#690 Can I run after a spiral fracture of the fibula? - DOC

#690 Can I run after a spiral fracture of the fibula?

Can I run after a spiral fracture of the fibula? Well, that’s what we’re going to talk about today on the Doc On The Run Podcast.



Today’s question actually comes from Elizabeth and she wrote in after she rolled her ankle and actually had a fracture, not just a sprain, and she wanted to see if she can get some advice. And I’ll tell you what she said. She said, “I’m a 27-year-old female. I twisted my ankle and I was rushed off for x-rays and discovered a spiral displaced fracture of my fibula in my ankle joint.” A spiral fracture means that it rotates up, and displaced means it’s moved apart. That means there’s a gap and it’s out of position.

She says, “I was severely swollen and surgery wasn’t an option because I was on holiday without medical insurance. I went to the hospital, the orthopod put me in a cast, and performed a reduction to reset the bone. When I got back home, I went for follow-up x-rays and the bone had realigned. The cast came off three and a half weeks later. I was put in a fracture walking boot and allowed to weight bear again. After a week or so, I was walking without the boot most of the time and wearing the boot no longer for walks or for work, but I felt more comfortable without it. I started doing some yoga and light walking to strengthen and loosen up my ankle after five weeks post-break and gradually started increasing my walking distance as well as doing some street workouts to gain back my mobility in my ankle. I was able to walk five or six kilometers semi-comfortably around six or seven weeks post-break, and I’m now able to walk, balance on the broken leg, and perform almost all activities. My follow-up appointment said the bone had healed and I’m able to return to normal activities, but the doctor said I should still wait to run again.”

“I’m dying to get back on the road and going a bit stir crazy. It’s been 10 or 11 weeks post-break now. I want to know if I will do damage by starting to run in increments to gain back some fitness and cardiovascular fitness or if it’ll be okay. The bones and muscles on the top of my foot hurt quite a lot, but the ankle is all right. Mild pain and swelling mostly at the end of the day, but manageable. Do you have any advice?”

Well, this is a great question. So do I have any advice? Not really. I can’t give you medical advice if I don’t understand your history. I don’t understand the progression of your injury, I don’t know how displaced it was, and I don’t really know what was accomplished with the reduction where the doctor tried to put it back in place.

So I can’t give you any direct advice, but I do have a lot of questions and maybe some of these questions can help you think about the way you should formulate your plan now. Because, irrespective of how it broke, whether or not you had insurance, whether or not you were on vacation when it broke, all of those things, none of that matters. What you have right now is today, so no matter what kind of injury you have, you have to figure out where you are today and what you can do going forward. So when I hear this story, I’ll tell you the way that I think about this. The first thing is when I heard surgery wasn’t an option. Well, reading that part to me says that surgery was probably a really good option, but because you were out of town or it just wasn’t convenient or you didn’t have insurance or whatever, you chose to not have surgery.

Generally speaking, if you have a displaced fracture, it is a lot easier to make sure that it is exactly in the right position if we do surgery. Well, you didn’t do surgery. You’re not going to go back and fix that now. That’s just the way it is. So you have to assume that when you put the bone back in position, if it’s a spiral fracture of the fibula, and we put a plate and some screws on there to make it stable, well then you should be able to move it sooner and get back to running sooner. But there are a lot of other things you can do to actually speed up that process of healing. Waiting is not a plan. If you have a fracture and it’s moved out of position and the doctor thinks that it’s in close enough position and you use a cast and then a fracture walking boot, well, then you have to follow the doctor’s advice.

The next thing I hear is that, at the follow-up appointment when you were told that it was healed enough that you could start moving and you’d been able to move without the boot and all that kind of stuff, I don’t really know how long after that was. Also, when you say the doctor said it was healed, well, what does that mean? I mean, if it’s healed, then you should be able to run and do box jumps and go skydiving if you want. But it implies to me that the doctor said maybe it is along the path of healing some way toward where you can run, but it’s not really there yet. And if it’s not there yet and the doctor says that you should not run, well, obviously, you should not run. It seems like that’s simple, but I also hear that you’ve got some ankle pain and you’ve got some swelling at the end of the day.

The swelling sometimes can be because there’s too much movement at the fracture site where it is still healing. So if you’re confused about whether or not you might do damage by doing some incremental running, I don’t know really what that means. That’s just not the way that I do it. So it would probably do some damage, at least I would guess so, because it sounds like you had a doctor tell you not to run. And I know I’m beating that with a dead horse, but, no, I would not tell you to run if some doctor said don’t run, particularly if I don’t know more about your case. So if we got on the phone, if we got on a webcam visit, if you were in the Runner’s Aid Station or you signed up for the Fast Track Challenge or something and I was able to get questions from you so that I could confidently give you advice on what to do exactly so that you can run, well, maybe I could help you with that.

But given the information I have, no, I can’t tell you that you should run because some other doctor said don’t. What I would do is I would figure out why the doctor said not to run right now. What exactly does that mean and how could you figure that out if it is safe to run? Because I talk to runners all the time who are told that they cannot run and yet they do. That doesn’t mean I just say, “Sure, just run and see if it breaks.” I mean, I had somebody just this past weekend that ran the Tokyo Marathon. She had a calcaneal stress fracture. She ran it successfully. She ran fast. She didn’t break it. But we talked about a whole lot of very specific things with her situation to strengthen the bone as quickly as possible to double check and make sure that it was safe to actually run.

I don’t do the plan of just go out and run and see how it feels. What I do generally is I go, “Okay, what is your goal?” The first thing is that running is not a goal. If you want to run a specific distance, a specific time, a specific place, that’s a goal. Wanting to run just because you’re going stir crazy, although I empathize and I understand how hard that is and you need to run, that’s not really a goal. The first thing I would do is say, “What is your goal?” The next thing is I would say, “What is your pain number?” And so in this entire story that Elizabeth gave us, there’s no information about pain levels, and I do not make decisions on people without pain levels. I’ll sometimes make decisions without X-rays, but not without pain numbers. You’ve got to know what your pain levels are.

Then you’ve got to figure out what you need to do to restore everything before you run. So when I go through the Fast Track Challenge, I never say, “Well, this is your injury. Yes, you can run. No, you can’t.” I say, “This is how you figure out if you can run and if it’s safe for you to run.” These are the things you can do to restore your fitness, your strength, your flexibility, your neuromuscular connections, all of the things that support you when you run so that you’re actually at lower risk of re-entering it as you return to run. You’ve really got to think about how you can make the bone stronger now and what you can do about that ankle. What is causing the swelling? Is it just stiff? Is it loss of proprioception? What is it? You’ve got to rebuild that fitness. You’ve got to get your balance back. You’ve got to get your stability back first before running.

That would be my advice. It’d be to figure out all of those things rather than just try to run and see what happens. Because if a doctor’s told you that you can’t run, I don’t think that always means you can’t run, but you have to be very systematic about your return to running so that you don’t get re-injured again. Thanks for sending in the question.

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


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