Why should I sleep in a boot for a fifth metatarsal stress fracture? Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
If you get a stress fracture in the fifth metatarsal, that is over here. So, now the toes are just out here, and this metatarsal is in the outside of the foot and that little bump, you can probably see if you look down at your foot, halfway between your pinky toe and your heel, you’ll see this little bump sticking out. That is the bump at the base of the fifth metatarsal.
There are a couple of reasons why you might want to sleep in a fracture walking boot if you have been diagnosed with this problem and the doctor is trying to get it better. Well, the way I think about it is a math problem. You are trying to keep the total amount of stress applied to that stress fracture under your threshold for healing, the total amount of stress throughout the entire 24-hour period.
When you roll over at night, you’re putting pressure on this or you’re pulling on the tendon that attaches to the base of it and that stress at night when you’re rolling over and you’re moving the fracture in any way at all means less working out during the day for you to stay under your threshold for healing. So again, the whole goal here is to make sure that any stress reaction, stress fracture, whatever’s wrong with the fifth metatarsal starts to improve as quickly as possible.
Your activity, the stuff that you do that applies stress to it, you want that to be fitness building activities, running, going to the gym, working out, doing something, balance exercises, whatever, but all of those things apply stress to it. Again, it’s called a stress fracture. So, if you have stress applied to it when you’re working out, you can only apply so much stress before you cross over your threshold for re-injury and you make it worse.
The last thing that you want to do is use up any level of stress while you’re sleeping. You just want to let it rest, recover, and heal. All of that healing happens when you’re asleep, not while you’re working out. So, that is why it’s all the more important to really protect it. So again, the two ways that this happens, one of them is that you roll over and you just push against the outside of the foot as you roll over. And if you have a stress fracture somewhere along here, or you have a Jones fracture in here, then it really torques that fracture site and pulls on it when you roll over.
If you’re in a boot, it protects it, it doesn’t do that. The other thing is it holds it still. So, if you actively move your foot around, you’re just wiggling your foot around while you’re sleeping, this is something you’re going to do reflexively. It’s not something you’re thinking about. Maybe you’re having a dream and you’re thinking about moving. Maybe you’re uncomfortable with the sheets and your foot just moves around as you’re asleep.
But either way, the peroneus brevis muscle attaches here and in order for you to pull your foot in this direction, the peroneus brevis has to fire and pull that fifth metatarsal bone. The fracture walking boot holds you still, so you won’t do that. Again, the goal here is to make sure that you protect it when you sleep, to not apply stress to it, accelerate the rate of healing while you’re sleeping, and further allow you to do more running, fitness, rebuilding activities during the day without crossing over the overall stress applied to that bone so it will get better and it will get you back to healing faster.
If you want to learn about all the exact strategies I teach to physicians when I go lecture at medical conferences, and the exact strategies I would use with you if you called me for a second opinion call, you can get all those strategies for free in the Stress Fracture Masterclass. All you have to do is go to www.docontherun.com/stressfracturemasterclass, and I’ll see you in the training.
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