Joe Biden Foot Hairline Fracture: What It Is and How It's Treated

On Sunday, November 29, President-Elect Joe Biden announced that he had injured his right foot after he fell while playing with his dog, Major, a German Shepherd rescue, the day before.

Biden’s injury appeared to be a twisted ankle at first, but further investigation showed otherwise, CNN reported.

"Initial x-rays did not show any obvious fracture, but his clinical exam warranted more detailed imaging," Biden's personal physician, Dr. Kevin O'Connor, said in a statement released by the Biden office. "Follow-up CT scan confirmed hairline (small) fractures of President-elect Biden's lateral and intermediate cuneiform bones, which are in the mid-foot. It is anticipated that he will likely require a walking boot for several weeks."

“[Biden] rolled his foot, and instead of the force going through his ankle, it went across the foot,” Jonathan Kaplan, MD, of Hoag Orthopedic Institute in Orange County, California, tells Verywell. Kaplan did not treat Biden.

The cuneiform bones are critical to balance and mobility, Andrew Schneider, DPM, of Tanglewood Foot Specialists in Houston, Texas, who is also uninvolved in Biden’s care, tells Verywell.

“They form the arches of the feet and help with the overall stability of the foot," Schneider says. "The joints are not hinged, like other joints. They are flat surfaces that slide along one another."

“Cuneiform bones break less often than other bones in the foot,” Kaplan adds. “I think Biden is lucky he did not tear any ligaments. That type of inversion injury usually causes an ankle sprain.”

What Does Recovery Look Like?

Biden will be wearing a walking boot for approximately 4 to 6 weeks, which is the first course of action for his type of injury.

“When the ligament is intact, and the bones are aligned, the treatment is non-operative,” Kaplan says. “Usually, patients can walk in the boot.”

Some additional support in the shoe may be helpful after the boot.

“As we transition out of the boot, we may use an orthotic in the shoe to give a little extra support to the foot for about a month, as long as the individual is pain-free and walking without a limp,” Kaplan says.

For patients whose injury is not improving after 6 to 8 weeks in a boot, Schneider says a bone growth stimulator, a medical device that uses electromagnetic or ultrasound waves to stimulate bone growth, can aid in healing.

Patients can expect additional recovery time after they discontinue the walking boot.

“Full recovery can take up to 6 months due to soreness or mild discomfort with strenuous activity,” Kaplan says.

Most hairline fractures to the foot heal with no long-term complications.

“As long as everything heals well, there is no long-term impact,” Kaplan says. “If the bones do not heal well, there is a chance of refracture, but the risk is low.”

What Does Biden's Age Mean for His Injury?

Biden is 78 years old and will be the eldest U.S. President ever to be sworn in on Inauguration Day.

“Any time you have a fracture, the typical healing time is 6 to 8 weeks, but you also have to take into account Biden’s age, which may impact his bone density,” Schneider says.

“With anyone who is elderly, my greatest concern, especially being in a boot, is falling. A walking boot is going to throw a person off-balance,” he says. "When you fall, there is a possibility of breaking something else, which may ultimately be more serious than the foot fracture you are already treating.”

Biden may still need a boot when he takes the President’s Oath in January, but it is unlikely.

“I suspect that he will be clinically healed enough by then to wear a regular shoe,” Schneider says.