Are you one of those who has been off your feet for several weeks because you had fractured your lower leg.
And feeling lost with no confidence on how to start walking unaided again. What steps to take?
For this article I rely:
⚫On the knowledge I gained as a diagnostic radiographer working with patients with fracture injuries.
⚫Additionally, I have referenced scientific studies at the end of the article to support my insights.
⚫Also consulted a physiotherapist for rehabilitation tips.
Happy reading!😀
All references at the end of this article, let’s meet in the comments section🙏
Last updated: Feb 2024. Written by Juliet Semakula, diagnostic radiographer.
Disclaimer: no affiliate links
▶️Steps to guide you to gain your walking confidence.
When you have been non-weight bearing for 6 weeks or more. This is a critical step in your recovery and it is always needed before you resume walking again.
This period typically marks the beginning of transitioning from non-weight bearing to partial to complete weight bearing.
Step 1️⃣: You must identify the specific dos and don’ts of leg fractures.
After your leg fracture (hip, femur, tibia, fibula, ankle and foot) you will be given instructions from your doctor about walking again after treatment.
This will depend on the type of fracture and the treatment you were given.
♦The location of the fracture
♦Did you get an operation
♦ Was it a non-operation treatment?
After treatment, your doctor will examine your injury, post check x-ray, tests and other scans will be used to see how well your fracture is healing.
After examining your bones, pain levels, muscle strength and joint range of movement. You will be given a go ahead to put weight on your leg or not.
▶️Walking after rest involving non-weight bearing for long will follow progression of different steps.
♦Touch down weight bearing: Here the toes can briefly touch the floor to maintain balance.
♦ Partial weight bearing within tolerance: still using your crutches you may bear a small amount of weight on the affected leg and foot, then try to walk using
♦Weight bearing within toleration: this will depend on how well you can tolerate and support as much weight as you can.
♦ Full weight bearing: here the fractured leg and foot can support your full body weight, and you can walk without discomfort.
Before you start bearing partial weight on the injured leg, you must have received at least five physical therapy instructed weight bearing sessions from your physiotherapy.
Usually, the measurement will be done with a standard bathroom weight-scale to see how you can control your weight bearing on the injured leg.
Generally, if you can load 10-30% of your body weight using a bathroom scale while standing and then try to replicate that when walking.
1️⃣Take a bathroom scale
2️⃣Place something like a big volume book, to help you put one foot on the scale and the other on the book to level both feet at the same height.
3️⃣Step on the scale and support
4️⃣Try to shift more weight or less on the affected leg by tilting your hip to that side.
Demonstrations:
A patient stepping on a scale more weight tilting to the affected right leg.
▶️A guide for partial and full bearing fracture (tibial shaft, ankle, femur, hip)
| Parameter or recommendation | Partial weight-bearing | Full weight-bearing |
| Weight bearing | 20kg weight-bearing with CAM boot & crutches | Permissive full weight-bearing, crutches for comfort |
| Physical therapy as inpatient | Minimum of 5 sessions with weight-scale instruction technique | Minimum of five sessions teaching 3- & 4-point crutch-assisted walking as comfort permits |
| Physical therapy after discharge | Minimum of twice weekly, weight-scale instruction technique for 6 weeks | Minimum of twice weekly instruction of 3 to 4 point crutch-assisted walking as comfort allows |
Braun, 2017
| Overview of the common leg fractures: |
| ♦Ankle fractures are painful and temporarily disabling. If not properly treated, it can lead to significant, long-term complications and debility. |
| ♦Tibial fractures are caused by twisting or falls from standing height or high-energy caused by high levels of force, such as a car accident or a major fall. |
| ♦ Fibula fracture caused by a forceful impact, such as landing after a high jump or any impact to the outer aspect of the leg |
| ♦Foot fracture is an injury to one or more bones in the foot. A bone might break from a sports injury, a car crash, a heavy object dropped on the foot, or a misstep or fall. |
| ♦Calcaneus fracture caused by severe high-energy impact because of a fall from a height, such as falling from a ladder |
| ♦Hip fracture can be caused by a fall or accident. |
| ♦ Femur fracture caused by high-energy injuries, such as falls from significant heights, or motor vehicle collisions. |
| ♦Patella fracture caused by a direct blow to your kneecap, such as in a fall, from a sports injury or from a car accident. |
If you have had any of these fractures, you may have been given some instructions when you can start walking on the affected injury.
Weight bearing typically happens over 2,4, or 6-weeks period or sooner in some of these cases. This is determined based on your injury and healing status.
Here are some of the situations.
Situation1️⃣: If you have not been given instructions as to whether you may walk, or you have been told you can walk normally.
This means that your doctor believes your fracture is stable enough for you to put weight on the affected leg.
You can walk as much as you want, but let your feelings during and after you have walked a distance guide you on how much you can go.
For example, when you have had an avulsion fracture which generally occurs when a tendon or ligament comes away from the bone, pulling a small piece of bone with it.
Image from Kch.nhs.uk
You will be given instructions as part of your recovery to rest and elevate the leg, cold packs and early movement is always recommended.
Early weight bearing (putting weight through your injured foot) usually helps increase the speed of healing.
You may have been told to walk as normally as possible as this will help with your recovery.
But remember in the beginning since the fracture is in the healing process, you should take it slow, let pain guide you.
Do you feel a lot of pain when you walk, if so try to do a little less the next time you try until you gradually learn to balance on the affected leg.
Situation2️⃣: You have been told that you are not allowed to put weight on the broken leg (touch down weight bearing)
In such a situation you may have three options.
🟣To use a wheelchair to help you get around.
🟣Put your feet on the floor with outputting weight or pressure on it at all which is called a touch down weight bearing.
🟣Rest your leg and follow the doctor’s instructions even when your feel you can try to walk. Resting will help speed up recovery.
Situation3️⃣: You have been told that you can put some weight on the broken leg.
Usually, your doctor will give you a guide on how much weight you can start putting on the affected leg.
You will probably need to use both crutches until it’s possible to put weight on the leg again fully.
I have seen patients when they are able to place 50 and 70 % of the weight on the injured leg, they then transition to using one crutch as they progress their walking journey.
Caution!⚠️ Even if you are allowed to put weight on your broken leg, you may still encounter difficulties.
▶️Assess your current challenges that limit your walking abilities.
♦Are you in pain when you try to put partial weight on the fractured leg?
It is common to experience discomfort when you start to weight bear on the broken leg.
♦Is it just a concern: Try to prepare your mind and body because they both play an important role in regaining mobility.
♦Is it due to lack of balance?
♦Is it due to stiffness in the foot, knee or hip
Step1️⃣: Deal with these problems with different remedies.
You may need to first address these related issues for example for:
If you have pain and swelling
🟠You can apply a cold ice pack during and after any activities.
🟠You may have been given painkillers to help with the pain.
🟠You can also reduce putting weight on the affected leg.
If you are concerned about your confidence on walking again.
🟠Try to stay positive and focus on your weight progression timeline this will help you stay confident in your ability to walk.
For Knee stiffness when you try to walk.
🟠Exercise may help you restore knee flexion or extensions.
Feeling tired too quickly when you try to walk
🟠You might feel that exercise is the last thing on your mind. But, in fact, regular exercise will make you feel less tired in the long run. Start small.
🟠Practice standing for a little longer each day.
You can also seek advice if you are not sure of what to do from your healthcare provider.
Step 2️⃣:Choose a suitable walking aid.
Even when you have been told to walk on the injured leg, you will still need to use crutches, a wheelchair, walking frame or a walking stick.
They will help to ease pressure on the affected leg. Gradually you will learn to use one instead of two until you can walk without assistance.
With the different types of walking aids, you must choose the correct size, height and strength to be able to help you move without causing danger.
Step3️⃣:Find the walking style that suits you best
▶️Demonstration of walking without crutches
Partial and toleration weight bearing with crutches (steps)
🔵Put the crutches ahead and to the sides of your feet for the best balance.
🔵Move both crutches forward at the same time.
🔵Move the injured leg forward between the crutches.
🔵Gently squeeze each crutch into your ribs. Put weight through your hands and keep your elbows straight.
Demo showing walking with crutches
Walking with a forearm crutch
When walking with only one forearm crutch, it’s better to place it on the side not affected by your broken leg
🔵Move your stronger leg ahead of the crutches, or to between the crutches for better balance.
🔵Step forward with your strong leg
🔵Step forward with your recovering leg and the crutch in your opposite hand at the same time.
🔵Use your crutch to support your weight as you move forward, not putting more pressure on your recovering leg.
Step4️⃣:Gradually increase your walking
Ideally you only want to get off crutches once you can walk without a limp or pain.
Evaluate how your body responds the next day and adjust if necessary.
Gradually increase your walking depending on how you feel, rest when you need to, remember ‘ROME’ was not built in one day.
And try to set realistic goals that are achievable week by week by increasing your walking time.
A You tube video demonstrating walking with crutch :Retrieved from nhsinform.scot.
▶️Stay motivated, most people recover completely after a broken leg!
You must have a positive mindset during your recovery period,
For most people, a broken bone will heal within a few months with no any further problems.
Most people I have seen in the period of my professional experience, do return to their normal activities after a few weeks after recovery.
You will certainly be able to walk again, drive and engage in sports as you did before you injured yourself.
1️⃣Driving will be possible again a few weeks after your fracture.
2️⃣You will be able to go back to work after your recovery
3️⃣I have seen people return to sports activities at the same level as before.
4️⃣Swelling can sometimes take weeks, months and even years for some people but with no associated pain or discomfort it should not worry you.
5️⃣Permanent limitations are an exception rather than the rule.
It’s understandable that immediately after you break a bone, it creates several difficulties in your life.
Your concern will kick in!
You’re likely going to miss going to work, sports, lose mobility until you recover, and you might even need surgery to fix the fracture.
All in all, stay positive with proper treatment and rehabilitation you will be able to go back to your normal activities like before.
We have come to the end of this article, wishing you a quick recovery!🙋
📚Sources:
Braun BJ, Veith NT, Rollmann M, Orth M, Fritz T, Herath SC, Holstein JH, Pohlemann T. Weight-bearing recommendations after operative fracture treatment-fact or fiction? Gait results with and feasibility of a dynamic, continuous pedobarography insole. Int Orthop. 2017 Aug;41(8):1507-1512.doi: 10.1007/s00264-017-3481-7. Epub 2017 Apr 19. PMID: 28421239.
Sehgal M, Jacobs J, Biggs WS. Mobility Assistive Device Use in Older Adults. Am Fam Physician. 2021 Jun 15;103(12):737-744. PMID: 34128609.
Sherrington C, Lord SR, Herbert RD. A randomised trial of weight-bearing versus non-weight-bearing exercise for improving physical ability in inpatients after hip fracture. Aust J Physiother. 2003;49(1):15-22. doi: 10.1016/s0004-9514(14)60184-7. PMID: 12600250.
Physiotherapy :how to use crutches https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=custom.ab_physio_crutches_inst