How long should a patient with an avulsion fracture of the lateral calcaneus use crutches and a cam (controlled ankle movement) boot?

Management Duration for Lateral Calcaneal Avulsion Fracture

For a lateral calcaneal avulsion fracture, maintain the patient in a cam boot with functional support for 4-6 weeks, allowing protected weight-bearing as tolerated after the first 10 days, with crutches used only during the initial acute phase (up to 10 days) for pain control. 1, 2

Initial Immobilization Phase (0-10 Days)

• Use crutches during the first 10 days maximum if needed for pain and edema control, as short-period immobilization can decrease pain and swelling while improving functional outcomes 3
• Apply a cam boot immediately for protective immobilization of the small, non-articular avulsion fragment 1, 2
• NSAIDs should be prescribed for pain management during this acute phase 1, 2

Functional Weight-Bearing Phase (Days 10 Through Week 6)

• Transition to protected weight-bearing in the cam boot after the initial 10-day period, as prolonged immobilization beyond 10 days produces inferior outcomes compared to functional support 3
• Continue the cam boot for a total duration of 4-6 weeks from injury, as ankle braces show the greatest treatment effects compared to other functional supports 3
• Weight-bearing should be as tolerated with the boot protection, since functional support allowing controlled loading produces better outcomes than rigid immobilization 3

Critical Timing Considerations

The 4-6 week timeframe for boot use is evidence-based from ankle ligament injury studies, which demonstrate that this duration optimizes healing while preventing the complications of prolonged immobilization 3. Immobilization beyond 6 weeks results in suboptimal outcomes including stiffness and delayed recovery 3.

Rehabilitation Phase (After Week 4-6)

• Discontinue the cam boot once clinical and radiographic evidence of healing is present, typically at 4-6 weeks 1, 2
• Initiate physical therapy to restore range of motion and strength after the immobilization period 1
• Transition to supportive footwear for gradual return to weight-bearing activities 1
• Avoid premature return to high-impact activities before adequate healing is radiographically confirmed, as this is a common pitfall 1, 2

Common Pitfalls to Avoid

• Do not keep patients non-weight-bearing on crutches for the full 4-6 weeks - this represents outdated management that delays recovery 3
• Do not use rigid casting for 4+ weeks, as this produces worse functional outcomes than the cam boot approach 3
• Avoid allowing patients to abandon the boot before 4 weeks, as inadequate protection risks re-injury 1, 2
• If pain persists after 6-8 weeks of appropriate conservative management, obtain advanced imaging (CT or MRI) to evaluate for complications 2

Algorithm Summary

1. Days 0-10: Cam boot + crutches as needed for pain control
2. Days 10 through Week 4-6: Cam boot with protected weight-bearing as tolerated, discontinue crutches
3. After Week 4-6: Transition out of boot once healing confirmed, begin rehabilitation
4. Weeks 6-12: Progressive return to normal activities with supportive footwear