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The response to the question below was authored by Marc Mitnick DPM

Top of foot discomfort

by Larry
(Canada)

I am a distance runner with 30 years of experience and no history of stress fractures. I am now experiencing some discomfort on the top of my foot toward the outside. Oddly, there is not any discomfort at all when I run but only when I first get up in the morning for the first few minutes until I have walked around a bit. I sometimes feel it at times throughout the day, but intermittently.

Is this more likely tendonitis or should I be concerned that it is a stress fracture?

RESPONSE

Hi Larry,

The only way you will know if you have a stress fracture is by an x-ray. If the x-ray proves negative but the pain persists then a bone scan would be indicated, simply because sometimes small "cracks" in the bone will not show up on an x-ray.
Having said, on the surface, your narrative is not suggestive of a stress fracture.
I say that for a couple of reasons. The first would be location. Not that you can't have a stress fracture in the area of the foot you mention, but most stress fractures occur in the second, third and fourth metatarsals. Fractures of the fifth metatarsal where you are describing, and the first metatarsal are more likely the result of trauma and you do not mention any history of trauma.
Secondly, stress fractures

universally will hurt the more you are on the foot and will especially be painful when running as that is where you are maximally "stressing" the bones of the foot.
Most instances of musculo-skeletal pain that hurts on initial ambulation in the morning and then subsides the more you walk, is usually attributed to arthritis.
The is what is known as morning stiffness and is characteristic of early arthritis, so based on your story it sounds more like an arthritic problem than a stress fracture.
Additionally, some times pain on initial ambulation may also be due to a tight ligament or tendon. When you first stand up and stretch the tight ligament or tendon, there is pain. As you walk along, the ligament or tendon starts to loosen up and the pain subsides. A classic example of this would be plantar fasciitis.
Now, you do do not mention how long you have been bothered by this problem, but in general, if it has been over two weeks, there is a good possibility that the problem may not resolve on its own.
Since you are an active runner and should this problem worsen, it would curtail your running, a visit to a foot specialist might not be a bad idea.

Marc Mitnick DPM
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ADDITIONAL REFERENCES

Mayo Clinic

Johns Hopkins Medicine

MedlinePlus

Arthritis Foundation

University of Rochester Medical Center

Harvard Health

Drugs.com

American Academy of Pediatrics

Penn State Medical Center

National Institutes of Health

Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center

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