How to Return to Walking After Being in a Cast Boot

You have endured the weeks of immobilization following a fracture, or a bad sprain, or a  surgical procedure.  You have returned to your doctor or surgeon, and have been cleared to start walking again.  This is an exciting moment for all patients. 

The question becomes “how”? 

How do you restore the ability to walk normally, after weeks of having pain and restricted movement?

It isn’t as easy as just taking the boot / post op shoe off and walking. When the surgeon or doctor says that the Xray shows that everything has healed well, what they mean is that there has been enough healing, which would allow the patient to return to walking without suffering a setback. What it does not mean is that you will have the strength, the flexibility, or the balance to be able to walk smoothly without a limp.

Being able to walk without a limp is very important because limping involves movement  compensations, usually to the hip, SI joint, or low back, and it is never a good idea to trade one painful body part for two of them.  Limping also means that the way a person walks is not very efficient, and will result in being very tired quickly. 

Simple Instructions

A good rule of thumb is that when one body part does not work the way it should, it takes 3X the amount of energy to do the same activity

So, here are a few simple instructions that I give all of my patients to make their return to normal walking happen as quickly and as smoothly as possible.

• Balance, Balance, Balance!  Balance is reaction time, and it is often the overlooked component when people start to restore their walking mechanics. 
  • Start in a tandem (heel to toe) stance with the recovering foot in front (the front foot only carries 20% of your body weight). 
  • I prefer to do this exercise in the corner of a room.  If you lose your balance, you have a wall on either side of you.
  • While holding that heel to toe stance, increase the challenge by looking up towards the ceiling, then look down towards the floor, then to the left, and finally to the right.
  • Hold each 2-5 sec
  • When it gets easy, increase challenge by doing it on a couch cushion or by switching the recovering foot to be the back foot in your heel to toe stance.

• Use a Treadmill to restore both weight bearing and walking mechanics
  • Start with only your recovering foot on the tread
  • Put all your weight on your non recovering leg and arms
  • Start the treadmill at a 1 mph speed
  • Let the treadmill do all the work.  It will pull your foot backwards giving you a much needed hip flexor stretch
  • When the treadmill causes your heel to lift off the treadmill then actively reach out in front and put your heel down on the tread in front of you allowing the treadmill to take your leg through another cycle
  • As this becomes easy, and natural, or as you start to feel confident, increase the challenge by adding 10% of your bodyweight. 
  • If you are able to maintain good heel to toe walking mechanics at 10% body weight without limping, then progressively at 10% until you are able to walk with full weight on the recovering foot without limping.
  • At this point you can walk with both feet on the treadmill and your journey to walking normally out of the Boot / post op shoe is complete.

• One important rule to follow.  Your pain should never increase while on the treadmill, nor 2-4 hours after the treadmill (or any exercise performed for that matter).  An increase in pain means you have created an irritation and the swelling that may result can limit your mobility at the foot or ankle and slow down your progress

I hope this is helpful to you, and that it will make the return to walking following an injury, an easier and more straight forward process!