#756 Do I have to use crutches for a fibula stress fracture? - DOC

#756 Do I have to use crutches for a fibula stress fracture?

Do I have to use crutches if I have a fibula stress fracture? Well, that’s what we’re talking about today on the Doc On The Run Podcast.



If you get a fibula stress fracture, what does that even mean? Well, if you look at your foot, if this is your left foot, and the big lump on the inside of your ankle, that’s the end of the tibia, and that’s your shin bone. So that’s the biggest bone in your lower leg and the smaller one is the fibula. So, this is on the outside, that big lump on the outside is where your fibula is. This goes all the way up to just below your knee on the outside of your knee. But you could have pain anywhere along the fibula, you might get a thing called a fibula stress fracture.

One of the questions I get often with this is like, well, how do I get it to heal better? How do I get back to running faster? Well, the way to do that is to remove the stress so that the stress fracture can actually heal as fast as possible. That sounds obvious, but most runners aren’t doing that.

I talked to a runner just a couple of days ago who actually was not running on it, but she was walking on it a lot. And she said, “Well, I have a fracture walking boot but I’m walking in it and it hurts” and my first response was, well then why aren’t you using crutches to take the stress off of it if you’re making it hurt, you’re not going to get better quickly. It’ll get better eventually, probably, but not as fast as possible.

So, the real question is when do I have to use crutches and when do I not? Well, interesting thing, most stress fractures, not surprisingly happen because there’s too much stress applied to the bone. What we think about most of the time is that it’s pounding, it’s landing on hard surfaces. Its landing is a heel striker. It’s jumping too high and falling down too much and applying too much force from hitting the ground that actually causes the stress fracture.

If you use crutches, what are you doing? Well, primarily you’re keeping your foot off the ground, because when you stand you have your body weight pushing down and ground reactive force pushing up and the bones get caught in the middle and you get a stress fracture. But that’s only one way you can get a stress fracture. You can also get a stress fracture because you have muscles pulling on the bone and loading the bone by tugging on it and that’s different. If the cause of the fibula stress fracture was from pounding to the ground, well, crutches may be necessary.

One of my anatomy professors actually would argue this point to the bitter end. In fact, I remember him very clearly saying in an anatomy lecture in medical school, he called the fibula a useless bone. He said it’s a non-weight bearing bone, and it’s basically a useless bone. Obviously, your tibia, if you stand on that, if you break your tibia in half, you’re going to fall over, you can’t stand on it if it’s broken. Same with your femur. But the fibula doesn’t really bear weight in the same way that the femur or the tibia happened to bear weight.

So, if you have a weight bearing bone, like your femur or your tibia, it’s very important to use crutches to take the stress off of it. But much of the time, you don’t have to do that if you have a fibula stress fracture. However, when you use crutches, it not only stops what we call axial loading, meaning along the axis of the bone or up and down between you and the ground. But it also stops a lot of motion because you’re not standing on it and moving. And when you move when you walk, when your foot comes up, you push the fibula out a little bit, muscles pull on it and tug on it. So, in short, although it’s not truly a weight bearing bone, it may be helpful to use crutches.

The reason I know it’s not a weight bearing bone and that this is true that ou can still run even if it’s gone. I had a call just a couple of days ago with a runner who does not have a fibula on one side. Long story, but she doesn’t have a fibula at all. It’s gone. It’s not bearing weight, and she is qualified for the Boston Marathon more than a dozen times so she can run without a fibula. That does not mean that you should ignore pain and run until you break your fibula. You don’t want to do that. But you have to think about the cause of the stress in order to decrease the stress enough that you can get that fibula stress fracture better.

If you liked this episode, please like it, please subscribe, and if you haven’t checked it out, you might want to check out the ankle pain masterclass where I talk about different forms of pain in the ankle that could be something like a stress fracture versus a tendon or ligament sprain. You can get that for free at docontherun.com/anklesprainmasterclass. So, check it out, and I’ll see you in the next training.