A Bone To Pick
Want to make bone jokes, but don’t knee-d to.
I broke my foot last year while out on a trail run. Something caught my toe and threw me off-balance; I tried to stay up, but my left foot landed in a slight depression. Since I was off-balance to begin with, my FULL weight, plus the force of gravity, combined to flex my foot downward, and my running sneakers — not Trail Running sneakers (lesson learned) — that I was wearing allowed that flex to happen. Spiral fractures of the fourth and fifth metatarsals were the result.
Approximately twelve weeks later, I was able to run again. 20 minutes of pain-free treadmill. Approximately 10 weeks later, I completed an Ironman 70.3. My secret? I did NOT try to run while my foot was healing. Not even a little bit. After 3 weeks, I began to swim a little. At about four weeks in, my doctor cleared me to start walking. I added in some stationary cycling shortly afterwards, as well as kayaking and paddle boarding. I waited for the doctor to clear me for outdoor riding, and then continued to ever so slightly increase time and effort, always wary for the slightest sign of discomfort or swelling, which fortunately never appeared. Finally the day came when the doctor said I was good to go, and that’s when I got on the treadmill. First for 20 minutes, then within a week up to 30 minutes. 40 minutes, 45, 50; tiny, incremental increases in distance surrounded by all the other cross-training.
Injuries happen. What’s important for us as runners is knowing how to properly recover so that we don’t make things worse in the meantime. Often, this is far easier said than done. For me, I knew that at an absolute minimum, a bone needs six weeks to heal from a fracture. This is both a biochemical and a mechanical process which, if allowed to run its course, can actually make the bone stronger than it was before! Fracture healing is complex, and has four distinct stages: the first, which occurs immediately after fracture, is the hematoma formation (bruising and blood clotting). Then after a few days (up to two weeks), is the granulation tissue formation, creating a spiderweb-like collagen-rich fiber network across the fracture, which starts the process of regaining bone integrity. That is followed by what is known as callus formation, where endochondral ossification, or the process of turning the collagen fibers into calcified immature bone, takes place. This ossification descends from the surface into the deep cavern the fracture created, and also allows for the capillarization of the bone tissue (the blood flow through the bone tissue) to be re-established. The length of time for this process can vary widely, depending one how deep the fracture was, or in the case of a complete break, exactly how big the bone was, and whether the break is displaced. This is a critical process which can not be rushed! Finally, there is bone remodeling, or the process where the immature bone regenerates into normal bone structure. This remodeling can take months in some cases.
A bone injury to the foot is never a simple thing. The foot has 26 bones, 33 joints, and 4 layers of muscle, all strapped together in a package that is only (on average, males) 293mm long, 72mm high, and 104mm wide. Those 26 bones carry the weight of another 180 bones and everything that is attached to them. Screw around with the healing process of the bones of the foot (or any other bone, for that matter) at your own peril. Taking care of our bones needs to be a priority.
Want to read the rest of this journal entry? Join the Breath Runner Club and enjoy full journal entries, videos, and more!
Ready to give the Breath Runner Method a try?
Training plans are available exclusively on TrainingPeaks!
Feel free to contact us for more information!
