: this helps bones heal faster so patients can get back to running. (My patients loves me for this one!)
  • Custom orthotics
  • Limit your activities


  • Early Detection. My best recommendation is to seek medical attention at first symptoms.  You might not like the fact that I may put you in a walking boot for 10 days and no running for 8 weeks, but it will prevent complete bone fracture.  While you are in a boot- Cross training is done and after only 10 days you can run again.


  • Get bone density test. A bone density test uses X-rays to measure how many grams of calcium and other bone minerals are in a bone. This is a good predictor of your risk of fractures.


  • Labs: get a Vitamin-D level check ( 59 % of population are deficient in Vitamin-D). Vitamin D is key to keep bones strong, it aids in the absorbing of calcium. Vitamin D also helps to prevent cancer and autoimmune diseases. Vitamin-D level is crucial, especially in women, as it can prevent Breast Cancer. Vitamin-D level  is not a routine test that physicians perform, but you should ask your doctor about it.


  • Easy does it: Increase the intensity and duration of your training gradually to allow your bone to adapt.

Common Running Injuries: Part 2 of 4 – Plantar Fasciitis can be found here. Common Running Injuries: Part 3 of 4 – Hallux Limitus can be found here.

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