#581 Do I need a fracture walking boot for extensor tenosynovitis? - DOC

#581 Do I need a fracture walking boot for extensor tenosynovitis?

Do I need a fracture walking boot for extensor tenosynovitis? Well, that’s what we’re talking about today, on the Doc On The Run podcast.



If you get this pain on the top of your foot, where you have some aching and you think that it’s the extensor tendon sheath, or the little tube around the extensor tendon, so it goes out to the toes on the top of the foot, you might want to figure out what you got to do to stop those things from moving and let it calm down. Well, there are lots of ways to do that and one of the questions I got in the Runners Aid Station recently, where I answered questions directly for runners for all month long, when they’re trying to figure out how to get back to running and training with these kind of injuries, well, this was a question I got is, do I really need a fracture walking boot? So this is somebody who went to the doctor, they said, “You have extensor tenosynovitis. The best way to get it to calm down is to remove the inflammation and stop aggravating the tendons.”

One way to stop aggravating the tendons is to hold the tendon still. One way to do that is by wearing a fracture walking boot. Now, a fracture walking boot may seem like overkill to you, and it’s understandable. I mean, it is a pretty significant intervention. This is what we use for people after surgery, or when you have a fractured bone, and we’re trying to keep you moving. But it does immobilize the foot and hold it really still. And it also keeps you from moving your toes and bending the toes in a way that pulls the tendons through the tendon sheath over and over pretty effectively.

As long as you put it on and you don’t get the strap on the top of the foot too tight, it really can decrease a lot of stress and strain on the tendons. Now, if you overtighten the straps on the top of the foot, well, then you can actually compress the tendon sheath, and that can cause more pain and irritation. But the question, of course, is it really necessary? Well, it will help, that is true.

For sure the fracture walking boot could help, so would a fiberglass cast. Why not use a fiberglass cast? Well, that’s really restrictive. It’s expensive, it’s troublesome, you can’t get it wet, it’s hard to change clothes. There are lots of reasons why you don’t want to have a cast and a fracture walking boot is just a little bit simpler version of a cast. It functions like a walking cast.

It is effective at holding the foot still, and it really will help the tendon sheaths calm down faster, but it’s not always necessary and I really think, particularly if you’re an athlete, if you’re a runner, the least restrictive intervention is always best. There’s always a price to pay for using the fracture walking boot. When you hold the foot still and you decrease your activity because you have to wear the boot and you can’t do certain activities with that boot, that costs you fitness. You also get weakness, stiffness, loss of neuromuscular connections, all kinds of bad things happen when you wear a fracture walking boot and it gets considerably worse, the longer you wear it.

So if you use a fracture walking boot, because you have extensor tenosynovitis and your doctor only wants you to use it for a short period of time, well, that can make sense because it might speed up your return to activity overall, a whole lot faster, by kind of compressing the time that you’re actually healing and recovering and then it gets you back to the desired activities like running, potentially even faster. It just depends upon how bad your circumstances are.

If you have tons of tenderness and you can barely walk, well, you might be better off anyway with a fracture walking boot, but I don’t really think it’s necessary for most people most of the time. So it’s pretty rare. I’ve had extensor tenosynovitis myself and did not use a fracture walking boot when I got it. So hopefully, this helps you understand why you might need a fracture walking boot and how it could actually help you. You just have to figure out whether or not it’s really bad enough, given your circumstances, to actually warrant that amount of restriction.

If you found this helpful, please like it, share it, and I’ll see you in the next training.