#864 The 3 problems (not 2) solved by boot and crutches - DOC

#864 The 3 problems (not 2) solved by boot and crutches

What are the three problems that are actually solved when you use a fracture walking boot and crutches at the same time? Well, that’s what we’re talking about today on the Doc On The Run Podcast.



I’m not going to tell you that you want to use crutches. I’m also not going to tell you that you would like to wear a fracture walking boot and I would never tell you that you’d enjoy wearing it for six weeks. And I would almost never tell you that you should.

But there are reasons that you want to do things a little differently if you’re a runner and part of the way that I think about this in runners is that you want to really try to speed up the healing process as much as possible, so that you can get back to running as fast as possible and lose as little fitness as possible.

There are really three things going on when you’re injured and if you just walk on the foot, if you just wear a fracture walking boot and walk on it, you get a couple of problems that are really actually solved if you’re using crutches for some short period of time with a boot or a cast.

The first one is pressure. So, if you’re wearing a fracture walking boot, and your foot is on the ground, and your other foot swings through the air, 100% of your weight is on the foot. So, if you have an injury to the bottom of the foot, like the plantar fascia, you have a torn plantar fascia ligament, or you have a stress fracture and the grounds pushing up on the metatarsal or you have a plantar plate injury and the grounds pushing up and squishing that plantar plate ligament that’s injured.

Well, that’s pressure. So, when you’re using crutches, you’re strictly non weight bearing. That foots not on the floor, it’s not touching the floor, there’s no pressure on it. That’s problem number one.

Problem number two is movement. The fracture boot looks like it’s going to hold you still. It looks like it’s going to make you miserable and it will, but it’s supposed to reduce motion. Pretty effectively reduces the motion around your ankle but if you have a fracture walking boot on and you’re walking and you can see your toes, just watch them move. They’re gripping, they’re moving, they’re tensing up and they’re sort of holding on to the boot for balance.

Whenever you’re walking in the boot, you’re still moving muscles, tendons, ligaments, and the bones in your foot in a way that you have to in order to stabilize yourself. And when you really immobilize it and you keep it off of the ground with crutches helping you, you’re moving in a whole lot less and so it’s better immobilized.

The third thing is that not a lot of people talk about this, but you actually have muscles that pull on the tendons and of course, they pull on the ligaments and the bones too when you’re moving everything. So, you have tendons, ligaments, and bones, and the muscles that actually attach to the tendon to the bone, well that when every time it fires, obviously it’s doing something that’s working. But they’re also pulling the bones which are consequently pulling on ligaments.

Whenever you’re balancing in the fracture walking boot because your foot’s on the floor, and you’re trying to not wobble and sway when your other foot swings through the air, well, you’re pulling on all those muscles, tendons and ligaments. A lot of stress fractures happen not because of the bone is getting pounded necessarily, but because its muscles tugging on the bone so much that it causes a decreased density in the bone and then leads to a stress fracture.

Those are the three things. It’s not just that you put on a boot and holds it still and it fixes everything because when you use crutches and you do that at the same time, you really decrease the pressure, you really decrease the movement and you really decrease all of the little muscles pulling on everything in your foot at the same time.

That’s why sometimes I recommend people use crutches with a fracture walking boot for a shorter period of time instead of using a fracture walking boot for a longer period of time.

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