Q.I am a 35-year-old runner with a severe stress fracture that my doctor says needs surgery. It is on my tibia and had been painful for quite some time.

Initially, it seemed like bad shin splints but then worsened to the point where walking was very painful. The original X-rays did not show anything, but a bone scan was very positive for the stress fracture. I stopped running for three months and used crutches for a while until the pain went away.

When I resumed running recently, the pain came back and a lump formed where the stress fracture was found by the bone scan. My doctor repeated the X-ray and now says there is evidence that I need surgery. I am not sure why, can you explain?

A. You sound like you have a stress fracture in the tibia that never healed and is evidenced on the X-ray by a black line running horizontally into the bone. Radiographically, this is known as the “dreaded black line” and indicates a lack of complete bone healing.

The current treatment for this problem is to drill a hole through the bone where the black line is with a slow hand drill so the bone does not burn as it is being drilled.

This is followed by placing a rod down the shaft of the tibia so the bone marrow can go through the drilled out hole and promote complete healing. The success rate from this surgery is extremely high, so I believe you will be running again in the future.

Q. I am a 20-year-old female runner with foot pain on the inside of my foot that began last February while I was training for a half marathon in March.

The pain actually is a numbness that goes down the inside of my foot under the ankle bone into the foot on that side.

I had X-rays taken that were negative. I recently saw another physician who said I had some inflamed nerves in my foot and that I just needed to rest it. I have tried icing and over-the-counter arch supports without help. Do you have any suggestions?

A. If you have pain on the inside (medial) side of your foot, and it causes numbness farther down into the arch, you may have something called tarsal tunnel syndrome.

This is very much like the carpal tunnel syndrome experienced by some people in the hands and wrists. In the foot, it can be caused by over pronation, tight shoes, running on a slanted surface for too long or problems with the posterior tibialis tendon.

You can reproduce the numbness and tingling by tapping your finger on the area just below the medial ankle bone. A physical therapist can help decrease the swelling in the area with various modalities (ice/iontophoresis) and then help rehab the muscles/tendons running through the area.

Many times a custom arch support may be needed to take the stress or pull off the area while running. If the pain persists, an MRI may need to be done to rule out any other problem such as a severe tendon injury or stress fracture.

Dr. Doug Cutter is director of the Sports Medicine Center at CJW Medical Center (Chippenham). Look for his column each month. Contact him at or at: C/O Balance, Richmond Times-Dispatch, P.O. Box 85333, Richmond, VA 23293.

- Republished from InRich.com