My husband (age 57) fractured his calcaneous July 15 jumping from a ladder onto concrete driveway. Surgery July 18 with plate and 10 screws. Has been doing PT since 3 weeks post op. Has great ROM and both therapist and OS thinks he is doing great. Has not complained of pain. He's hoping he will get approval to weight bear at next week's appointment which is 11 weeks post op.

Can anyone give him an idea of what walking for the first time is going to be like? Will there be pain on the heel? Will he need his crutches, a cane, or his boot for a while longer? Should he try to go on short walks right away, going a little further everyday? Or should he just walk around the house at first?

I know we will get instruction from the Dr but would like some first hand experience.

Thanks.

Hi LNM,

Getting back to walking will be slow, but steadily progress. Sometimes it's a week on crutches and then just keep them handy. Other times it’s a month then a cane for a bit. It is also not unusual to require pain medication at this stage. He should ask the doc about that and not be afraid to call in if necessary. There are a lot of factors. Anything that was injured initially will still be healing: heel pad, subtalar joint, tendons, and other foot parts. Great ROM without those hurting now is a good sign. Still, the non weight bearing time will have taken a toll. The Achilles tendon will have shrunk some. Circulation, flexibility, muscle tone and even general stamina will not be up to the demands of regular walking. It might be a lot more comfortable to use the boot at first, working on weight bearing and locomotion, followed by foot and ankle strength and stability sans boot. It seems to be automatic to dump the boot when it becomes more trouble than it is worth, so don't worry about that. Ditto for medications.

Those who were the most active pre-injury seem to bounce back quickest. Partly because of the condition they were in but also possibly because of the amount of effort they were willing to put into recovery. How far he can get at first isn't important. For some it is "Whoa" on the first step. What counts is doing more of what ever he can so he can build on that. If he manages 10 steps he could do that throughout the day. When he can get around the block, he should extend the distance next time. There's one snag: 2SF1SB. That's two steps forward, one step back meaning there will absolutely be times when he over does it and needs a day off. Rather than being disappointing, this should indicate to him that he's not being a slouch.

PT is great and essential. Don't let him quit until he is walking with a proper gait (no limp). While PT is good because they are specialists on the subject, I would recommend that he at least match the formal effort with real world activities - on stairs, carpets, outdoors and any environment he will be returning to. It's also a good idea to keep up with the range of motion exercises because the limited amount of walking at first won't be contributing to that.

The next three months could result in as much impatience as I'm sure characterized the previous three. When he says: "I can't do 'A'." take note. Then later when he says: "I can't do 'B'." remind him that last week he couldn't even do 'A'! There will be 'new' pains until the foot bones get comfy again, especially at the very top of the foot. The same goes for the scar tissue at the surgery site as it works free again and from the swelling that seems to take forever to disappear completely. Don't let those all be a worry, but don't hesitate to check with the doc when in doubt.

TC

TC - Thank you so much for taking the time and writing such a long and comprensive reply. You certainly gave him some good pointers and advice. He was glad to read your reply.

We'll find out Thursday, Oct 5 whether he gets the go-ahead for weight bearing and he is counting the hours practically. I will post the results of that appointment.

Thanks again.

LNM,

Good luck tomorrow. If you've had any questions for the doc: Write them down so you don't forget to ask. I'm sure you'll hear an OK for weight bearing. Also sure your husband won't be winning any foot races this week.

TC

"We" had my husband's Dr appointment this afternoon and the X-ray taken looked very good and Dr was very pleased with his ROM but wants him to have a CT scan before he will give his blessing for 100% weight-bearing. That won't be until Monday but we're hoping the CT scan will be favorable enough for him to start walking.

Dr. did say he would let him do some 50% weight-bearing as long as his boot is on and he does it with his crutches so he'll be working on that for the next few days.

tchair - Hubby got his "walking papers" last Wednesday (the 18th) and everything was finally looking up. He did really well. Straight into regular shoes, walking really good with a little assistance of a cane but could walk without it, too. Even drove the car for the first time in 3 months. FREEDOM. No heel pain but foot and ankle swollen which was normal.

You said to expect 2 steps forward, 1 step back but today it was 20 steps back!! Last night (after 1 week of freedom) his foot started swelling and hurting really bad plus he started running fever. Went to Dr today who took one look at it and said hardware needs to come out NOW. Would have operated this afternoon but hubby had just had lunch and so he'll have surgery tomorrow morning at 7 AM.

I guess it's back to square 1 now. Also I guess it'll be back to non-weight bearing for 3-4 more weeks ?????

The worst part, we had a cruise scheduled (for a year now) that was to leave Tuesday, which I'll be cancelling tomorrow.

Hey LNM,

You'll be back when you read this and it's more positive than negative. Every heelie experiences some degree of discomfort from the hardware and only a few get it taken out. The rest have to live with it and even if it's not so bad they end up second guessing whether it's worth hounding their doc and going through another surgery. So hubby has put all that behind him. The hardware has been in long enough for the bone to heal solidly so it's usefulness is done. I'd be surprised if the NWB period is so long - unless the doc is being extremely cautious. And square one for hubby is miles ahead of many others who took weeks to walk unassisted and months to get back into regular shoes.

Keeping the foot elevated will go a long way to promote healing. Also, next time you get a chance - when the stitches come out? - if he still isn't permitted to walk, make sure to ask what exercises are allowed to help with circulation and maintaining muscle tone.

Too bad about the cruise. Maybe you could paint some port holes on the walls at home, rock the bed around, splash water on him and otherwise simulate the experience.

TC