Question
Dr. Schneider,
I have been training for a half marathon, increasing my mileage gradually over the past 4 months. After a long run last weekend, (later that night), I had pretty significant pain in the lateral aspect of my foot. I did not have any pain in my foot during the run. Before this time, I have had heel pain in the morning upon first steps.  This, I suspected was plantar fasciitis and it had been causing intermittant pain for several months. Since Sunday, it has been painful to place pressure on my foot, especially with walking.  Today, I went to an urgent treatment facility and they thought the heel pain was unrelated to the lateral foot pain. I am slightly point tender at about mid-metatarsal but not as tender as i am on the bottom of my heel.  They are suspecting a stress fracture, but I am unsure since I, A) am not really that tender to the touch, and B) have had this heel pain over the past several months, which makes me think this is all part of the same problem.
I am also wondering if an MRI will diagnose a stress fracture.  They have ordered a bone scan but I would prefer not to have that diagnostic, due to the amount of radiation.  If it is a stress fracture, will the pain subside after a certain amount of time with just weight bearing?
Thanks so much for any advice you can give.

Answer
My first thought would be that it is likely not a stress fracture, but actually a compensatory pain from attempting to offload your heel pain.  To diagnose it, however, a bone scan is much more sensitive than an MRI when it comes to a stress fracture.  Considering your training and investment of time and energy, the radiation is relatively low for a bone scan...nothing to worry about unless you are pregnant.  An MRI is much less sensitive and a stress fracture can be missed.

You also may not want to rely on the impression of an ER physician in this matter.  Visit with a sports medicine podiatrist who can offer your a more thorough evaluation

All the best,
Andrew Schneider, DPM

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