#871 2 Reasons for morning pain with a fracture boot - DOC

#871 2 Reasons for morning pain with a fracture boot

What are the two reasons you might get pain when you have been wearing a fracture walking boot for a running injury? Well, that is what we’re talking about today on the Doc On The Run Podcast.



If you get an overtraining injury like a metatarsal stress fracture or a plantar plate sprain or Achilles tendonitis, or peroneal tendonitis, a doctor might prescribe a fracture walking boot. Well, it is designed to hold you still so that you can hopefully walk on something like a fracture and still let it heal.

It is stiff. It immobilizes you. It has those curved outsole that is very stiff, you cannot bend it at all. And because of that, it decreases the stress and strain to certain tissues when you are wearing it and even when you are walking in it. The thing is, is that a lot of times I talk to runners, in fact that the reason for this episode is this morning I was on a call with someone who has been wearing a boot and he is curious why all of a sudden he is starting to have some aching pain in the boot in the morning when he first gets up and steps on his foot while wearing the boot.  Again, he is sleeping in the boot.

We were talking about this and there really two reasons that is going to happen given that particular scenario. One of them is that the boot itself, either the straps or the plastic stuff on either side is pushing against your foot. If you take a finger and you press it in your forearm real hard, you feel it, but it is not killing you right? It doesn’t really hurt.

But if you hold it there for eight hours, well that is going to start to ache because one, it is a lot of pressure that is not normal and two, it cuts off some of the blood supply in that little area where you push down hard enough to stop the blood flow in that area. Right.

You see this in the movies, in a war movie, somebody gets hurt, they get wounded, and they say apply pressure and they are just pushing on the wound hard enough to cut off the blood flow so the person won’t bleed to death. Well, you can cut off the blood supply by pushing on your foot with a boot too much. So, if it is too tight, if it is pushing against you, if it is too small for you, if it does not you right, it can cause that kind of discomfort just because you’ve been aching.

When you get up, if you loosen the boot, if you take off the boot, that discomfort will sort of temporarily be there even after you remove the boot, but it will start to go away. It will dissipate and it will dissipate gradually.

The other scenario is where you are holding the foot completely still and you are asleep and because you are holding everything so still in the boot, you are getting what we call cross-linking or you are getting some little strands of collagen that are trying to heal the tissue but they are getting to where they kind of make tissues sort of stick together. They are bound together in a way that is not normal. And when you are asleep and you are laying down and you are not stepping on the foot, that does not really matter but when you step up, out of bed and step on the foot, even in the fracture walking boot, your foot actually elongate slightly, and it will pull some of those little pieces of scar tissue or collagen or however you want to think of it or pull those apart.

When you have that discomfort, it is very fleeting. It is only for a second and then it is gone, and like if you step on the foot and you have this sudden discomfort, but then it doesn’t happen again, you push on the foot and you can’t reproduce it, it is more likely that. If you have a sore spot because the boots been pushing against the side of your foot and you push on that spot, it is going to hurt more.

So, that is a couple of different ways you can tell those scenarios apart. But it is just a couple of different ways you can get discomfort when you are in a fracture walking boot.  If a doctor gave you a fracture walking boot, the most important thing is to remember that the longer you are in it, the more fitness you are going to lose and the weaker and stiffer you are going to get. So, it is super important that you tell your doctor, “I want to run, I don’t want to just heal this thing, I want to heal this thing so I can run so, tell me what I can do to get over this as quickly as possible so I can use the boot as short as possible and get back to running.”

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