Patient Overview
A 45-year-old lady presented to Access Ortho. She described persistent pain on the top of her right foot. She explained that she had been training for the upcoming Gold Coast Marathon. When asked about her training, she explained that she had significantly increased her weekly running distance over the past six weeks. Prior to this, she maintained regular gym attendance and ran 5km once or twice a week. In preparation for the event, she had increased her training load to approximately 30km per week.
History and Presentation
The patient reported that she had noticed a gradual increase in pain over the dorsum of her foot, most noticeable during and after running. Over the past two weeks, the pain had intensified and, in the last week, had progressed to the point that she could no longer complete her training runs. She had trialled Nurofen and ice with minimal relief. Concerned about her symptoms, she sought help after finding Access Ortho online.
At her initial consultation, the Orthopaedic Nurse Practitioner assessed the foot and noted point tenderness over the mid-foot, particularly around the second metatarsal. There was no visible bruising or swelling, and she reported no other joint or foot pain.
Diagnosis and Management
A foot X-ray showed potential early changes consistent with a stress injury, although the findings were subtle. Given the clinical suspicion for a stress fracture, a moon boot was fitted to protect the foot, and crutches were provided to offload weight. The patient was advised to avoid running and high-impact activities until further imaging was available.
An MRI 3 days later confirmed the diagnosis of a second metatarsal stress fracture. She was advised to continue using the moon boot and crutches as needed for pain control and to engage in water-based exercises to maintain cardiovascular fitness during her recovery.
Recovery and Outcome
At her six-week review with the orthopaedic surgeon, the patient was no longer using crutches or the boot and was mobilising pain-free. With 12 weeks remaining until her planned run, she was given clearance to resume running gradually. She was also encouraged to purchase new, supportive running shoes and monitor her symptoms carefully.
At a follow-up visit four weeks later, she reported a successful return to training. However, she had decided to complete the half-marathon rather than the full marathon. She was discharged from our care with advice to return if symptoms recurred. We wish her all the best for the half-marathon and hope she can fulfil her goal of running the full marathon next year.
Preventive Discussion
As part of her assessment, a discussion was held about bone health and the potential role of underlying osteoporosis in stress fractures. She was advised to make an appointment with her usual general practitioner, so they could further evaluate and offer preventive care if required.
Important Points to Note
- A sudden increase in training volume or repetitive activity can significantly raise the risk of developing stress fractures.
- Biomechanical issues or poor footwear can also contribute and should be addressed to avoid recurrence.
- Recovery requires a gradual, pain-limited return to activity, ideally guided by a clinician.
- Consideration of bone health, especially in women over 40, is essential to reduce long-term injury risk.