What is the typical duration of wearing a walking boot for a small avulsion fracture of the distal end of the lateral malleolus?

From the Guidelines

For a small chip fracture of the lateral malleolus, you should wear a walking boot for 4-6 weeks, as functional support for this duration is preferred over immobilization, according to the most recent evidence 1. This recommendation is based on the update of an evidence-based clinical guideline published in the British Journal of Sports Medicine in 2018 1. The use of an ankle brace or similar functional support shows the greatest effects compared to other types of support, and this principle can be applied to the use of a walking boot for a small chip fracture of the lateral malleolus. Some key points to consider during this healing period include:

• Wearing the boot continuously except when bathing for the first 2-3 weeks
• Gradually transitioning to weight-bearing as tolerated while still wearing the boot
• Elevating the ankle when sitting or lying down to reduce swelling
• Applying ice for 15-20 minutes several times daily to reduce swelling and pain
• Taking over-the-counter pain medications like acetaminophen or ibuprofen as needed for pain, following package directions for dosing The walking boot provides necessary stability and protection, allowing the bone fragment to heal and preventing further displacement of the chip, while also enabling the surrounding soft tissues to recover. Regular follow-up with your healthcare provider is crucial to monitor healing progress, typically at 2-3 weeks after injury and again at 4-6 weeks to determine when you can safely transition out of the boot. Complete healing of the bone typically takes 6-8 weeks, though the ability to discontinue the boot may occur earlier depending on the specific injury and individual healing progress.

From the Research

Treatment Duration for a Small Chip of Bone from a Fracture on the Distal End of the Lateral Malleolus

• The duration of treatment, including the use of a walking boot, for a small chip of bone from a fracture on the distal end of the lateral malleolus can vary depending on the severity of the fracture and the treatment approach 2, 3.
• Studies have shown that for isolated lateral malleolus fractures, the average time to full weight bearing can range from 4.5 weeks to 6.8 weeks 2.
• A retrospective study on the treatment of lateral malleolar fractures found that the implementation of a structured treatment algorithm can reduce the number of surgical treatments and increase the number of patients permitted full weight-bearing 3.
• The treatment approach may also depend on the stability of the fracture, with stable fractures being treated non-operatively and unstable fractures requiring surgical intervention 4.
• Operative treatment options, such as Knowles pin fixation, have been shown to be effective in treating displaced lateral malleolar fractures, with a 100% union rate and an average satisfactory outcome of 88.1% 5.

Factors Affecting Treatment Duration

• The severity of the fracture, including the size and location of the bone chip, can affect the treatment duration 2, 4.
• The presence of other injuries, such as ligament damage or avulsion fractures, can also impact the treatment approach and duration 6.
• The treatment algorithm and approach used by the healthcare provider can also influence the treatment duration and outcome 3.