PWB to FWB, I can’t get the hang of it!
It’s 7 weeks today since my debridement/repair surgery. I’ve been PWB for 2 weeks now and that has been going fine. My incision looks really good and doesn’t hurt at all, so I know I’m making progress.
My next appt with my Surgeon is next week (8 weeks out from surgery). He would like me to ditch the crutches by that appointment. The problem is, I can’t quite figure out HOW to put full weight on my “bad” foot! My boot is a knee high non-hinged rocker boot that is a bit higher than my other foot with a shoe. I am supposed to stay in the boot as I go FWB. I can stand with both feet on the floor (although the boot foot hikes that hip up much higher) I’ve tried one crutch on the boot side, but it feels not quite right. I’ve tried just stepping on the foot w/o crutches, but what happens doesn’t resemble a “step” at all, and is scary! The pain isn’t in my heel where the bone was removed, nor in my achilles or ankle…it’s across the base of my toes on top and under my foot. It’s not really “pain” as much as stiffness, tightness, weirdness. Results in red and blue toes after each try. I’ve been playing with how much to inflate the boot. My thought is more compression probably make the toes more red/blue but might be better for my heel and AT. Less compression makes it easier to feel my whole foot.
I know many of you have been through this step already, so I could really use some guideance on how to ditch these crutches! Maybe I’m just being a great, big Scaredy Cat??
Thank You!!!
normofthenorth said,
May 22, 2012 @ 1:20 pm
One important step is to build up that non-injured foot/shoe so it matches your boot. No good destroying the rest of your body while your repaired ankle heels! There are many ways to do it, just choose one and do it — or one for indoors and one for out, whatever.
People who use one crutch (I hated it!) usually recommend using the crutch OPPOSITE the injury/
Not so sure about the boot fitting, the discomfort and discoloration, etc. Try stuff. Gel insoles often give relief from sole-and-heel tenderness. (Though the added height has to be balanced on the other side!) I quit using the air bladders in my AirCast boot, mostly because I found them too plastic and “sticky” for my taste, even with a sock (and in the Winter).
Work on the padding and the strap adjustment, trying to get even well-fitting support without pressure points. Don’t be shy about elevating and such when you’re NOT standing or walking.
Mrboro said,
May 22, 2012 @ 2:46 pm
I’m at nearly 9 weeks post op and I also found walking in the boot a nightmare.
I eventually just ditched it and put gel inserts into a pair of trainers.
This made FWB so much easier for me. I just found walking in trainers much more natural.
As you mentioned, the height difference of the boot makes it feel like walking on stilts….
(PS for US readers trainers = sneakers)
ryanb said,
May 22, 2012 @ 3:32 pm
Maybe try coming at it from a different direction. I assume you are moving along, taking good strides, while PWB. So, instead of just dropping the crutches, keep them in your hands. Work on gradually decreasing the amount of weight you put on your hands. Gradually work it towards zero.
For me there was no trick or process. It just happened. One day, I realized: “hey I can stand on my leg”. And shortly thereafter: “Hey, I can take a little baby step”. It happened a few weeks before I thought it would- but I never looked back. I wouldn’t try to walk until you are fairly comfortable just standing on your (single, booted) leg. And start out, taking very small, slow steps- especially with the “good” leg.
eastcoastrunner said,
May 22, 2012 @ 4:04 pm
Thanks, Guys!
Norm—building up the good foot makes sense. I’ll try seeing if one crutch in the OTHER hand works. (haha, I feel silly for thinking it went on the “bad” side, but no one told me how to do it!)
Mrboro—I’m stuck with the boot for at least another 4 weeks. I still have to sleep in a smaller boot. My surgery wasn’t ATR, so my recovery process is a bit different. If I took off FWB in my running shoes now, my doctor would have my head! But I am looking forward to that day of two shoes!
Ryan—your method of just using less pressure on the crutches is what I’ve been trying to do, but reached the point that I can’t “let go”. My PWB strides are a normal length…I will try just baby steps. I think that is it, too. I was trying to make the steps “normal” stride.
I’ll try all the suggestions and let you know how it goes! Thanks for your replies!
kimjax said,
May 22, 2012 @ 4:23 pm
I know what you mean about the tight, weird feeling across the top of your foot. My ankle feels cemented together at 3 weeks post op - creepy feeling to have little elasticity! I’m following you “PT’ers with interest as I move towards PT.
ryanb said,
May 22, 2012 @ 4:42 pm
Baby steps for sure! Starting out, each step should probably be just a few inches - not even fully passing your other foot. PWB, FWB, 2-shoes- as you move from one phase to another, you’ve got to start all over again. I’m betting you slowed down a bunch when you started PWB too. I hate to tell you this, but- when you get there - the move to two shoes will be REALLY starting over.
Once you get to full weight bearing (baby steps); it won’t take you very long to work back up to a decent stride in the boot. I bet you’ll be cruising right along in a week or so; it just takes a little while to learn how to utilize the boot (hint: for big walks, strap it down good and snug).
kiwiclaire said,
May 23, 2012 @ 1:49 am
Don’t be too hard on yourself because the reality is that if your boot is fixed at 90, however good the rocker is it will never be like walking with some dorsiflexion and at that stage if I pushed it too hard then lots of other things hurt because they are compensating for the lack of dorsiflexion. I walked around the house and short distances outside, but often resorted back to two crutches for longer distances because it was faster and less stressful.
starshep said,
May 23, 2012 @ 2:13 pm
Eastcoastrunner,
In addition to building up the non booted shoe, (I stuffed about 4 folded socks into the heal of my shoe), the other key for me was to lead with my booted foot. The non booted foot can easily dorsi flex and you can get a decent stride. At first when you bring the non booted foot forward, it will only go slightly past the booted foot. As you grow in skill and confidence, you will be more comfortable in leading with the heel and letting the rounded bottom of the booted foot, act as a pseudo dorsi flexation. You you can lengthen the stride of your non booted foot. Once you really get good at it, you will feel yourself pushing off with your big toe in the booted foot. When you’re able to do that, you can really move along pretty fast. It probably took me a few weeks to build up to that point.
Going up stairs is fairly easy if you lead with your booted foot. Going downstairs is a bit more challenging. Once again, lead with your booted foot and work to the goal of putting about half the sole of the boot overhanging the stair you landed on. That way the edge of the stair acts like a fulcrum and gives you that pseudo dorsi flexation. BE SURE TO HOLD ON TO THE HANDRAILS WHILE YOU DO THIS BECAUSE YOU CAN GET GOING REALLY FAST REALLY QUICKLY. When learning this move, start by only putting your toes over the edge of the stair until you get a feeling for where the pivot point of the boot is.
Another thing that might help you is to search on YouTube for videos of “walking in a CAM boot” You could also substitute various synonyms for CAM boot such as “Orthopedic boot”
Hope this helps. Keep trying, and once you get the hang of it, you’ll wonder why you thought it was so difficult.
eastcoastrunner said,
May 23, 2012 @ 7:28 pm
I’ve been trying all the variations and suggestions. I think just knowing that it IS hard makes me feel better about having a hard time!
Starshep—your descriptions were helpful. I’m having issues with my toes still being numb, especially my big toe, so the push off is where I’m getting stuck. Glad I don’t have too many stairs to deal with!
Kiwiclaire—what you said about the 90 fixed position makes sense. Thanks!
Ryanb and Kiwiclair—knowing that it’s not a sign of “not making progress” by going back to the crutches when needed and with each new step really helps, too.
I haven’t started PT yet and although my doctor is awesome, he kind of assumes I know this stuff for some reason.
Ultrarunning316 said,
May 28, 2012 @ 1:49 am
Hi Eastcoast…Sounds like you’re making a good recovery, I know when I went from PWB to Full I had to dig out a seldom used hiking boot & placed two extra dr shoal type soles in my boot & also double socks…I used injinji socks to help stave off blisters(individual toe socks). That evened out my gait…Then it was just taking it slowly trusting that it was time as the body adjusts. God Bless & keep moving forward in faith.
eastcoastrunner said,
May 28, 2012 @ 9:51 am
Hi Ultrarunning!
Every time I attempt the FWB, I think of you walking the Big Sur! I still can’t put full weight on the front of my foot, so I think there is “something else” going on there. I re-try every other day. I have an appt with the Ortho on Wednesday, so I can ask about this. I’m wondering if I have nerve damage. Thanks for your kind words!
Ultrarunning316 said,
May 28, 2012 @ 2:43 pm
Hopefully it’s just your foot needing to re-acclimate itself to the feeling of bearing weight…I know my foot felt weird at first & I even had some numbness & tingling to work out but these are things that diminished with use. You’ve got the Spirit that it takes to over come this
I hope the Doc can alleviate any of your worries…That’s basically what I ended up paying mine for, peace of mind…He’s a good doc too just seems like at some point there’s not much else they can tell you but that you’re on the right track or not. Stay motivated as I know you will 
eastcoastrunner said,
May 29, 2012 @ 7:45 am
I just had a thought on the stiffness/pain in my forfoot. It seems to be originating mostly from the big toe joint.
Has anyone had a GOUT flare caused from the AT surgery? In my case it might make a whole lot of sense as I have an auto-immune/mixed connective tissue disease– and RA is one of my “mixed diseases”. I read up quickly about gout on an arthritis site and it seems that surgery can be a cause. Since I’m seeing my Surgeon tomorrow, I can toss that into my questions. But if anyone has any experience, I’d be glad for the info. Thanks!
Gary said,
May 29, 2012 @ 3:11 pm
Yep, I had minor gout in my big toe joint for about 6 months post ATR. Made (attempted) calf raises a bit painful.