Equally I wrote in a previous post with much more than item (see here), I barbarous off a mount and broke my ankle in three places, then managed to pause a os in my 5th toe on the other foot. This meant that my right ankle was in a hard cast for 6 weeks and I was 100% not-weight bearing…only this was challenging because the human foot meant to exist my stable base for crutching or knee joint scootering was oft pretty wobbly and in a lot of hurting.

This mail service is a follow upwards with more detailed tips and lessons learned of things that were helpful in living with a leg cast, too as what the return to weight begetting was really like. I couldn't notice a lot of good information nearly the transition to weight bearing was really like, and so this is my have on information I was looking for and would accept appreciated earlier and during the weight bearing progression process. (And if you're looking for diabetes-specific stuff, it'south in the last department!)
Tips_weight_bearing_DanaMLewis
Dealing with lack of energy and fatigue

First, it's worth noting something major about a fractured bone, and *especially* true if it'southward a big bone fracture similar some of mine were: it takes a lot of healing, which means a lot of energy going to the healing and not much energy left for every day living. I was constantly exhausted – and surprised by this fatigue – pretty much throughout this process. It made sense in the early days (say weeks ane-2 after fracture), but was frustrating to me how little I had free energy to do even in the four-6 weeks after my fracture.

Simply, then it got worse. Returning to weight bearing took *even more* energy. For case, on the get-go day of partial weight begetting, I was tasked with putting 25 lbs of weight on my foot in the walking kicking. Start by placing my foot on the scale and getting reliable with existence able to put the right amount of weight on the boot; and then by standing and repeating with the scale; then taking a few steps (with the crutches taking the rest of my weight) and re-calibrating with the scale until I was confident in that weight. With weight bearing progression, you're supposed to spend up to an 60 minutes a 24-hour interval working on this.

I took to eye what my ortho said about not progressing fast if y'all only exercise 5-10 minute chunks, so after the first twenty-four hour period, I tried to ever do 10-15 minute chunks at a minimum, with a longer clamper wherever possible as permitted by hurting and my energy levels.

Merely the commencement few days were really, actually tough. It was hard to switch to a new weight every ii days – because this meant readjusting how I was stepping/walking, and how much weight and where I placed my crutches. I started with a blister on my right palm, which turned into a squished nervus that made my right paw become numb, and ultimately damaged some tendons in my right wrist, too. This made information technology painful to use the crutches or even bulldoze my knee scooter when I wasn't focusing on weight begetting. And so I had a lot of pain and suffering in the WB progression procedure that probably contributed to how fatigued I was overall.

So ane of my biggest pieces of advice for anyone with broken bones is to look your free energy to take a(nother) dip for the first few weeks after y'all offset returning to weight-bearing (or return to normal activity outside your cast). It'south a *lot* of work to regain force in atrophied muscles while still too doing the internal healing on the broken bones!

Tips to deal with so much fatigue as you lot return to weight bearing:

Some of the tips and things I figured out for being non-weight bearing and sitting around with a difficult cast came in handy for the weight-bearing progression fatigue, besides.

  • I got a shower demote (this is the one I got) so that it was easy to sit down on and swing my legs over into the shower/bathtub. One time I was out of my hard cast, I yet can't weight carry without the boot, then I nevertheless need a sitting shower/bath solution while I return to weight bearing. I too removed the back later a while, so it was easier to sit in either direction depending on preference (washing hair/non) without having to ask Scott to remove the back and re-attach it on the other side.
  • Speaking of showers, I put a toothbrush and toothpaste in the shower so I can also brush my teeth there while seated.
  • I still keep most of my toiletries in the bedside table (or you lot could take a caddy past the bedside) so I can brush my hair, take my contacts out or put them in, wipe my confront (facewipes instead of having to stand at the sink to launder my face), etc. from the bed.
  • I am taking ibuprofen 4x a day, and I go tired of opening the bottle. And so I dumped a pile of ibuprofen on my bedside tabular array to get in easy to reach and remember to have first thing in the morning or at night. (There are no kids or pets in my household; keep safety in listen if you have kids etc in your household – this solution may not piece of work for you).
  • The one fourth dimension I tended to forget to proactively take my medication was mid-day, so I added a recurring calendar event to my agenda saying "accept ibuprofen if you haven't 2x a 24-hour interval" effectually 2pm, which would be the latest I would take my second circular, even if I woke up subsequently in the solar day and my first dose was afterwards in the morning. This has helped me remember multiple times, peculiarly on weekends or times when I'm away from my desk-bound or bed where I would accept the meds visible equally a reminder.
  • Pre-mix protein powder (this is what I chose) into the potable of choice in advance, and go on it in individual containers and then it's like shooting fish in a barrel to get and accept (and if I'm actually tired, round tupperware containers that accept measurement lines make it easy to measure liquid into, put the lid on to shake it up, and drink out of without having to find some other cup). I had Scott do this several days in advance when he went on a trip, and we kept doing it in advance fifty-fifty afterwards he got domicile.
  • I kept using my portable desk for working, taking video calls propped up in the bed with pillows behind me, and also laying the surface flat to swallow meals from when I was too tired to become out of the bed.

Other advice for the return to weight-bearing:

If yous're like me, you'll switch back to weight-bearing accompanied by getting out of your difficult bandage and getting a walking kick of some sort. If yous can, ask your ortho/dr. in advance what kind of boot they'll put you in. It'south oft cheaper to get the kick yourself. Perfect example: my ortho didn't tell me what kind of boot I would need, and I looked at various boots online and saw they ranged $50-100 on Amazon. At my appointment he asked if I brought a kick and since I didn't, they'd provide one..and the paperwork I signed stated the price would exist $427 (::choking::) if the insurance didn't cover it. Insurance negotiated downwards to $152 for me to pay out of pocket for since I haven't hit my deductible…which is still ii-3x more retail price. UGH. And then, if you tin, buy your walking kick via retail. (Aforementioned goes for purchasing a human knee scooter (here's the one I got) – information technology may exist cheaper to purchase it new through Amazon/elsewhere than getting a medical buy that goes through insurance and/or trying to exercise a rental.)

  • You'll also probably end up with a kick with lots of velcro straps. When yous undo your boot, fold back the strap on itself so it doesn't stick to the kicking, another strap, your clothes, etc.

Other equipment that has come in handy:

  • Become multiple talocrural joint braces. I had a slightly structured talocrural joint caryatid with difficult sides that fabricated me experience safer the first few nights sleeping out of the cast, and it was ofttimes easier to go from the bed to the bathroom on my knee scooter or crutches with the talocrural joint brace(s) instead of re-putting on my walking boot and taking information technology off again for a shower. (I transitioned to sleeping in a lighter talocrural joint brace later a week or so, but all the same used the structured caryatid inside the waterproof cast handbag for swimming laps to help protect my talocrural joint.)
  • An ice pack with a strap to put effectually your ankle/broken joint. I had gotten this ice pack for my knee last fall, and strap it and another ice pack to my talocrural joint to get total joint coverage.
  • Wide leg athletic pants…ideally ones that you can put on/off without having to accept your boot off. (Women should notation I found ameliorate able-bodied pants for this purpose in the men'due south athletic section at Target..but be aware a lot of the mod men'due south mode have tapered legs and so make sure to watch out for those and take enough width to get over your boot). Taking off the boot is exhausting with and then many velcro straps, so whatever time I can get dressed or undressed without having to remove the boot if I am not otherwise removing the boot is a win.
  • Look online for your country's rules for a temporary handicap parking pass, and take the paperwork to your first ortho appointment to get filled out. Also, brand sure to annotation where the places are that you lot can drop off the paperwork in person (in Seattle it was not the same equally the DMV offices!), or otherwise exist enlightened of the time frame for mailing those in and receiving the pass. The handicap parking placard has been helpful for encouraging me to get out of the house more than to go to the store or go to a restaurant when otherwise I'm besides wearied to practice anything.
  • A new shiny notebook for writing down your daily activities and what you did. If you're not a notebook blazon person, apply an app or note on your telephone. Only despite being more often than not digital, I liked having a small notebook by the bed to list my daily activities and check the box on them to emphasize the activities I was doing and the progress I was making. At the commencement, it was helpful for keeping track of all the new things I needed to practise; in the middle, information technology was useful for emphasizing the progress I was making; and at the cease information technology felt really expert to come across the light of the terminate of the tunnel of a few pages/days left toward being fully weight bearing.

Weightbearing_notebook_DanaMLewis

Other tips for getting used to a walking kick and transitioning to weight begetting:

  • Don't be surprised if y'all accept pain in new areas when you motility from a difficult cast to a walking kick. (Remember yous'll exist moving your leg or limbs in different means than they've been accustomed to).
  • My ortho told me the goal of weight bearing progression is to understand the departure betwixt discomfort (lasts a few minutes) and pain (lasts a few hours). You're probable going to be in discomfort when doing weight begetting progression – that'south normal. Pain (i.e. precipitous pain) is not normal, and you should have a suspension or back down to a previous weight (follow your protocol) if you have it. I was lucky – the only few times I had hurting was from trying to printing downwards forcefully on the scale when seated, rather than standing on the calibration and naturally letting my weight on my leg. I didn't end upwards plateauing at any weight, and was able to follow my protocol of 25lb weight bearing added every 2 days and get to full weight bearing with no delays.
  • If you take a spotter with a stopwatch feature, employ it. Information technology'south hard to keep track of actual time spent walking (especially at first when xc seconds feels like 6 minutes) with just a normal lookout man/clock. You could besides use your smartphone's timer characteristic. But tracking the time and pausing when yous pause or take a break helps make sure you're accurately tracking toward your hr of walking.
  • The process wasn't without discomfort – concrete and emotional. Putting weight on my leg was scary, and every new weight mean solar day was hard equally I dealt with the fearfulness and processing of the discomfort, as well as learning how to step and walk and practice my crutches in a new mode still again.
  • Merely what I learned is that the first v minutes of every new weight day E'er sucked. Once I recognized this, I set the goal to e'er tough out a 15 minute session after I calibrated on the scale by walking slowly effectually my apartment. (I put my headphones in to listen to music while I did information technology). As long as there was only discomfort and not hurting, I didn't stop until afterward 15 minutes of ho-hum walking with that weight and also re-calibrated on the calibration during and afterwards to make sure I was in the right ballpark.
  • I had to spend the first half hour or and so working on my weight begetting by myself. I couldn't talk on the phone or talk with Scott while I did it; it required a lot of concentration. (The only thing I could do is listen to music, considering I'm used to running with music). And then distractions did non help when I got started, but toward the end of the hour I could handle and appreciate distractions. Same for day 2 of a weight – having distractions or a task to practice (e.g. walk from A to B, or walking while my nephew was on his scooter) helped pass the time and go me to consummate my hour or more of weight-bearing work.
  • Be careful with your hands and wrists. Blisters are common, and I managed to both squish a nerve (which caused me to have a numb side of my manus and be unable to type for several days) and also pull or harm tendons on both sides of my wrists. I was torn between choosing to delay my weight bearing progression work, only also recognizing that the sooner I got to full weight bearing the sooner I could completely ditch my crutches and be done hurting my hands. So I chose to go along, but in some cases shortened my chunks of WB walking down to fifteen minutes wherever possible to reduce the pain and force per unit area on my hands.

Yous'll probable too be doing range of motion exercises. At get-go, it'southward scary how jerky your motions may be and how niggling your muscles and tendons respond to your brain'south commands. I affair I did was take a video on solar day 1 showing me pointing and stretching my ankle, and doing my ABC'south with my foot. Then every week or so when I was feeling downwardly and frustrated almost how my talocrural joint wasn't fully mobile yet, I'd take some other video and watch the old i to compare. I was able to see progress every few days in terms of existence able to bespeak my pes more than, and wider motions for doing the ABC'south with my foot.

Too recall, in one case yous're weight bearing and working toward getting rid of your crutches, you can use things like strollers or grocery carts to assist you balance (and also kill some of your weight bearing time!) without crutches. The practice will brand it easier for re-learning your posture and gaining conviction in walking without crutches.

Don't you usually talk about diabetes stuff on this blog? 😉

(If anyone finds this postal service in the future mainly for talocrural joint fracture and weight begetting transition/progression tips, yous tin ignore this part!)

Diabetes-wise, I've had a pretty consistent feel as to what I articulated in the last post about really breaking bones.

  • It was common for my first few days of progressive weight bearing to have a small pain/stress rising in my BGs. Information technology wasn't much, only 20-30 points was an obvious stress response as I did the first few 15 minutes of weight begetting practice. The following days didn't see this, and so my body was obviously getting used to the stress of weight bearing again.
  • However, on the flip side, the first week of weight begetting progression also caused several lows. The hour of walking was the equivalent of any new activity where I ordinarily have several hours later delayed sensitivity to insulin out of nowhere, and my blood sugars "go whoosh" – dropping far more than they normally would. I had ii nights in a row in the commencement calendar week where I woke up two-3 hours later on I went to sleep and needed to eat some carbs. This commonly happens maybe once every few months (if that) now every bit an OpenAPS user, so it was obviously associated with this new surge of physical activeness and hard work that I was doing for the weight bearing.
  • Overall, while I was 100% non-weight begetting, I was eating slightly (just not much) lower carb and slightly less processed food than I usually practise. Only not e'er. One twenty-four hours I ended upwardly having 205+ grams of carbs for me (quite a bit more than my boilerplate). However, cheers to #OpenAPS, I nonetheless managed to have a 100% in range 24-hour interval (fourscore-150 mg/dL). Similarly on a travel day soon after, I ate a lot less (<50g carb) and also had a peachy twenty-four hour period where OpenAPS took care of any surges and dips automatically – and more importantly, without any extra work and free energy on my part. Having OpenAPS during the broken os recovery has been a HUGE do good, non only for keeping my BGs in range and then much of the fourth dimension for optimal healing, just besides for significantly reducing the amount of work and cerebral burden it takes to stay alive with blazon 1 diabetes in full general. I barely had energy to eat and exercise my hour of weight bearing each day, allow alone anything else. Thankfully good BGs didn't fall by the wayside, but without this tech it certainly would have.

And finally the pep talk I gave myself every day during weight bearing progression work:

This is short-term and necessary discomfort and suffering on the way to weight bearing. It sucks, but you tin can and will do information technology. You have to do it. If you demand to take a interruption, take a break. If you need to do something else to get yourself pumped upwards and motivated to do your weight bearing, it's ok to do that. But you'll get there. Slowly, but surely. You've got this!

Proof that I did get in that location:

—

All-time of luck and lots of support and encouragement to anyone who'due south working their manner to weight bearing subsequently an injury, and many cheers to anybody who's supported me and cheered me on virtually forth the mode!

2021 update – meet this post almost (finally) running the marathon that I had signed up for before I broke my ankle!