Feet > Stress Fracture > Treatments

   Immobilization

Treatment Introduction

Some stress fractures, especially in the navicular bone that is part of the arch of your foot, may need to be immobilized for two to four weeks in order to ease pain. Crutches are prescribed so you can keep your body weight off the injured foot as it heals, but stress fractures treated with immobilization may not completely heal for over eight weeks. These stress fractures typically are at risk of complications like a dislocation or complete fracture. Therefore, it is important to avoid putting weight on your foot until your pain goes away. Depending on your physician’s preference, your foot may be immobilized in either a short leg cast or cam walker.

A short leg cast wraps around your foot, ankle, and lower leg. Made of layers of fiberglass, it starts below your knee and is open around your toes to allow toe movement. Your physician usually rolls a thin, elastic stocking, called a stockinette, over your skin and then pads your leg with soft-roll bandages. A dry layer of fiberglass is wrapped around your leg and foot. Extra fiberglass strips are wrapped around the sole of your foot. Additional fiberglass layers are applied wet over the first layer. When the short leg cast dries, it should immobilize your foot but still allow you to move your toes. It should be snug, but not tight.

A cam walker is a removable hard plastic boot, made with nylon straps that fasten around your calf and foot. Most cam walkers have an adjustable hinge at the ankle that can be set to immobilize your foot and ankle. The sturdy bottom of the cam walker is made of hard plastic so your foot cannot bend.

Home Recovery

It is essential to keep weight off your foot until the pain from a stress fracture goes away. The time this takes is highly variable, based on the extent of your stress fracture and your body’s natural ability to heal. Everyone heals at a different pace, so use your crutches as often as necessary to avoid pain in your foot. As pain decreases, you will rely less on the crutches over the course of three or four weeks. Recovery is easier when you have someone around the house who can help with any physical chores. When you can put weight on your foot without pain, your physician typically removes your short leg cast and puts you into a cam walker. If you were put into a cam walker initially, you will continue wearing it as you begin walking. When you are comfortable walking short distances without pain, you can usually return to normal shoe wear. When you can walk in normal shoes without pain, you begin a period of relative rest, which lasts until your foot can withstand the stress of the activity that caused the stress fracture. Relative rest means that you need to keep your activity level below your level prior to injury. For example, if your were running two miles a day when the injury occurred, you should run less than two miles a day when you return to activities. How much less you run is relative to the pain and symptoms you feel in your foot. Some people may be able to run up to a mile without pain, but others may only be able to walk a mile.

Formal physical therapy may not be necessary after a stress fracture. Many patients can adequately restore motion and strength in their foot with a regular cardiovascular exercise program, and most patients can return to sports and activities in a month or two. Begin exercising with short walks and increase the duration and intensity as pain allows. You may be able to use stationary cycles without causing much pain in your foot three to four weeks after the injury. When your pain is gone, start with light jogging before sprinting, jumping, and cutting. Gradually return to activities with pain as your guide. Understand that your level of activity prior to the injury was somewhere above your foot’s threshold to withstand the forces and stress of that activity. Though it is difficult to determine your precise threshold for a stress fracture, it is likely to be somewhat below your previous activity level. Increase your workouts slowly, and if pain returns, decrease the intensity and duration of your walks, runs, or other physical activities.

As you continue increasing your activity levels after a stress fracture, your foot’s muscles and tendons can become stronger. With proper training, by the time you return to your previous activity level, your foot can be stronger than it was prior to injury, and most patients can return to activities at full strength without risking future injuries. Your physician may prescribe orthotic shoe inserts if your stride is putting abnormal stress on your feet. Orthotics can help distribute weight evenly through your feet when you have problems such as leg-length discrepancies, flat feet, or rigid arches. To avoid reinjury, it is important to wear the proper shoes for the type of activity you perform. Shoe manufacturers design shoes to withstand the forces put on your feet during the motions you encounter in a specific sport. Basketball shoes are designed to withstand cutting and jumping on hard courts; running shoes are made to withstand a sustained, rhythmic pounding, and cleats to prevent imbalances on soft ground. You also should remember the activity level that caused your stress fracture. You have the advantage of knowing the amount of repetitive strain your foot can withstand. If you decide to increase your workouts above the level of intensity or duration that caused the injury, be sure you have stretched and strengthened the muscles in your legs and feet to a higher degree of fitness.