Is a fracture walking boot the best thing when you have a calcaneal stress fracture? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
A calcaneal stress fracture is a terrible injury.
What is a calcaneal stress fracture?
“Calcaneus” is the medical term for heel bone. When you get a stress fracture in the heel bone, doctors call it a calcaneal stress fracture. When you run with a calcaneal stress fracture there is a risk the bone can actually shatter and break apart.
That obviously would be bad. But there are three really interesting facts about the heel bone that you should think about.
Number one, the heel bone, as you can see, is by far the largest of all the bones in your foot. So that’s interesting fact number one. Fact number two is that you cannot walk without putting stress on your heel. So if you step on the heel with your heel on the ground, normally, as you do when you heel strike during the normal phase of gait, you put stress on it. But because it actually contacts with the cuboid bone, if you stand up on your toes you’re still putting force on the heel bone. So there’s no way to really remove the force when you’re walking on your heel or on your toes to the heel bone itself. Now the third thing, the most interesting one that you’re probably interested in if you’ve got a calcaneal stress fracture, is that the heel bone heals faster than any other bone in your foot. It has a great blood supply. This is a good thing.
But when injured runners, and they’re frustrated and they’ve called me for a diagnosis with a calcaneal stress fracture and they’ve been wearing a fracture walking boot, not surprisingly they’re bummed out that they’re losing all their running fitness, and maybe they’ve even seen one of the videos I put out on why I think fracture walking boots are so bad.
What we’re going to try to talk about in this episode that really kind of answers the question of this title is whether or not this is really great for you or good for you or the best thing for you and the answer is pretty simple. A fracture walking boot is the best treatment if you have a calcaneal stress fracture and your goal is to walk. But if you’re a runner, I would assume that the goal is not to walk. The goal is to run. If you want to lose all your running fitness, a fracture walking boot for a couple of months is probably the best way to do that. And you may not think it’s that big of a deal using a fracture walking boot for four weeks or six weeks, but I can promise you there are a lot of problems with that.
You have to remember now, if you’re using the fracture walking boot, you’re walking. When you’re walking, you are putting stress on the heel bone no matter how you walk, even if you’re in the boot. Yes, it may hold it still and it may decrease some of the forces going through the heel bone during the gait cycle, but in my mind if the goal is to actually heal the stress fracture as fast as possible so that you can start running as fast as possible, a fracture walking boot may not be the best thing.
What I mean by that is that instead of taking somebody who has a calcaneal stress fracture and just putting them in a boot and saying, “Well, we’re going to use this until it calms down or it looks better on your X-ray” or something, I don’t generally do that. What I think many times is that if you do some more aggressive stuff, like let’s say even using crutches during the initial period, you can actually get it to calm down faster. It just stands to reason that if you’re standing on the foot, even in the boot, and it’s putting stress on the stress fracture, and you stop doing that by using crutches even for a short period of time, it’s going to compress and accelerate and shorten the overall healing time.
Remember, when you’re a runner it all comes down to your goals. What’s most important to you? Do you want to wear a fracture walking boot for a long period of time and be able to walk around without crutches? Or would you rather use crutches for a short period of time so that it can heal a lot faster overall and that you can get back to running faster?
So you’ve got to think about your goals and you have to discuss them with your doctor. If your doctor is not somebody who focuses on runners, it’s all the more important. But if you want to run and you have a calcaneal stress fracture, you might want to think about this very carefully and try to think about it differently.
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