7 Weeks PWB/FWB
October 28, 2013
This Wednesday will be my 7th week since surgery. My doctor told me to go ahead and start putting weight on my injured leg, incrementally. I’ve been doing so very slowly and kind of satisfied with the results. I’m not getting any pain really in the Achilles, just some slight ankle pain and a little bit of soreness in the calf. I kind of half expected this since I have been immobile for quite some time.
I worked my way up to one crutch and even brought one crutch to work one day. My injured leg felt fine with no pain again in the tendon. I’m pretty confident on one crutch, however I prefer two crutches because I can just get around much faster. I must say however, walking without crutches has been quite disappointing. I haven’t really been able to walk “normally” per se. I can stand on two feet without the crutches and put a good deal of weight on my injured leg (whilst in the boot of course). When it comes to walking without crutches however, I just can’t do it. I just kind of balance a little bit on my injured leg and do a hop type movement with my right foot. Has anyone else started off like this? I’m kind of worried that it might be a mental thing, because like I said, I feel no pain in the Achilles when I put a good deal of weight on it.
I appreciate all the tips if there are any!
Happy Heelin’
Justin
October 28th, 2013 at 11:50 pm
Hey Justin,
I’m sure others will chime in with more experience, but we on the same pace (I am 7.5 weeks in). The most difficult part I had was walking in the Frankenstein-style boot. I had to start by turning my foot outward a bit, and widened my stance. Otherwise,
If I have to walk a lot, I take 2 crutches because it’s quicker and easier on my back and hip. Get the Evenup shoe clips to make both feet the same height. It will save your back, hips and make it easier to walk. Amazon for $27.
Lastly, if there is no pain, you should be good to start FWB. The bottom on your foot and heel will be sore, but apply compression\ice, accordingly.
Take small steps and don’t over do it. Make sure you also do your ROM exercises.
At this point, I can stand barefoot, move a bit, ride my stationary bike, workout out, and walk in my boot FWB with the Procare Evenups, all day - w/o crutches. I started FWB between 5-6 weeks, and am currently working on my PT for 2 shoes (slowly).
Good Luck,
Ron
October 29th, 2013 at 12:02 am
As you build up weight/pressure on the boot using 2 crutches (or maybe 1), you should be able to get to the point where you’ve got all your weight on the booted foot. Many protocols, including bit.ly/UWOProtocol , move from PWB to “FWB As Tolerated”, because FWB takes some getting used to, often a couple of days even “when the time comes”.
Once you can comfortably support your full weight on your booted foot, the next trick is to learn to use the boot to do the job a healthy AT-and-calf do. Specifically, you should first plant the heel of your boot, then shift your weight forward while pushing your knee forward “normally”, so the contact-with-the-floor-point moves from under your heel to under your toes (or at least the ball of your foot).
If your boot is properly fitted, adjusted snug enough, and stiff enough, the pressure under the ball of your foot (= your full weight) should be transferred by the boot’s structure to the front of your shin, where it hits the top of the boot’s cuff.
Your calf and AT just go along for the ride, and the bottom of your booted foot has to hold up your FW. If the boot fit is sloppy, snug it up. Some boots (including the AirCast) also get very soft and flexible when their straps are loose, and none of that is conducive to good or safe boot-walking.
Once you get the hang of it, you should be able to walk about as fast as pre-injury — maybe even FASTER in a hinged boot! All of these boot-walking moves can be rehearsed on crutches with PW.
You can even walk down stairs normally, FWB in a boot, with the help of a trick that I’ve posted in a bunch of places including on my blog page (in a recent reply). Many people walk down stairs boot-leg-forward, but it’s not necessary or helpful. And that same trick works just as well in 2 shoes, when many switch to walking down stairs boot-leg-forward.
October 29th, 2013 at 12:09 am
Hi Norm,
…speaking of 2 shoes, can you give me\us some tips on how to transition from FWB to 2 shoes. I can stand up and feel fine, but to be honest, I am afraid to even THINK ABOUT walking. LOL.
Since this is Justin’s next step as well, I thought it was relevant.
I will find your stair walking tip in the blogshere.
Thanks and Good Luck,
Ron
October 29th, 2013 at 12:12 am
As Ron said, it’s important to get SOMETHING like an EvenUp to elevate your shoe so it’s as high off the floor/ground as your boot. Me, I would avoid walking toes-out (the way you may have walked in the days between ATR and treatment), because (a) it shouldn’t be necessary with a boot, (b) it’s not helpful, and (c) that kind of abnormal gimp-walking can do harm, either physically or mentally-habitually (by teaching you habits you have to work to un-learn later).
I got good speed while crutch-walking, but I also got very good speed while boot-walking. Once in my hinged boot I found myself walking on sidewalks downtown with a bunch of young friends for a few blocks, and they couldn’t keep up!
I actually got into trouble that time, because in order to keep up the conversation, I spun around and started walking backwards in the hinged boot — BAD idea!! I stopped doing that immediately, because it was much too strenuous “eccentric” exercise for my still-recovering calf and AT.
I was the mid-60’s old guy with the healing ATR, and they were a bunch of 30-something uninjured fit people, and I was waiting for them, so boot-walking isn’t slow. A fixed=non-hinged boot is a smidge slower, but not slow.
October 29th, 2013 at 12:18 am
Norm’s boot walking instructions are spot on. I felt like my pace was normal (and I’m a fast walker) in a boot. It’s kind of disappointing to get to two shoes because I had to slow down so much. Good luck!
October 29th, 2013 at 12:25 am
Hi, Ron, we’ve gone from a fast blog page to a slow overlapping chat!
Some people recommend heel wedges when going to 2 shoes; I generally don’t, because bit.ly/UWOProtocol didn’t, but it’s probably no big deal.
Either way, the challenge when you’re first in 2 shoes is that your calf-and-AT are still weak and vulnerable, and your DF ROM may also be limited. But with or w/o DF ROM, you can’t USE that ROM while walking (the way you normally would) because you don’t have the calf-and-AT strength to hold yourself up when you stride ahead of your healing foot. You’d fall if you try, and trying would hurt, and might even cause a rerupture, so it’s a total No Go.
So when you’re walking-standing on your injured foot and moving the other foot forward, you can’t move it far before you’ve gone too far. For your first steps, you may just bring your “good” foot up to your healing foot — or maybe not even. Planting your injured foot way ahead of you and catching up to it isn’t a big problem, but doing the mirror image is.
So: some people take the “walk normally” advice even farther than I do and recommend a short-strided, slow, symmetrical gait. I.e., don’t do anything on one side that you can’t do on the other side. I don’t see any advantage to going THAT slowly, and I don’t think anybody is going to make a habit out of walking with one short stride and one long one.
So: I recommend taking one stride as normally as possible (when you’re striding “over” your “good” foot, injured foot forward), and shortening your other stride as much as you have to, to keep your injured foot safe. You’ll get around MUCH faster that way, and I haven’t heard from anybody who’s been harmed by that asymmetrical (but otherwise normal) walking. Again, avoid NON-normal walking, like sticking your toes out to the side and rolling over the inside of your foot, because that CAN cause harm. And it’s not on “the path back to normal”, either.
October 29th, 2013 at 12:36 am
OK Justin,
I just did it. Got up and walked around and noticed that I am walking forward, BUT from side to side. With my vacocast at PF 0 and the rocker, it’s a different feel then my Air Cast Cam Boot. I tried in both, but I still walk from side to side a bit with my foot turned out. Try different techniques.
I agree with Norm. I grab rail and put my good foot down first, and good foot up first. I put crutches in one hand and push up with them along with the rail. Pretty easy, but still scary, so I go slow, bro. LOL.
Good luck,
Ron
October 29th, 2013 at 12:39 am
Sorry Norm and Justin,
I LOVE the answer and the community needs to know that. Will post, so please copy-paste (new topic).
Thanks,
Ron
October 30th, 2013 at 1:46 pm
Not sure I understand, Ron. You’re planning to copy-&-paste the answers to one of your answer-anthology blog pages? Or you want me and Justin to paste them somewhere?