Resolved Calcaneal Stress Fracture: Email Advice

Hi Dr. Blake,

Good news - my foot is back in action!  I’ve put it to the test over the summer and all systems are a go.  I’ve been running 100%, gone backpacking, and hiked dozens of miles (including a 17 mile day) without pain!  Thanks for all of your help getting me back in action!

I don’t see a need to meet up again, but am curious about how I should proceed over the long term.  My recovery program was focused on 1) protecting my damaged heel (now recovered), and 2) supporting my high (collapsing?) arches - presumably until they can hold their own.  I’ve got orthotics in all of my athletic shoes, am using cushy HOKA’s or Oofos 90% of the time (in everyday life), and am doing 15 minutes of stretches after all of my runs.  Since I’ve been babying my heel and arches for 2+ years, I’m wondering if I should be conditioning them over time to "toughen them up" and/or get them more used to “unassisted”  or “less-assisted” walking/running.  Questions:

• At what point (if any) should I stop wearing orthotics?  I’ve been rotating shoes and orthotics, sometimes going without (eg. Just walking around) with the thinking that they shouldn’t get too comfortable with one set system.  My hope is that at some point my high arches will be able to “hold their own” without the aid of my heavily-built up supports, but I don’t want to rush it.  Just wondering if I should be taking some sort of gradual approach to ween them off of the super-duper high arch supports that I’m currently using.  

• Are HOKA’s a good choice from here on out?  I have several pairs of different levels of cushiness that I use for all athletic activities.  Is there value in moving back to (or rotating in) non-rocker footwear or shoes that aren’t so cushy?  

Many thanks!

Dr Blake’s Response: Thanks for your feedback and great questions. I reviewed your chart today before answering so everything was clear. You developed a heel stress fracture from pounding at heel strike while running. The goal of each of your mechanical treatments are: cushy shoes for impact shock attenuation, arch supports for weight transfer into the arch and off the heel, and rocker bottom to decrease the pull of plantar fascia that push off on the heel bone. 

     So, theoretically you could now just go “cold turkey” back into traditional shoes with no rocker and no orthotic devices. I love to gradually change stresses since you are doing so well. You may find that you love either the orthotic devices or rocker bottom cushy shoes so running forever, or the orthotic devices while you have the added weight in backpacking. So, as you gradually change the mechanics, each level should be evaluated for any symptoms. 

     If would emphasize, especially for the reader, that orthotic wearers should do single leg balancing for 2 minutes each evening and metatarsal doming once a day (10 repetitions). You can use the search box on this blog to find these videos. This keeps the feet very strong if any weakness is occurring with the orthoses. 

     So, for now I would start and do half of your runs in Hokas and half in traditional shoes. Listen for any symptoms. You could very easily keep this pattern for years to expertly vary stresses. Initially, start with longer runs with Hokas and shorter runs with traditional shoes, but over the next month you will not have to be particular about the distance any more. 

If there are no increase in symptoms, in 2 months start not wearing your orthotic devices on short runs only, and short walks. I would stay this way until 4 months from now (therefore all the highest stress activities have the extra protection of the orthotic devices). If all is going well, the next 2 month interval you could either go without Hokas completely, or without orthotics in all activities but running. In two more months, you could then go with no orthotic devices at all. 

     So, this outlines a gradual 8 month progression into both traditional shoes and away from orthotic devices if that is your goal. If you have some symptoms as you change, we would have to address that if it comes up. Right now you are doing so well with all this protection, but like a cast, we eventually have to cut it off! 

I sure hope this makes sense. Rich