Learning to walk trimalleolar fracture

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I am 12 weeks post op after having ORIF surgery to fix a trimalleolar fracture of my right ankle.

2 days ago I was cleared to weight bear as tolerated. Pretty lenient instructions other than start with the boot in the House then no boot in the House then sneakers and come back to my OS in 6 weeks unassisted and in sneakers.

I have been going to PT every week since week 4, and have gained much of my ROM back though I am still struggling with dorisflexion. I will go back this week and start a new routine to help me learn to walk.

My question is- is intense pain normal when I try to walk unassisted? Or is it a sign of something being wrong? I think I am partially weight bearing in the boot and with my walker as I can go back and forth across the living room relatively easily. I can also stand unassisted. It is taking steps without my walker that hurt the most.

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4 Replies

  • Posted

    I remember it was pretty normal. You want to push every day, but not to the point where it’s too hard to push the next day. 
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  • Posted

    The pain is probably normal if you jump right into the unaided like a lot of people do. I'm in no hurry and see no reason to be in tons of pain, so I've taken it slow. I'm also a trimalleolar fracture plus dislocation. When cleared to weight bear I started with just standing and shifting weight on to my foot (while wearing the boot), increasing the amount of weight over time. When I felt ready, I started walking with 2 crutches, then down to one, etc. I spent about a week at each stage. I practiced walking correctly, rather than just walking, so I don't develop bad habits that will need to be fixed later. So far that's working for me and I'm happy with my progress. Good luck!

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  • Posted

    Hi coll45445!

    I'm am learning to walk again too. I like you, have no pain standing, but walking is very painful. My ankle is very tight as well as my toes. I am assuming that when the tightness lessens, it will get much easier and less painful to walk. 

    Good luck and kudos to us for going through all this pain. 

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  • Posted

    Hi Coll,

    Is intense pain normal when walking unassisted? It depends.

    If your practitioner has suggested you go immediately to full weight bearing (in boot) after 12 weeks of immobilization-- that might be too much too soon. Typically, weight bearing and walking are advised in stages-- partial weight bearing (assisted by crutches or walker), then full weight bearing in boot, and finally full weight without the boot.

    This gradual process allows an injured ankle (after bone is healed enough for weight bearing) to adjust to stress of activity-- patients still have to deal with soft tissue damage (muscles, nerves, ligaments, tendons, joint capsules, etc.) that they may have sustained in original injury, and possibly even during the surgical procedure.

    Some pain at first is inevitable for most of us-- however, the pain should not be excruciating or completely demoralizing (that's what 'as tolerated' means). If you hurt too much back off on walking a bit, or rely on crutches or walker. The important thing is not how much you force yourself to walk at first, but how you can gradually increase your activity with minimal pain.

    One of best ways to accelerate your healing is proper ankle rehab exercises. You should be intensely doing them now. Many of these exercises do not require weight bearing. They will help tone, stretch, and strengthen all those soft tissues.

    Once you are walking without boot you can up your game with more challenging rehab.

    Don't neglect proprioception exercises-- these are very important to regaining control of ankle and attaining a normal walking gait again. After weeks of immobilization (and likely nerve irritation or damage) the nerves in ankle need to relearn how to support and balance you while standing or walking.

    If you want to hurry recovery along please adhere to a strict, nutrient-dense diet (no junk).

    Good luck.

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