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Bone Marrow Oedema 2nd metatarsal
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Okay, so I thought I had a 2nd metatarsal stress fracture from the 3rd May. I had an MRI on the 24th which showed bone marrow oedema of the 2nd metatarsal which is apparently termed a "pre-stress fracture" and is what happens prior to a stress fracture. My consultant prescribed an aircast boot which I've had since Friday for 6 weeks! That is around 10 weeks in total and then physio, biomechanics assessment etc and more MRIs and x rays - it's going to take forever!!!!! He also said only swimming in the meantime. I know that I'm being stubborn and stupid but come on! Surely a pre-stress fracture is better than an actual stress fracture and those don't take that long do they?? and I've been cycling, elliptical training and rowing in since the 4th with no problems or pain and since the boot on Friday there is no pain at all in my foot any more (even without the boot) just a slight ache on a morning.
Does any one have any opinion on this at all? I want to be safe and careful but I'm very disheartened!
Help!!!
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Comments
Lizzy,
Try not to think of a stress reaction of bone (as shown on your MRI) as a different beast to a stress fracture. You cannot talk about the two as if they are wildly different issues -as they are on the same continuum. So yes, you could be forgiven for thinking that a stress reaction is 'not as bad' as a stress fracture, but if not treated appropriately it will soon become one. If you don't have any underlying mechanical issues sorted now then you are at higher risk of this all returning at some point in the future. Very frustrating presently of course - but the aim is to get people back to running asap (and keep them running!)
SDoB
Hi everyone,
Thanks for advice. I'm finding it very hard to stand it! The weather if fabulous and the runners are making me sooo jealous. I don't even want to go back to distance or speed or any of that any more - just a nice 5 miler along the railway line would do me.
I went swimming on Monday and to be honest I found that slightly uncomfortable whereas the x trainer and bike aren't at all.
This boot is also extremely hot in this heat! I am a very twisty twisty woman today!
SDoB - what do you do? You sound like a clinician? Is it a secret?
Thanks again
Thanks D2D that makes sense to me too.
I know with clarity that I pushed it way too hard, too soon, too far, too fast and added hills!!
A beautiful old railway line - very scenic and a 5 mile route I used to thrive on before I thought I was "better than it"! Harsh lesson though!
PS I know I am dwelling and feeling sorry for myself and that there are much worse things! I shall give it up and be grateful!
Lizzy,
Don't make the mistake of getting too concerned with what the Doc or Radiologist actually calls it. The nuts and bolts of it are that the bone has been abnormally loaded and these changes are seen on the MRI. Keep loading it in same way = bad. Rest/allow it to recover and address poor patterns of loading = good. Simples!
Lizzy - I have been diagnosed with a Stress REaction in my Tibia, and am waiting on MRI results. Should hear today.
when I initially was told about it, I thought 'right - lets get this sorted asap', and went non-weight bearing and into an aircast. Lower leg started to swell and become VERY painful...which was a tad confusing. Stopped wearing the cast after 4 days as it was pretty damn uncomfortable....and it sort of improved a touch. Went back to phsyio who diagnosed 'Reflex Sympathetic Dystrophy'.....Although I believe it is quite rare, I simply wanted to mention it to you....and to be aware of it. I started a thread about it as there was nothing on the forums about it, and wanted to hear from others if they had experienced it. If you wanted to read it just have a look on my profile.
When I eventually saw the consultant prior to the MRI - he seemed to think it could also have been a DVT - again something for concern! My physio said she would 'eat her arm if it was a DVT' though, and I have a great deal of faith in her.
Not sure what sdob thinks about the above.
I have been since advised to use my leg normally now, with regards to walking - although I am being 'gentle' with stairs etc.
POint of my post is really to make you aware of the RSD and DVT...as I was wondering what the hell was going on.
Lizzy,
I wouldn't want to contradict your Physio, and by no means am advising you to do anything - but in my opinion there are actually very few injuries which require complete rest - there is always something you can do. I would think that low impact cardio would probably be ok at this point as long as pain is used as a guide.
(No secret really - yes I am a clinician)
Thanks Nick & SDoB,
Nick let me know your MRI results when you get them.
I have no real pain at all now - it's very confusing. I have had the aircast since Friday and now there's no pain at all. I have a sense of the injury but no more.
I think I need a holiday, oh and a stiff drink! After cardio of course!
Hi Nick,
RSD (or 'complex regional pain syndrome' as it is often referred to) is a cruel mistress. I'm sure you've looked into it, but its basically a malfunction of the autonomic nervous system usually following an initial trauma. (Sometimes simplified as saying the 'pain tap' has been left on). Rare as you say, and in Lizzy's case given the information she has supplied does not sound like a contender. DVT is also low on the index of suspicion when faced with isolated foot symptoms (and no lower leg involvement). Your point is a great one though - these things are not always as simple as we first think/hope. Another reason not to ever rely on forum advice alone for an injury!
I haven't read your thread about it - but wish you all the best. It is often a bit of a long-term battle when dealing with RSD/CRPS. Stay mentally strong.
SDoB
sdob - yes it was a cruel mistress, luyckily i had only for just over a week before it being picked up, and then it was a balance of 'use your leg to make it go away'....tricky when you are meant to be taking it easy, but moreover cos it fecking hurt! Just wanted to say a heads up to lizzy, as my fizz and I think that the aircast was possibly the catalyst for me re: RSD, and as you say sounds as though she doesnt have it (she would KNOW!)
There is still some tenderness, but 95% gone - probbaly cos i didnt let it go on for a long time. So it was present for just over 2 weeks really.
Lizzy - will let you know how things go. If it is inconclusive, I have a bone scan booked for tuesday which will show up pretty much everything I am told.
i found this article quite 'to the point'....about SF, but continue with advice from your phsyio as far as I am concerned. The forum can often add to things, but in terms of a specific diagnosis should be used with great caution.
this article.....
http://runningtimes.com/Article.aspx?ArticleID=12894
Hi Nick,
Nice article thanks, let me know if you come across anything else. SDoB do you have any experience of how long the stress reaction takes to calm down? I'm just slightly confused at the time frames with my injury. Since the 4th May I haven't done any running and indeed not much walking which will be 5 weeks on Tuesday yet I haven't a follow up appointment until 13th July which will be 10 weeks in total since the injury. To me it seems like an awful long time and especially as I have no pain as such with just a tiny sense of the injury at the moment. I know I'm impatient but would anyone "try it out" in a couple of weeks or even 3 if the pain is completely gone? I know you're all going to say no!!!
Lizzy - there are plenty of articles and info out there. Stress fracture is (as I understand it) the end of a continuim, which initially are reactions.....get worse until it actually 'breaks'.
I read quite a few bits and bobs, but that one was most succint. I did see another about somewhere, and will see if I can find it.
@D2D - No diagnostic imaging is 100% - they can all miss things (as can the person interpreting them), but as a general rule stress fractures will only show up on X-Ray once they have begun healing (4-6 weeks onwards). MRI is less likely to miss them (but not impossible). Bone scan is even less likely to miss...
@Lizzy - It varies, and depends on its initial severity and how it continues to be loaded. Metatarsals usually take 6 weeks (roughly), but certain other factors can slow things down such as not resting, inappropriate day to day footwear, diet, general health...you get the idea. Healing is location dependant as well - the second metatarsal is the longest and thinnest metatarsal in most people (making it the one which is structurally susceptible to bending moments). If it makes you feel slightly better my own stress reaction (of my pubic ramus) took over 1 year.
ah thank heaven for google desktop.
Note fig 2.11 with regard to the progression
http://www.clinicalsportsmedicine.com/chapters/2.htm
However, dont read too much into recovery times and 'case-studies', as I got myself into a right state about the RSD. An article that detailed 'it was diagnosed, treatment given, it got better' doesnt make for great reading, even amongst the academic papers I tended to read.
that's great too. All good information. Thank you all so much - you've really kept my spirits up today.
SDoB - a year!!! Now that must've been stressful! Was it caused by running?
Has anyone tried running in an aircast?? I bet it's dodgy! Can you imagine the looks? especially in my village.
I've had brand new trainers in a box now for 5 weeks - they smell so good and are soooo pretty! I had my gait analysed a couple of days after my injury as didn't quite think it was as severe then (I thought I'd bruised my foot with laces too tight) and subsequently bought new trainers which I still haven't worn.
Ooooh could too tight laces cause a stress reaction of this sort? My shoes were too big! Or do you think it is perhaps due to the longer, faster, hillier runs!!!!!!!! erm...........
Lizzy,
Caused by running and football combined (and by not stopping when I should have...)
I'm sure you were joking, but I'd give running in an aircast a miss. Its bulk/height would make that leg function as if it were significantly longer. You'd either get back pain or you'd run round in circles
Could tight laces cause a bony stress reaction? Erm - no. Not in my opinion.
yes only joking but I must confess to trying to use the elliptical with it on! Wasn't much fun.
Lizzy, at least with an aircast you can take it off, I had a lower leg plaster for months and was absolutely delighted to move into an aircast.
I broke a toe a few months ago by stubbing it on a door - it took a good 5+ weeks to heal, I could feel that it wasn't ready when I was testing it out.
Frustrating though it is to be out of running, don't be tempted to go back too soon, you'll only end up causing more damage and being benched for longer.
Hope you get on OK.
info
http://www.nursingtimes.net/the-skeletal-system-bone-growth-and-healing/201797.article
Hi Nick,
Any word on your MRI?
Have rested all weekend. Got a sore ankle bone from the aircast in the heat so walked around Saturday afternoon without it - no probs at all - not even a twinge. Pleased the pain is gone but frustrated at having to wait another 5 weeks. I want a follow up NOW!!!! Sorry!!! I'm tired today. 2 year old has had me up at 5.30 all weekend and I had too much red wine to cope!
anyone got an opinion on me trying 5 mins on the treadmill?
Lizzy,
No official word on the MRI. Good friend works as secretary to various consultants (including the one i went to which is handy!) and she says that she thinks the MRI fine...as she has seen the report, which suggests that MRI hasnt picked it up...which is why I am going for bone scan tomorrow. Fizz said all along that she suspected that even an MRI wouldnt pick things up....but a bone scan would.
As for the 5 mile run.....I think you know the answer to that one yourself.......
no 5 minutes?? Just to test it?
Will they give you the result straight away?