A self-inflicted injury from sports or from trying to lose weight is even worse. Being a distance runner, minor aches and pains pop up for me all the time. But that pain in my foot just won’t go away, and the big race is coming up. Run through the pain? The best thing to do is to get checked out by a professional before that little pain that could be a stress fracture becomes a big problem. Stress fractures occur from overuse—when you push your body too hard, too fast—or from weak bones due to osteoporosis. Your bones can’t always handle repetitive, stressful activity—like your foot slamming on pavement for 26.2 miles. This can cause tiny little cracks in bones, most often in your feet, toes, or shins, that hurt like hell. If you notice pain or swelling in a specific spot, along with pain during your workout that progressively gets worse (and less pain when you rest), you might have a stress fracture and should seek treatment. Just as a warning, prepare yourself for a potentially long recovery time.
Stress fractures pop up when you push your bones beyond what they can support. Tiny cracks appear in weight-bearing bones, most often in your lower legs and feet. Warning signs to look out for include: The best way to not have stress fractures is to avoid them. Technically speaking, the best way to avoid a sports injury is to become a lazy bum and swear off sports. But for us die-hards, the best way is to live a healthy lifestyle outside of your sport. Stay hydrated, eat your Wheaties, take your vitamins, stretch properly, lift weights to keep muscles happy, or cross train with another low-impact activity. And whatever sport you enjoy, get nice gear for it! Your favorite old, worn-out shoes cannot support your body properly, even if they did win every basketball game back in high school. The moment you think you might have a stress fracture, take a break. Pushing your body when it’s broken is not going to make you stronger. Especially with stress fractures; that hairline crack is only going to get bigger and deeper when you apply more pressure, so lay off it.
Depending where your injury is, you can do other activities to stay active. Elliptical machines and swimming are great options that keep your blood going and they’re easier on your bones. Apply ice and take over-the-counter pain relievers to feel better. This won’t make your problem go away, but it will make the whole process more tolerable. You can ice a few times per day, for about 10 minutes each time, to help relieve pain. Just remember to wrap your ice pack/frozen veggies in a cloth before applying; straight on your skin isn’t so good for you. Taking Tylenol or another pain reliever (like Aleve, which Amazon sells) will make you feel a little better for stretches of time, and can help with swelling. Only a visit to your doctor can confirm your stress fracture suspicions. You can try to self-diagnose and medicate, but your doctor is the only one who can figure out exactly what is going on with your particular injury, and tell you the best way to recover from it. Stress fractures can be tricky;
they can be so fine that a plain old X-ray won’t be good enough. MRIs or other diagnostic imaging might be necessary to really find the problem. Remember, doctors can also prescribe the good stuff to make your pain go away. Do what the medical people tell you to do. They’ve been to school for a long, long time. They took out enormous amounts of debt simply to be able to help you. Follow their advice, the main component of which will most likely be rest, for at least two weeks, but up to a few months. Other treatments might include: calcium supplements (to give bones a leg-up on healing), pain relievers, possibly a cast, and (for the most severe cases), surgery. The last two options are pretty rare, but they’re a possibility if you really screw things up. You’ll also have to resume activity slowly, increasing duration and intensity gradually.Remember what your mom used to tell you? You’ll grow up big and strong! Bones need calcium to stay strong, so eat your dairy products and/or take calcium supplements to keep them in tip-top shape so you can abuse them more in your athletics.
You can order Calcium from Amazon.I know people that swear by these things. “Feet were designed to move in their own way; don’t screw things up with clunky shoes,” they say. Well, I don’t see that humans were especially designed to run marathon distances in the first place, and I love running. But if you’re going to do it, one way to go is natural. Some people, myself included, hate going to doctors unless at death’s door. I mean, doctors are pretty smart people, but they can’t magically fix things. A friend of mine had three stress fractures in his tibia after a marathon, and they only told him to quit running for two months and get plenty of calcium. Prescribed treatment for minor stress fractures might not be more than you can figure out yourself. If it hurts, don’t do it for a while. Ice it and self-medicate with an over-the-counter pain reliever. But even if this is all your primary doctor or sports medicine specialist tells you, at least you’ll have the endorsement of someone who actually knows what they are talking about—which can make you feel better about your injury.
So, although I’m not dragging you to your local clinic, it is the only way to give your stress fracture the most effective treatment with the shortest recovery time, and will help prevent further injury.Last week's class-action settlement by Vibram, an Italian footwear manufacturer known for making silly-looking lightweight running shoes, recalls the recent case against Sketchers, a company that agreed to pay out $40 million after falsely claiming that walking in its product would give you Kim Kardashian's bootie. The difference between the two cases, as much as there is one, appears to be the readiness with which we, the public, consume the scienceish PR from running shoe companies. So let's take a look at the actual science that was on trial. To recap, the suit against Vibram's FiveFinger line of minimalist running shoe was filed by Valerie Bezdek in March of 2012. She claimed the company deceived customers by advertising that its shoe could reduce foot injuries and strengthen foot muscles, without basing those assertions on any scientific evidence.
After some legal haggling, Vibram decided to settle with Bezdek and others from California and Illinois who joined in the class-action suit. As part of the settlement, the company agreed to refund up to $94 per pair of shoes and to deposit $3.75 million into an escrow account to be distributed among those who purchased a pair of Vibram FiveFingers between March 21, 2009 and the settlement.1This seems like a victory for the little guy—for all of those who were duped into believing that a ridiculous toe shoe could reduce running injuries—but in truth, Vibram only settled to minimize the public relations damage and to avoid any additional legal expenses, and has given the standard denial of wrongdoing that goes along with most of these settlements. So what's the deal? Was the company lying about its product? Or was there some evidence to suggest that the FiveFinger could really prevent injury? As it turns out, there are just a handful of peer-reviewed studies examining the company's claims, and the results paint a mixed picture.
Barefoot running has been around for centuries, but it has enjoyed a renewed popularity the past few years. Part of that has to do with Born to Run, Christopher McDougall's book about Tarahumara Indians who figured out how to run hundreds of miles without rest or injury within Mexico's Copper Canyons. (Spoiler: They don't wear Asics). A number of scientific papers support the claim that going barefoot is healthy and natural and that running shoes are not only unnecessary but also potentially dangerous. For most of us, running barefoot isn't practical—I see plenty of glass, nails, and needles on the ground when I jog in Manhattan—so a company called Vibram created an extremely lightweight shoe called FiveFingers that was supposed to mimic the barefoot experience while providing a thin layer of protection.2 Seems reasonable, right?The first small study to formally examine the claims made by Vibram was released in 2009, and looked at how the shoe affected eight experienced barefoot runners.
Each participant was given a pair of the Vibram FiveFingers and instructed to run for six minutes at 12km/hr on a specially calibrated treadmill that could measure stride length and frequency, foot pressure distribution, and a host of other variables relating to the foot-ground interface. The runners then performed the same experiment barefoot and then again with a conventional running shoe. The researchers concluded that the FiveFingers model was effective in imitating the barefoot conditions while providing a small amount of protection. The study was tiny—just eight participants—and only examined experienced barefoot runners, but it reaffirmed conventional wisdom about the shoe: It was like running barefoot, but safer.Two years later, another study using the same type of calibrated treadmill compared the FiveFinger to a conventional running shoe in fourteen experienced male runners. The study found that compared to the Vibram product, cushioned running shoes impair something called ankle proprioception which, generally speaking, is how the body senses the position of the ankle joint.
(This is obviously important for runners.) Again, the study was small and not particularly generalizable to the average consumer because it just looked at experienced runners, but it suggested that FiveFingers might be superior to that old pair of Reeboks in your closet and there was no indication that Vibram was intentionally misleading customers. Things took a turn, however, when more researchers began to investigate whether the FiveFinger could actually prevent or limit injury as the company claimed. In a 2013 study, 36 experienced recreational runners underwent magnetic resonance imaging (MRI) before and after a 10-week trial of running. Seventeen subjects were in the control group (they ran in their traditional shoes), while the other 19 were in the experimental group (gradually transitioning to the Vibram FiveFinger). Using MRI, the severity of bone marrow edema—fluid that accumulates after inflammation or injury—was scored on a range of 0–4 for all of the runners (0 = no bone marrow edema, 4 = edema in more than 50% of the length of the bone, which represented a stress fracture).
MRI scores revealed that subjects in the Vibram group had more bone marrow edema (a proxy for injury) after 10 weeks of running than those in the control group. Researchers ultimately concluded that runners transitioning to the Vibram FiveFingers needed to do so very slowly to avoid potential stress injury in the foot. It wasn't a devastating result, just an indication that the FiveFinger wasn't a panacea for all runners. But things got worse from there. A few months later, in December 2013, a larger study of 99 recreational joggers preparing for a 10k found running in the Vibram FiveFinger shoe increased the likelihood of experiencing an injury, specifically increasing pain at the shin and calf when compared to a neutral shoe like the Nike Pegasus 28 or the partially minimalist Nike Free 3.0 V2. Clinicians like me were instructed to exercise great caution when recommending minimalist footwear to runners who were otherwise new to it. It appears that study—which contradicted everything about Vibram's marketing campaign—made winning the class-action lawsuit difficult for the company.
While there's no doubt that many have enjoyed great success with the FiveFinger running shoe, the company could no longer claim that it's product reliably reduced running injuries. They could've commissioned more studies to continue the fight in court, but clearly the costs of doing so were outweighed by the benefits of settling. So people who like the shoe will continue to use it; those who don't can get their money back.As for the utility of other minimalist running shoes, it appears that the jury is still out. A study published last month shows that barefoot inspired footwear may reduce the incidence of knee injuries, but the shoes do so by putting more stress on the Achilles tendon. Other studies muddy the picture even further, presenting some evidence of the benefits for certain types of runners. So while it might be satisfying to say that Vibram and other minimalist shoe companies lied to consumers, it's probably not that simple. There are studies that show the benefits of running barefoot as well as studies that show the pitfalls and the truth — whether the shoe is actually good for you — will vary from person to person.