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Stress Fractures: To Boot or Not To Boot
Without a doubt the most dubious and frustrating injury and athlete can develop is a stress fracture. It not only derails your athletic endeavors, it waits patiently until you have given up months of Saturdays, passed up countless happy hours, and pushed your body to the brink of competition ready to let you know it has other plans. While the nature of this injury is a cruel one, knowing how to best combat it is crucial to getting back faster and healthier!
Stress fractures occur most commonly in the lower leg: tibia (49%), tarsal bones (25%), metatarsal bones (9%), or fibula (6%) (3). If you’ve had the misfortune of developing a stress fracture in one of these areas, odds are your orthopedist, physical therapist, or old kickball teammate who had the same thing has suggested that you don a controlled ankle motion (CAM) boot for 4-6 weeks. The idea behind this is to completely immobilize your ankle and foot bones, so as not to disturb the healing process.
While there are definitely some situations in which a CAM boot may be beneficial, forcing everyone with a stress fracture to hobble around without an ankle joint, explaining to everyone what’s going on with their ankle is just cruel, and detrimental to their health! Little research suggests a CAM boot improves healing time for stress fractures. However, there is a whole lot of research that demonstrates the debilitating effects of immobilization. Not only will you lose over 20% of your muscle volume in both your calf and quad (2), but all your essential ankle stability muscles weaken, your ligaments lose tensile strength, your range of motion plummets (1)…and even after 2 months out of the boot you will still not have gained it all back (1,2)! Furthermore, if there’s anything we’ve learned about the human body over years of studying it, it’s that we NEED movement in order to heal. Pain free stress is essential to the healing process, as it is what signals a cascade of events that results in increasing the amount of osteoblasts (bone cells) in the area (3).
If you have pain in the area of the stress fracture, it may be advisable to wear the CAM boot while walking, but becomes vital to take the boot off daily for maintenance exercises. Complete immobilization will leave you trying to return to sport on a stiff, weak, unstable ankle that will put you at risk of continued injury.
Resources:
- Eiff, M. P., Smith, A. T., & Smith, G. E. (1994). Early mobilization versus immobilization in the treatment of lateral ankle sprains. The American journal of sports medicine, 22(1), 83-88.
- Grosset, J. F., & Onambele‐Pearson, G. (2008). Effect of foot and ankle immobilization on leg and thigh muscles’ volume and morphology: A case study using magnetic resonance imaging. The Anatomical Record: Advances in Integrative Anatomy and Evolutionary Biology, 291(12), 1673-1683.
- Milgrom, C., Giladi, M., Stein, M., Kashtan, H., Margulies, J. Y., Chisin, R., … & Aharonson, Z. (1985). Stress fractures in military recruits. A prospective study showing an unusually high incidence. The Journal of bone and joint surgery. British volume, 67(5), 732-735.
