Broad Street Foot Pain

April 27th, 2011

Hello my fellow Broad Streeters!  This is Dr. Pagano, a podiatrist/owner of Barking Dogs Foot and Ankle Care in Plymouth Meeting, PA. I am also a former distance runner at La Salle University in Philadelphia. Welcome to my blog.

 A very common issue among my runner patients is the looming concern of stress fractures in their feet.  As we train and pound the roads and trails, it not uncommon to develop this type of overuse injury. But how do you know if it’s a stress fracture or not?  How do you treat it?  Should you run through the pain?  How long does it take to heal?

 First, let’s talk about what a stress fracture in the foot really is.  Simply said, it’s a small crack in the bone.  The repetitive nature of running and the constant ground impact puts unusual stress on the bones in our feet.   Couple this with rigorous daily training and any of the 26 foot bones can fracture or easier said, break.  Unlike football and other so called “contact sports,” foot pounding on varied surfaces is the dangerous “contact” in running.   


There are many things that can lead to stress fractures including:

  • training error
  • incorrect shoes
  • genetic factors
  • poor nutrition


  • Severe pain that limits your ability to run
  • Rapid or gradual swelling in the foot 
  • Very specific location of pain
  • Bruising

Unfortunately, in my experience runners have stages of these fractures. An injury starts as a tweak that bothers you, but you run through it. Next this injury hurts while running but you can complete your run. Soon, even walking causes pain and you are unable to run. Unfortunately, most of my patients come into my office well after the final stage.


An x-ray can help to diagnose and rule out others foot problems like bone tumors and infections of the bones. Unfortunately, because a stress fracture can be a very small crack in the bone, it does not always show up on x-rays until it forms a bone callous (thickening). Bone scanning and MRIs can also help to diagnose, but it’s the pinpoint pain you feel that usually helps confirm the diagnosis.


How do we treat stress fractures? With the worst advice a runner wants to hear: stop.   A bone takes up to two months to resolve and this rest period is essential to heal the bone appropriately.  Since many runners find it difficult stop and rest, a major complication is the bone not healing properly.  What’s my advice: listen to your body, if you feel pain, address it. And rest it. You may have heard of RICE (REST, ICE, COMPRESSION, and ELEVATION).  And make sure you get seen by a podiatrist who runs…wink, wink.


  • Always wear shoes that are fitted by a specialist.  Go to a running boutique. Its runners who work in these stores and they are trained to properly fit different foot types and runners of all levels.  
  • Make sure you don’t run on old tattered shoes! You should replace your shoes approximately every 300-500 miles.
  • Make sure you follow an appropriate training plan. There are plenty of coaches or free online training programs!
  • Take your vitamins and eat right.

If you are having trouble getting motivated while training for Broad Street, think about how good you’ll feel to finish with all those people cheering you on, there’s no better feeling. It’s the best ten miler in the country!

 Always feel free to stop by the website at and leave me an email. I love hearing from my patients and

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