#159 When a fracture boot is necessary for a stress fracture in a runner - DOC

#159 When a fracture boot is necessary for a stress fracture in a runner

Today on the Doc On the Run Podcast, we’re talking about the 3 times you really might need a fracture walking boot if you’re a runner with a metatarsal stress fracture.

It’s no big secret that I really don’t like fracture walking boots for runners. I think doctors over-prescribe them. 

I think fracture boots are often over utilized and used for too long on runners when they get injured. And I really believe that fracture walking boots, particularly when they’re used for too long in runners can cause a whole host of problems that are completely avoidable and totally unnecessary. 

That’s what I teach to doctors when I go to medical conferences and I lecture on stress fractures and other running injuries and I try to get them to understand that most runners, heal quickly, they do not need fracture walking boots for as long as most normal patients. 

When you use fracture walking boots for too long, it causes weakness, stiffness, decreased bone density, loss of neuromuscular connections, and a whole bunch of unnecessary increased risks where you getting another different overtraining injury when you’re actually back to running and full training.

So, with that said, I’m going to talk about the three times when you really might need a fracture walking boot because there is a time and a place for everything and there are three cases in which you have a metatarsal stress fracture in a boot, a fracture walking boot that’s going to hold you still and protect you just as well as the cast when that might be really helpful for you.

So the first case is when you have an unstable fracture. So if you crack the bone and it cracks all the way through the bone. And when I take my thumb and I push on it in the way that I show you how to do that yourself in the metatarsal stress fracture course for runners, if it moves, then it’s unstable, the bones moving, it’s not stable, it’s not staying in place. And if you walk on that and you don’t protect it with a fracture walking into it, then it can start to move and cause a serious problem.

So that’s the first case. When you have an unstable fracture, you really want to protect it in a boot. So it can start to heal and heal a lot faster. You do not want to walk around unprotected on that kind of fracture.

Stress fracture breaks and moves out of position

The other thing is when it’s unstable, because it is an actual gap in the bone, you can see a gap on the x-ray. So if you go see your doctor and they do an x-ray and they see a gap in the bone, they tell you you need a boot, then you definitely need a boot. But you don’t always have to get an x ray to tell whether or not it’s an unstable fracture. That’s part of what I show you how to do in the metatarsal stress fracture course. But if it’s unstable, you have to protect it and let it heal and a fracture walking boot is the way to do that.

The second case is when you can actually see a crack in the bone on the x-ray. You have a real stress fracture, there’s a real crack in the bone and it’s stable, but you don’t respond right away to the the regular treatments that help stress fractures heal. So you know, there’s a couple of ways to figure out how bad the fracture is and if you get an x-ray, that’s one way. It gives you a rough idea of how bad it is, but you don’t really have to get an x-ray in all cases. 

A lot of times you can use a fracture walking boot and it’ll help you determine whether or not you really have a real crack in the bone, like a true stress fracture, or if it’s just a stress reaction or stress response where the bones kind of inflamed and irritated and it gets labeled as a stress fracture. But it’s really a much milder version of this problem that we sort of call stress fractures.

If you have one of those and you treat it with a boot for six weeks, you’re probably using the boot way too long. That actually happened to me when I was in medical school. I got a stress fracture that they said was a stress fracture. Now what I know is that was actually a stress response or a stress reaction. And I used a fracture walking boot. And I know I used it way too long. I had to cancel a trip. I was weaker, stiffer everything else as a consequence of using that boot. That’s part of why I teach it the way I do now.

Now the third case in which you might really want to use a fracture walking boot is that you have a tight timeline.

So it’s not really complicated. If you’re a runner and you’re training and you get a stress fracture, you’re training for something, you’re not just seeing how far you can run and how fast you can run. You’re probably training for a specific race. So if you have a tight timeline and you want to race on race day and you don’t want to wait another whole year for that race to come up again and you don’t want to, you know, can the race and then start training for a different marathon or a different triathlon six months out, well then you probably really want to figure out can you do the race or not. There’s actually another lesson I did that was, I think the title was how you can use a fracture walking boot for two days to tell whether or not you can run a 100 mile race.

And in that episode, I talked about how with many running injuries, you can use a fracture walking boot just for a couple of days and it’ll jump start the healing process. So if you’re a runner and you have a tight timeline, that’s the first thing is that with that timeline, if you can jump start the healing process by just really protecting it for the first couple of days, it may really calm down. And first of all, tell you that it’s only a stress reaction or a stress response, not a true stress fracture. It’ll improve a great deal and it will actually accelerate the healing process. But also if you’re trying to really make a decision about whether or not you can do your race, you don’t want to monkey around with it for a few weeks while you’re trying to figure it out without protecting in a boot.

Particularly if you can speed up that process. So if you have a really defined timeframe that you have to work in to try to get the metatarsal stress fracture to heal, using a fracture walking boot, even if it’s just for a couple of days, can really help that process. So even though I am not a huge fan of the blanket, you know, four weeks in a fracture walking boot, or six weeks in a fracture walking boot that many doctors prescribe to runners as a matter of habit, I really do think there is a time and a place for fracture walking boots in those three cases. 

When the fracture is unstable, when there’s a real crack in the bone that needs to heal quickly, or if you have a tight timeline and you’re trying to figure out how quickly you can heal so you can do your race. Those are the three times that you might really want to consider a fracture walking boot, if you have a metatarsal stress fracture and you’re a runner.

If you have a question that you would like answered as a future edition the Doc On The Run Podcast, send it to me, and then make sure you join me in the next edition of the Doc On The Run Podcast. Thanks again for listening!