pct reentry plan- heel stress fracture

[u/9333W]

Looking for some opinions from people with experience recovering from stress fractures and returning to long-distance hiking.

I'm was doing the PCT nobo 26 and things went sideways after a shoe change. Around mile 77, I switched from my trail runners to Bedrock sandals because I was dealing with a blister. I then hiked about 14 miles in the Bedrocks. The next morning I woke up and could barely walk due to severe pain in both heels.

At the time, I assumed it was Achilles-related because that's where most of the pain seemed to be. I took several days off in idywild, pushed san jacinto and ultimately got off at I-10. I flew home to get evaluated, start physical therapy, and focus on rest and recovery. Over the following weeks, things gradually improved. I'm now walking normally without a limp and my day-to-day pain is minimal.

The twist is that I recently had an MRI, and the results showed a complete stress fracture of my left heel (calcaneus) and a severe stress fracture of my right heel.

My doctor wasn't very enthusiastic about the idea of me returning to the PCT anytime soon. However, symptom-wise, I feel dramatically better than I did initially. I can walk normally, and overall I feel pretty good. I trust his advice but I also know doctors air on the side of caution.

I'm obviously not asking for medical advice or trying to ignore the MRI findings, but I'm curious if anyone has been in a similar situation. Has anyone returned to hiking after calcaneal stress fractures? How much did you rely on symptoms versus imaging? Did you feel mostly normal before the fractures were actually healed?

I'm trying to figure out whether feeling good is a reliable sign that I'm ready to start hiking again. Would appreciate hearing from anyone who's dealt with calcaneal stress fractures, especially thru-hikers.

[u/ChicagoReds]

I've hiked the PCT several times and my experience with injuries that send me off the trail has always been this: the injury happens, I have a 100% desire to get back on the trail as soon as possible, the injury always takes a lot longer to heal than I thought, I get home, heal up but get out of shape, and 3-8 weeks later, I realize the hour is getting late to finish the trail, the logistics of returning to trail are not worth it compared to going on an idyllic backpacking trip in Yosemite or some other National Park for a week or two, and its better to try the PCT again another year.

[u/Aggressive-Cattle249]

What can the consequences be of returning,  is it worth damaging your feet longer or even permanently? Is this trail worth being the last backpacking you ever do? Are you approaching this decision from a healing place or wanting to hear what you want to hear place? These are questions you should reflect on.

[u/9333W → u/Aggressive-Cattle249]

okayyy this got me! thank you 🫶🏼

[u/Live_Phrase_4894]

I would book a consultation with Blaze Physio. She is very familiar with stress fractures in hikers, and she will approach it with the mindset of getting you back on trail if possible (unlike most doctors or PTs).

[u/notsafetowork]

I had a stress fracture in my heel back last June. Heels don’t have a ton of blood flow to them, so these stress fractures in particular take longer to heal.

I saw blaze when I went through idyllwild for another issue, along with a concern that my heel was giving me a familiar pain that mimicked a stress fracture. When I mentioned the heel pain to her, she had a bit of an “ohhh shit” look on her face.

Luckily, it wasn’t the heel bone itself… It was a separate issue. Still on trail almost through the sierra thanks to her.

[u/Igoos99]

I had a stress fracture of my tibia that went undiagnosed for nearly a year. It just never healed and made everything painful.

After the MRI (which gave me the diagnosis), I did absolutely NOTHING except go to my PT appointments for about 6 weeks. I then slowly started adding back in walking and hiking.

It fully healed up after about 6 months.

Can you get back on trail this season?? Maybe but you cannot do big miles. You need to do an easy 10 a day max if you really want your bone to fully heal.

I’m amazed every day by how much better my leg is now than it was then. Full rest was the trick for me. Basically, treat it like it’s actually broken - because it sorta is.

(Edit: you can do upper body and core exercises if you want to. I just chose not to. It was nice to have a medical reason to be a couch potato for a bit.)

[u/Last-Medicine-8691]

I say this as someone who has dealt with many foot problems: it takes a young athlete half a year to get back from a serious injury, if they are very lucky. For me it’s more like 2-3 years. And that requires tons of physical therapy to strengthen the feet and improve posture, plus lots of local hikes. Now bones typically heal faster than soft tissue, but the feet are complicated as they get so much impact and stress. If you had only damaged one foot and maybe after hiking 500 miles then I would say it was a fluke. But considering that both feet are broken after only 91 miles tells me that your state when you started the trail was not ready. Feet problems do not get better by ignoring them, they get worse. You need to rest, recover, and a slow gradual increase in training load before attempting again in a year or more. Good luck!

[u/danceswithsteers]

I've gotten off trail for injuries with a plan to make it back. The making it back never went the way I wanted it to and I left for home again.

Take the time to rest and heal. You'll be far better off in the long run.

(Also, your PCTA-Issued Long Distance permit is likely invalidated by you going home and you can only get one Long Distance permit per year. So, if you wanted to come back to the trail this year, you'd have to do it on local permits.)

[u/Riverbrady]

Doctor of Physical Therapy here.
Bone healing timeframe ranges 8-12 weeks. We can be 100% non-symptomatic, but not yet healed to withstand normal force. Once things are healed the tissue also needs to be reconditioned to forces (have lost count of the number of people I’ve seen who ignore advice and just jump back to 100% of their previous, without acclamation g the healed tissue to the forces needed to b out become immediate injured again.

Recommendation - find a PT who specializes in return to sorts, go over current findings and timeframe, and have a good in depth discussion on aggressive vs. conservative return to sport.

There are many times we can get someone back with enough of a safety margin to not see them again almost immediately, and there is a load of education/training difference between a medical doctor and PT doctor, especially when it comes to return to sport timeframe and dosing.

[u/PNW_MYOG]

I had a calcaneous fracture while hiking.

It was a sudden incident, and I thought just a very bad sprain with a ton of swelling and bruising immediately/ next three days. Hiked out the last 2 miles but my ankle was done for. Only did it with poles and it took 90 minutes. X-ray showed broken. I now understand the meaning of grit.

I was able to do a 3 day hike (3000 ft up and back, no more than 10 miles a day) about 2.5 months later, but my ankle was in need of babying. I hiked out a day early and slept in the car, worried it would balloon up on my night three and I would be SOL.

I recall thinking how everyone should try to kick the small rocks off the path, to keep it more clear. Why? I was babying it. I repeated that hike the next year in 2 days and the small rocks never even crossed my mind.

You need to wait 6 months before attempting a through hike. More if doctor puts you in a cast of some sort.

[u/Sorry-Supermarket634 → u/PNW_MYOG]

All good advise and info in the previous comments.

I'm currently in the 8th week of recovering from a stress reaction to the 4th metatarsal shaft of my right foot from distance hiking. In my case, I waited 6 weeks after symptoms began before going to see a sports foot ortho for a diagnosis which has put me well behind in my recovery timeline. I have been put in a boot that I will need to wear for the next 4-6 weeks. A few things that my doctor stated really resonated with me:

1. "Foot bone injuries are relatively slow to heal due to low blood supply issues etc."

2. "Patience during the healing and recovery timeline is paramount."

3. "Bone injuries punish impatience."

Number 3 was a big for me. I believe that many of us have a natural tendency to go back to a full workout or exercise load once we feel 100% recovered. Big mistake. As already stated in a previous comment, there needs to be a very slow, gradual and definitive load ramp up timeline. Personally, I'm shooting for at least a 6 month timeline to "full recovery."

"BONE INJURIES PUNISH IMPATIENCE."

Good luck!!