Today on the Doc On The Run Podcast we’re talking about doctor’s goals when they give you a fracture walking boot versus your goals when you’re wearing a fracture walking boot and you’re a runner.
I talk a lot about fracture walking boots for treatment of specific overtraining injuries like stress fractures and partial ruptures of the plantar fascia and other conditions that really do need some aggressive treatment and maybe immobilization in something like a cast or a fracture walking boot.
When I lecture at medical conferences, I talk a lot about why I believe fracture walking boots are over prescribed, overused and often used way too long in many injured runners for common overtraining injuries. In talking to another runner the other day, I was thinking about this and thought this might be a good episode, in terms of the specific goals that are in conflict between you and your doctor when the doctor fits you for a fracture walking boot in her office.
So, the way to think about this is really simple. The reason that doctors want to put you in a fracture walking boot is to decrease the stress and strain to that injured piece of tissue so that you don’t make it worse. They also know that it’s highly unlikely you’re going to run with a fracture walking boot on your foot.
I have seen people do dumb things when I was in med school. I was in Yosemite and I actually saw a guy with a fracture walking boot hiking the Yosemite Falls Trail, which is a three and a half mile trail that goes up about 1500 feet or something. I’ll bet his doctor did not want him doing that. But that’s what he was doing, and, in that respect, doctors are trying to protect patients like that from themselves.
When I was in residency, there was a doctor I worked with who one day, he looked at me said “Chris, you know some patients it’s a lot more like veterinary medicine than it is Podiatric Medicine. You’re basically trying to keep them from chewing on their stitches” and I know that’s really derogatory but there is some truth to it and that when a doctor feels like you’re not going to follow directions and your doctor feels like you’re probably going to do too much too soon or whatever, they may tend to keep you in the boot a lot longer.
Your goals as a runner of course, should always be to use the fracture walking boot as shorter time as possible and that does not mean to stop using it before your doctor allows you to stop using it. It means that your goal is to try to compress the healing as fast as possible by doing as much as possible to get it to heal so that you’re in the boot the smallest amount of time.
One of the things that you can do that will actually prolong your time in the boot is doing activity that causes pain while you’re in the boot. So, you’ve got to be really clear on how to not do that. The boot’s not magic. The boot will help you heal lots of overtraining injuries. However, it will also rob you of your fitness and it will make you weaker and stiffer and potentially increase your risk of getting another overtraining injury later if you’re wearing it too long.
So, the goals of you to compress that time and get out of the boot as fast as possible and your doctor’s goal of trying to make sure that you use it as long as needed are not mutually exclusive. They are in conflict, but they can work together. The main thing is that you need to ask more questions and you need to make sure that your doctor understands your goal really, is to get out of the boot as fast as possible. And that means prodding your doctor to get more clues on the additional things you could do that would speed up the recovery of that specific injury. That’s really the key here.
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