Non-Weight Bearing Injuries

Lower leg injuries are common and unfortunately many of them need a period of non-weight bearing to give your body a chance to recover and heal.

If you’re facing weeks of being off your feet it’s natural to be feeling apprehensive about how you’ll cope. Fortunately there are things you can do to make this period more bearable. From tips on using traditional crutches to alternative mobility devices, we’ve got you covered.

In this guide, you’ll learn about the different levels of non-weight bearing and how to keep your mobility – and sanity – until your affected leg, ankle, or foot can withstand weight once again. We will also cover the various mobility devices available to you and how to choose / optimize for your particular circumstances.

What Does Non-Weight Bearing Mean?

The Definition of Non-weight bearing simply means that you can’t put any weight on your injured lower limb for a period of time, which can be anything from weeks to months (1). This is usually the result of a leg, ankle, or foot illness or injury, such as a fracture, ruptured tendon or damaged ligament. The amount of time that you will be non-weight bearing is variable depending on the type and severity of the injury.

In many cases this means you can’t bear any weight at all – not even for a few seconds. Doing this could cause further injury and prolong your recovery time. While being non-weight bearing will feel restrictive, it’s vital that you follow your doctor’s advice on how long to be on non-weight bearing crutches.

There are five different weight-bearing grades (2):  

• • Non-weight bearing: the affected leg, ankle, or foot cannot withstand any weight whatsoever and attempting to do so would cause further harm or prolong your recovery.

• • Partial weight-bearing: the injury can tolerate a small amount of weight. This can be a transitional period from non-weight-bearing to full weight-bearing. Partial weight-bearing can mean that you can bear 100% of your weight for a limited amount of timer per day, or it can mean that you can apply a certain percentage of your weight to the injury, but not all of it.

• • Touch-down (or toe-touch) weight-bearing: you can touch your foot or toes to the floor to maintain balance, but your leg, ankle, or foot cannot withstand any actual weight.

• • Weight-bearing, as tolerated: recommended for mild injuries that can tolerate anywhere between 50% to 100% of your weight, or at the end of your recovery period.
  • Full weight-bearing: the injury has healed and can now withstand the normal weight that occurs from standing, walking, etc.

What Does Partial Weight-Bearing Mean?

With a partial weight-bearing injury, you are allowed to place some of your weight on the injury. It is still important to only place as much weight on the injured leg as your doctor has determined is safe. Your doctor will tell you whether you can place 25%, 50% or 75% of your weight on your leg. He may also require that you can bear this weight for a specified amount of time per day. As you recover, that percentage will change over time until you are finally able to place your full weight on your injury. 

How Long Does A Non-Weight Bearing Period Last?

According to a survey of the members of the American Orthopedic Foot and Ankle Surgeons, the average time period for non-weight bearing is five to eight weeks depending on the patient and the injury.

If you’ve had surgery – to repair a complex ankle break or torn Achilles tendon for example – you should expect at least six weeks of non-weight bearing. For other injuries you may only need a couple of weeks before you can slowly transition to partial weight bearing and then to full, slowly being able to resume your normal activities again. Injuries such as a Lisfranc fracture can require 10 weeks or more of non-weight bearing.

As you progress in your recovery, you may feel like your foot or leg could tolerate a bit of weight. It is incredibly important that you adhere to your doctor’s advice concerning your transition from non-weight bearing to weight bearing.  and wait it out until the end of your non-weight bearing period to avoid further damage. Secondary images due to non-compliance are common, and only serve to prolong your time being non-weight bearing.

Your doctor will tell you how long you have to stay off your feet and when you can gradually start putting some weight down again. You may be advised to wear a boot or cast for a short time while your foot or leg gets used to taking some weight again after a long break.

Using Crutches While Non-Weight Bearing

While you recover, you’ll probably be issued with a pair of crutches, or advised to get some, to help you get around without putting any weight on your injured leg. These may be conventional crutches but an alternative hands-free crutch is becoming more widely recommended.

Learning how to use your crutches will have a big impact on how well you can endure the long recovery period. If you’ve never used them before, they can take some time to get used to and, if not used correctly, can cause further pain and discomfort.

Here are some tips on how to use your crutches correctly:

1/ Choose the Correct Size

Sizing is very important when it comes to crutches (3). If they’re too short, you’ll put an unnecessary amount of pressure on your hands, wrists, and your radial nerve, which runs from the back of your neck, under your armpits, all the way down to your fingertips.

A superficial radial nerve injury is uncomfortable, to say the least. You can avoid this by making sure your crutches are sized correctly. When you’re standing straight, the top crutch pads should be an inch or two below your armpits and the handlebars should be level with your hips.

2/ Check Your Padding

Crutches are padded in the areas where there is direct contact with your body, i.e. the hand grips and the under arm supports. If your crutches aren’t padded adequately, they can hurt the palms of your hands and your armpits. In extreme cases, improperly padded crutches can lead to axillary nerve damage. You’re putting all of your weight on your arms and underarms so these pressure points need to be comfortable and well supported.

If the padding is too thin, that repetitive pressure could cause your hands and underarms to ache and throb. Make sure you have plenty of cushion on the handgrips and the tops of the crutches. You may want to consider buying extra padding from a medical supply store.

More detailed information about crutch use can be found here.

3/ Plan Ahead

When you’re hobbling around on a pair of crutches, it’s important to plan ahead. If you have to be somewhere at a certain time, make sure you allow plenty of extra time to get there.

Think about whether you’ll have to navigate a flight of stairs and if you feel confident about doing this. Check the weather forecast and prepare for rain or snow. If it’s raining, it could get pretty slippery so make sure you dry your crutch tips regularly. If your recovery period is in fall or winter, you may want to buy a pair of non-slip crutch tips.

4/ Ask for Help

Traditional crutches are tricky to master, especially if you are trying to continue in your day to day life such as going to school or work. Even if you are fiercely independent, don’t be reluctant to ask for help.

If you’re a student, ask a friend to help you carry your books and schoolwork from one class to another. If you’re going to work, ask a coworker to help you carry your things to your desk, pull out your chair, make you a coffee – anything to keep you off of your injured foot. The more comliant you are to your doctor’s orders, the faster you will recover.

Using Crutches With A Partial Weight-Bearing Injury

Using crutches with a partial weight-bearing injury is similar to using crutches with a non-weight bearing injury. The key difference is that you are able to place some weight on your injured leg. To do this, you should place the crutches about twelve inches in front of your body, then move your injured leg forward so that it is in line with the tips of your crutches. Bear some of your weight on your crutches, placing only the allowed percentage of your weight on your injured leg. Step forward with your uninjured leg and repeat the process. 

Staying Active with A Non-Weight Bearing Injury

It’s common to feel restless and frustrated during your recovery period, especially if you’re used to being active. Not everyone has the luxury – or the desire – to sit around for six weeks watching daytime TV and being waited on hand and foot. 

Many people worry about how they’ll manage their responsibilities, like continuing with a job that requires you to stand or move around, looking after the kids or walking the dog. Activities of day to day living can be incredibly difficult or impossible when you are on crutches.

Fortunately there are some new devices on the market which can help you move about more freely than crutches, while still avoiding putting any weight on your injured leg. They include knee scooters and the iWALK2.0, an award winning hands-free crutch.

Knee Scooters

Knee scooters usually have four wheels, handlebars with handbrakes and a padded platform to rest your leg on. They allow you to scoot around easily and painlessly, while keeping your injured leg elevated. They can be very useful on level surfaces, but they can’t be used on stairs and can be heavy to load into a car. They also are difficult to navigate in tight spaces, and they require your hands to be occupied by holding onto the handlebar.

Hands Free Crutch

The iWALK2.0 is a new crutch that allows you to be hands-free while non-weight bearing. It functions like a hi-tech pirate leg and allows you to continue with your day to day life – going to work, training at the gym, taking the kids to school, doing the grocery shopping and walking the dog. It can be used safely on stairs and uneven surfaces.

Key benefits are that you walk using both legs, and, in so doing, both hands and arms are totally free to use as needed.

Exercising While Non-Weight Bearing

There are plenty of non-weight bearing exercises you can still doYou can still keep exercising when recovering from a lower leg injury. Focus on exercises that don’t involve putting any weight on the affected area. They include:

• Exercising with resistance bands while you’re sitting down
• Lifting weights (while seated or when using a hands-free crutch)
• Limited yoga or calisthenics
• Isometric exercises
• Swimming or water aerobics

Staying active can help to reduce muscle atrophy and keep you feeling happy and healthy while you recover. Make sure you consult with your doctor before doing any exercise.

Performing Daily Tasks

You may need to modify your daily routine to keep your weight off your injured lower leg.

For example, driving can become difficult or impossible, depending on which side the injury is on. Enlist the help of a friend or a driving service to help get you around town and don’t attempt to drive until you’ve checked with your doctor that this is okay.

Showering is another common problem for people in a cast or on crutches. If there’s space, place a small chair in your shower for you to sit on so you don’t risk slipping and falling. It’s also a good idea to place a non-slip mat on the floor (in and out of the shower) so you don’t slip. Some people prefer to stand in the shower wearing the iWALK2.0 hands-free crutch.

If you’re wearing a cast, you’ll need to get a shower guard, or secure a trash bag around your leg, above your cast, tight enough to keep the water out.

If you’re using traditional crutches it can be helpful to place chairs or stools around the house to kneel on – for example in the kitchen – so that you can rest your injured limb when you need to.

Relax

These days we very rarely get the chance to press pause on life and have some timeout, so use this time to relax and take care of yourself.

Take the time you need to ensure a healthy, risk-free recovery. If you use these tips and are patient with your body, you’ll make your recovery a lot more bearable. Sit back, relax, and keep your weight off your injury!

References

1. http://orthoanswer.org/foot-ankle/n-weight-b-full.html
2. https://www.physio-pedia.com/Weight_bearing
3. https://www.acfas.org/footankleinfo/crutches.htm