byEric J. Buchbaum, DPM
Although foot surgery is effective at correcting underlying bone deformities; Patients sometimes find the postoperative recovery frustrating when it involves periods of non-weightbearing in a cast or walking boot. In an effort to improve postoperative symptoms and enhance quality of life; recent research has focused on early weight-bearing with studies supporting that new protocols can improve short-term symptoms and outcomes.
Depending on the surgery, early weight-bearing in patients who have stable fixations with osteotomy surgeries (cutting and repositioning bone) can be a viable postoperative treatment option since it can help to reduce swelling (directly correlated with pain) and hasten recovery.
Data has shown that early weight-bearing can reduce symptoms without affecting union rates (bone healing) or complications during postoperative recovery. Patients who participate in early weightbearing are also potentially more comfortable during postoperative recovery than those who are in a cast for a longer period of time.
In 2010, a study in the Journal of Foot and Ankle Surgery was the first to demonstrate that early partial weightbearing approximately two weeks after a bunion surgery did not compromise outcomes. The duration of time to bone healing was similar to rates reported in previous studies describing procedures with longer durations of initial postoperative non weight-bearing. There were no complications requiring surgical revision and no hardware was broken before solid bony fusion occurred in the study group.
With advances in more stable surgical technologies, such as locking plates and screws, early weightbearing after bone procedures is possible without compromising hardware. In addition, this recovery may also reduce risks associated with prolonged non-weightbearing including blood clots, joint stiffness, muscle weakening, and osteopenia.
Decisions about whether to recommend early weightbearing after foot surgery depend on the severity of the deformity, the type of surgery and fixation used, as well as individual patient characteristics. Age and medical comorbidities play an important role in a patient’s ability to heal from bone surgery. Patients with peripheral neuropathy, obesity and osteoporosis are poor candidates for early mobilization. It is well known in the literature that smokers are more likely to develop bone healing complications and account for a majority of non-unions.
Bathing of the area and removal of the surgical bandaging can typically occur after one week. Depending on the procedure performed, I emphasize nonweightbearing for two weeks postoperatively until the incision has completely healed. I then allow partial weight bearing in a removable short leg boot if tolerated. Increases in weightbearing are progressed on a weekly basis and are guided by swelling and pain. In addition to patient symptoms; clinical and radiographic evaluation helps dictate the transitions from non-weightbearing to weightbearing to a return to athletic shoes and full activities. This becomes of particular interest to those patients who undergo surgery on the right foot as the return to an athletic shoe allows a return to driving.
Every patient requires a customized plan to best suit their post-operative recovery but it has been exciting to see advancements in both hardware and post-operative management as it has greatly affected patient outcomes and an early return to function.
FAQs
Depending on the procedure performed, I emphasize nonweightbearing for two weeks postoperatively until the incision has completely healed. I then allow partial weight bearing in a removable short leg boot if tolerated. Increases in weightbearing are progressed on a weekly basis and are guided by swelling and pain.
When can I start weight bearing after foot surgery? ›
Items needed to do this included a bathroom scale, protective boot or shoe and standard crutches (in some cases a walker may be used). Patient's that have used a knee scooter will need to use crutches for this transition. Weight bearing typically happens over 2, 4 or 6 week period or sooner in some cases.
What happens if I walk too soon after foot surgery? ›
Putting any weight on an operated foot or ankle can damage the repair that's been done. Bones need time to heal. Plates or screws that may have been added during surgery need the bones to heal around them. Adding weight too soon can interrupt this important internal healing process.
Is walking in a boot considered weight bearing? ›
The first phase is the non-weight bearing while using a walking boot, the second is weight bearing while continuing to use the walking boot and finally, full weight bearing once the walking boot is no longer needed. The first phase may not be needed, depending on the type and severity of the injury or surgery.
Does it hurt to start weight bearing? ›
Weight Bearing F.A.Q.s
You should expect some degree of discomfort when beginning to weight-bear. To help relieve this you can take over-the-counter pain relief or talk to your surgeon. Pain that increases, or sudden sharp pain may indicate re-injury in your joint.
Does early weight bearing help bones heal? ›
Studies show that osteocytes – a type of bone cell – are activated by the muscle contractions that happens during weight bearing exercise. This then causes the osteocytes to instruct other bone cells to create new and stronger bone tissue allowing them to patch the edges of the broken bone.
Can I rest my foot on the ground when non-weight bearing? ›
Non-Weight Bearing (NWB): Do not place any weight through the surgical/injured leg. This includes resting your feet or toes on the ground. While walking and sitting, make sure to keep your foot elevated off of the ground at all times.
Is spinning considered weight-bearing? ›
While cycling can be rigorous and demanding, it is not a weight-bearing exercise. Unlike weight-bearing exercises like running, jogging, or jumping, cycling involves sitting on a bike seat and pedaling, which does not put direct pressure on the joints and bones of the lower body.
When can I stop elevating my foot after surgery? ›
It is important to rest and keep your foot elevated above the level of your heart for 23 hours a day for the first 2 weeks after your surgery. Elevating of your foot will encourage healing and decrease the chance of wound infection and break down. It will also help with pain and swelling.
What happens if you accidentally put weight on a non-weight-bearing leg? ›
Signs that you need to see your healthcare provider if you accidentally break your weight-bearing status may include: Increased pain in your injured or operated leg. An increase in redness or swelling in your leg. Difficulty moving around that causes more pain.
Early weight bearing
Weight bearing, which provides axial loading to the fracture and stimulates osteogenesis, will also counteract the paradoxical impairment of bone healing caused by an excessively rigid fixation.
How much weight is weight bearing as tolerated? ›
With weight-bearing as tolerated, the individual may support 50% to 100% of body weight on the extremity. The amount of weight depends on the circ*mstances. With full weight-bearing, the affected leg can carry the entire weight of the body and can ambulate.
How long after foot surgery can I walk with a boot? ›
-At your next visit the cast will be removed and you will be placed in a boot walker for 4-6 weeks. This begins a gradual increase to full weight bearing as pain and swelling allow. The boot is taken on and off to shower and sleep. Range of motion is encouraged when the boot is removed when you are non-weight bearing.
What happens if you accidentally put weight on a non-weight bearing leg? ›
Signs that you need to see your healthcare provider if you accidentally break your weight-bearing status may include: Increased pain in your injured or operated leg. An increase in redness or swelling in your leg. Difficulty moving around that causes more pain.
What happens after 6 weeks of non-weight bearing? ›
At the six-week mark, transitioning from non-weight bearing to partial weight bearing is a significant milestone. It's essential to follow your healthcare provider's instructions carefully during this phase. Gradually introducing weight to your injured leg will help you rebuild strength and stability.
How long after foot surgery do you need to keep your foot elevated? ›
To reduce swelling and promote comfort, elevation is very helpful. Elevate the foot/ankle above the level of the heart, using several pillows, for at least 14 days after surgery. Do not place pillows directly behind the knee. Elevation for 30 minutes every 2 hours is a good initial recommendation.
