#816 When is a boot better than crutches for tibial stress fracture in a runner? - DOC

#816 When is a boot better than crutches for tibial stress fracture in a runner?

When is a fracture walking boot better than crutches for a tibial stress fracture if you’re a runner? That’s what we’re talking about today on the Doc On The Run Podcast.



If you get a stress fracture in your tibia, the shin bone, this is a bad injury. So, if it’s an injury, you don’t really want, you definitely don’t want it to break. So, if you get a stress fracture you want to allow it to get better. The big question is what will make it better, faster crutches or a fracture walking boot?

Most of the people who call me for a second opinion when they have a tibial stress fracture, they’re actually wearing a fracture walking boot and most of the time they’re not using crutches. There are people who have commented saying there’s studies that show returned activity time with runners and having a tibial stress fracture is such and such with a boot, I’m not disputing that. I’m telling you the way I think about this, given certain circumstances about the cause of the stress fracture that may change things and might change the approach that you have, particularly if you discuss it with your doctor.

The first thing is, is that let’s say that the stress fracture is caused by axial loading, actually pressure on the bone from you pounding over and over and over. If you’re somebody who runs with a lot of vertical oscillation and you go up and down a whole lot when you run. If you have a ponytail and it  swings around a whole lot, because you’re bouncing up and down, well, then you might have had a tibial stress fracture caused by axial loading.

A fracture walking boot does not stop axial loading, you’re still standing on it, it’s just holding it still. So, in that case, crutches I think is a significantly better choice because you’re not stepping on it, you’re stopping the deforming force, the axial loading, the pressure between you and the ground that’s applied to the tibia.

Second option is that, that’s not the only way to get a stress fracture in the tibia. The other way you get a stress fracture in your tibia is that you have muscles attaching to the tibia, that attach over here and over here and down on the bottom and all over the place. And those things control the position of your foot and so if the stress fracture is actually caused by repetitive pulling, or tugging on the bone from one of those muscles that’s controlling the position of your foot underneath you and it’s actually all of that tugging on the tibia is what causes stress fracture, then a fracture walking boot is actually better than crutches because it actually holds you still.  It stops the tugging and pulling.

The moral of the story is, is that if you have a tibial stress fracture, you want to try to limit as much as possible that thing that caused it in the first place. If you want to heal it faster. It’s really that simple. So, a tibial stress fracture as if you have the tugging and pulling and all of that, that that can cause a stress fracture, it’s a similar thing to the mechanism that can cause shin splints. And I talked about both of these things at length in the shin splints masterclass.

If you want a little more detail, you can go check that out. It’s a deep dive into all the topics about loading of the tibia, shin splints and how they come about, how they get misdiagnosed as tibial stress fractures. You can check it out and you can get it for free to www.docontherun.com/shinsplints. So, go check it out, and I’ll see you in the training.