#844 When is fracture boot really needed with metatarsal stress fracture? - DOC

#844 When is fracture boot really needed with metatarsal stress fracture?

When is a fracture walking boot really necessary for a metatarsal stress fracture? Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.



I believe that the most commonly prescribed but most overprescribed treatment for injured runners is a fracture walking boot. Now, this is a thing I lecture about at medical conferences many times a year. I’ve done lots of episodes talking about this in different ways. But the reality is, is that the big question when a doctor tells you, you need a fracture walking boot, is it really necessary or not?

Well, there’s a couple of times it’s really necessary, a couple of times it’s maybe necessary and sometimes when it’s not necessary all. The reason I know. Well. I lecture on stress fractures all the time at medical conferences when I get invited and I teach doctors how to treat stress fractures differently. I believe that a fracture walking move first of all will almost always help a metatarsal stress fracture. However, it won’t necessarily help your running fitness.

I wore a fracture walking boot myself when I was in med school and I still remember clearly, about a week after I’d had the boot, I took the boot off, pushing on my foot,  I was pushing on the stress fracture, I was moving the stress fracture, I was messing with it in all different ways and it caused no discomfort or pain. And I remember very clearly thinking how is it possible that it’s necessary that I need to wear this boot for a whole another month when this thing doesn’t even hurt at all after just one week. It didn’t make any sense to me and it doesn’t make sense to me today.

In retrospect, if I had gone back in time, I would have done some different things to test it and see how much better it really was and I probably would have stopped using the boot a whole lot earlier. Now, that is not to say that this is medical advice for you. So, if your doctor told you, you need a boot, you need to talk to your doctor about this but don’t just stop using the boot. Don’t ignore your doctor’s advice.

The reality is, is that when you need a fracture walking boot for a metatarsal stress fracture really depends upon the cause, first and foremost, a little bit on the severity, but a lot on the cause. So, if you have a metatarsal stress fracture and the metatarsal stress fracture actually developed because of axial loading, like when you move up and down on the ground when you’re running, if it’s pounding of the metatarsal, the fracture walking boot doesn’t do that much to stop axial loading because you’re still standing on the foot every time you take a step in a fracture walking boot and your boot’s on the ground and the other foot is in the air swinging through, well what happens? You’re standing on that. You have full axial loading all of your body weight is on that foot.

Fracture walking boot, they don’t do anything to stop that. Fracture walking boots stop movement. They’re very effective at that. So, if your stress fracture actually developed because you have structures or muscles or things pulling on the metatarsal and it’s the movement that really caused a stress fracture, well that will help. The boot will help hold you still. The fracture walking boot also decreases some of the forces of loading, not axial loading but some of the forces because it stops a lot of the motion. The boot has a curved soul so when you’re walking, you kind of roll across the boot instead of just bending the foot and putting stress directly on the metatarsal.

But the fracture walking more than anything else keeps you still. So, if you need to hold it still, it can speed up the process of healing your metatarsal stress fracture, but you have to think about the cause and you have to think about the severity. So, if it’s not really severe, you might need a boot to speed things up. But you probably don’t need it for six weeks and most doctors I see seem to have these blanket policies, if I put somebody in a boot for four weeks, or I put somebody in a boot for six weeks and if you look at the largest meta-analysis ever done on stress fractures, the average time of returned activity was anywhere from 4 weeks to 52 weeks, that’s a month to a year. Big difference between a month and a year. So, you really have to be thoughtful about treating your metatarsal stress fracture so that you can get back to running as quickly as possible.

If you enjoyed this episode, but you want to learn more about stress fractures, you got to check out the stress fracture masterclass. It’s where I do a big presentation. I go into all the details on stress fractures and the strategies I use with injured runners who want to run, even if they want to compete in a race and some doctor told them no. I’ll tell you how I do that. You can go check it out at www.docontherun.com/stressfracturemasterclass and I’ll see you inside.