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  • Purpose of a walking boot if you're NWB?

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    Old 08-26-2018, 10:24 AM   #1
    RustyDodge
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    Purpose of a walking boot if you're NWB?

    Since having a non-displaced, intra-articular calcaneus fracture 9 weeks ago I spent two weeks in a splint, five weeks in a cast, and for the past two weeks I've had a walking boot which I am allowed to remove for bathing and sleeping. I was also told to do range of motion exercises, which are progressing very well. I still have a lot of swelling and discoloration although I really feel like I could walk on it (but I'm not). So, far I've worn the boot only once when I ventured out for dinner one evening. My question is: what does that boot do for me now and why should I wear it when all I do is watch TV or read from a horizontal position, no different than sleeping? I return to the doctor in two weeks and I probably will begin PWB depending on the X-Rays and I understand that the boot might have a purpose then when I'm actually walking. But why wear it now?

    Thanks for any insight anyone can provide.

     
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    Old 08-26-2018, 10:39 AM   #2
    yayagirl
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    Re: Purpose of a walking boot if you're NWB?

    Dear RustyDodge,

    The whole purpose of the boot is to keep the fractured bone from moving so that the healing process is not interrupted until it is completely healed. All it takes is tripping or turning your foot the wrong way one time to take you back to square one, sometimes with a worse problem.

    The doctor will tell you when the boot is no longer necessary.

    Hon, take it from one with 40 years experience with broken bone issues, do as the doctor says. It's fine to ask, but really we don't need to know every reason why.
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    RustyDodge (08-27-2018)
    Old 08-26-2018, 02:06 PM   #3
    Titchou
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    Re: Purpose of a walking boot if you're NWB?

    It's far more comfortable than a cast. You can remove it to bathe the leg. You can sleep better-which you probably need by now. You can do more exervises than with a cast.

    Seems all like good reasons to me!

     
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    RustyDodge (08-27-2018)
    Old 09-04-2018, 07:41 PM   #4
    TheJumper
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    Re: Purpose of a walking boot if you're NWB?

    I had two of them together for fractured heels and felt the same way. Mostly, I wore them for protection. They also help prevent drop foot which is when your foot heals at an angle greater than 90, shortening your achilles. I hear it's pretty painful to correct. If you've been stretching, you're probably ok.

    If you can, try lowering your foot throughout the day. The blood rush might be painful at first so it helps to deal with this now rather than when you start weight-bearing. In this case, the boot will help act as compression. Your skin basically adjusts to not having pressure against it so at first your foot will swell a lot and this takes about a year to return to normal for many.

     
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    RustyDodge (09-06-2018)
    Old 09-06-2018, 06:38 AM   #5
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    Re: Purpose of a walking boot if you're NWB?

    Thanks Jumper for sharing your experience. I agree totally with your observations about swelling and turning blue after dangling my foot. I found that taking Zerk's often prescribed advice about wearing merino wool socks, which I happen to have for hiking, serves as a compression stocking but with less compression. When I remove the sock there is far less swelling and discoloration than if I just go barefoot.

    I return to my orthopedic doctor on Monday, 9/10, and I intend to bring the walking boot with me but not wearing it. I wear 6 inch work boots for protection when I go out. I have real good flexibility, even side to side. I just hope he's not going to scold me for not wearing the boot. I'm hoping he's going to tell me to start putting weight on my injured foot because I really feel like I can walk with full weight no problem. And even then I don't think I will need the boot.

    Thank you again for your post which shows you have a real good understanding of the healing process.

     
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    Old 09-11-2018, 07:00 AM   #6
    RustyDodge
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    Re: Purpose of a walking boot if you're NWB?

    I saw my ortho doc yesterday - more X-rays - and he gave me the green light for 50% weight bearing while wearing the boot and using crutches. After one week at 50% he said to try full weight bearing in the boot and work up to not using crutches at all. After week three he said I could go into a regular shoe. I think he is being very cautious about returning to FWB. I asked him if the "slow" progress was because of my age (70) and he said "no, it's just the nature of this injury." He said the earliest anyone should begin introducing weight onto a fractured calcaneous is 10-12 weeks.

    The only weird feeling I've had so far is sometimes when I put weight on the injured foot I get a shot straight up the leg from the heel. I guess that's the nerves waking up. I don't know how to accurately gauge 50% weight either. The only other thing is I did have peripheral neuropathy in my feet prior to my accident and I don't know how that will come into play.

    He wants me to begin physical therapy at week three also. Apparently PT is delayed longer if you don't have Open Reduction Internal Fixation because there are no mechanical fasteners to prevent any movement in the bone fragments, which are still fusing at this point (12 weeks).

    I asked him what purpose the boot serves and he said that the rigid sole keeps the heel-toe flexing to a minimum while walking, whereas a regular shoe will bend in the middle of the sole. I've had an idea to address the even-up problem for week two when I will be attempting to walk without crutches. I have a second walking boot from a previous injury about 10 years ago. I decided I will try to wear both boots even though I only really need the one. That should keep me at an even height to avoid the biomechanical problems of one foot being higher.

    I have a return visit in six weeks for an X-ray in the standing (weight bearing) position. Also physical therapy in three weeks, I guess to rehabilitate all the atrophied stuff from the knee down.

    I'm only posting this information as it relates to my case hoping it helps someone else on the forum. I know I learned a lot from reading everybody's experiences and for that I thank you all.

    Bruce

     
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    Old 09-14-2018, 12:49 AM   #7
    TheJumper
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    Re: Purpose of a walking boot if you're NWB?

    Good to hear he's got you up and moving. I definitely learned a lot and had plenty of time to read about it while I was laid up.

    I didn't know about the ORIF impacting the length of time before PT. That's interesting and I had ORIF on both. I'm not sure if you read about the heel at all but basically because of its shape, makeup, and the weight it bears, its a difficult bone to heel. People cringe when I repeat this but I once heard the analogy that the heel is like a hard-boiled egg. When it is fractured, it is very fragile because it's "shell" is cracked and if weight is placed on it too early the heel can be fully crushed and basically destroyed. This may be a little exaggerated but it was enough for me to strictly follow doctor's orders. I assume they usually wait the full time because of the difficulty in telling what % you are really putting on it. Once I was 12 weeks out of surgery, he said I could go full weight with pain being my only limitation, and it was a great limitation at that, ha ha. At this point, I was off it for 14 weeks so the atrophy was pretty bad.

    The rigid sole is still really helpful for me, even two years out. It's weird to think so many muscles and tendons can be in such a small part like your feet. Sounds like you are good to go. Good luck with the rest of your journey!

     
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