Cast away - transitioning to a walking boot

Since I fractured my ankle 8 weeks ago, I have gone through 2 splints, and 4 fiber glass casts. My orthopedist would cut open the cast every two weeks to take an xray before re-casting. Yesterday, the last cast was removed for good and I was put into a walking booth with partial weight bearing allowed.

Goodbye cast!

While I was trapped in the non weight bearing world of casts, I imagined my life in a boot would be immediately back to normal. I thought that I would only have to wear a heavier than usual shoe, and be able to move around without problem. I was wrong. Since I still cannot put my entire weight on the injured foot, I have to use crutches to move around. Below are the things I did not expect when transitioning to a boot.

Stiff joints

For 8 weeks, my foot was stuck in the same position, just past 90 degrees. The restricted movement during that time led to atrophy and stiffness of the muscles and tissues around the fracture. During dorsiflexion (pointing my toes towards my knee), I can only get my ankle at 90 degrees. In order to walk properly, I have to break 90 degrees since the knee goes ahead of the toes with each step. So when I walk, most of the pain does not come from the fracture or the surgery incision, but from the Achilles being too stiff and the bruises on my foot.

To remedy the stiffness of the joint, I stretch it by pulling my toes towards my knee with a towel and holding it for 3 seconds.

Dorsiflextion stretch

Eventually, my range of motion should return to normal.I’m also building up to doing ankle circles, although right now they look just like really flat ovals.

Soreness & atrophy

Since I’ve taken my cast off every two weeks, I saw the process of muscle atrophy at work. There is significant muscle loss of the affected leg while recovering from an ankle fracture [1]. The size difference between my left and right calves and quads is noticeable. After just one day of introducing movement and some weight bearing back to the limb, I have terrible DOMS on my injured leg. At least I know the muscle will eventually come back with increased activity.

Here’s a photo showing the difference between my calves. The left one is the atrophied one. Calf comparison

Slow movement

Walking in crutches with partial weight bearing is slow compared to walking in crutches will no weight bearing and even slower compared to a wheelchair or a scooter. With partial weight bearing, I’m really slow to transfer some weight to my injured leg because I don’t know how much weight it can take. My doctor advised that I take it slow and increase the weight as I am able. I think once I am more confident in my foot I will be able to move faster.

Dry skin

I’ve heard multiple times that our bodies are covered in dead skin. I didn’t really believe it until I saw my leg yesterday. Without a proper was for 8 weeks, a lot of dead skin accumulated. Just putting on and taking off a sock knocks off a lot of skin flakes. To wash off the dead skin, I gently scrubbed it away using a sponge and warm water. It’s taken a few tries, but I’ve seen the amount of flakes decrease.

Sources

  1. Calf muscle wasting after tibial shaft fracture

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