Broken Ankle Articles
Weight-Bearing After Ankle Surgery: Answers To Your Top 10 Questions
Now that we’ve established my thoughts on returning to “normal” after ankle surgery, I want to talk about a huge, critical, weighty milestone along that journey: weight-bearing.
As you likely know if you’re reading this, ankle surgery often comes with a non-weight-bearing diagnosis: 2 weeks non-weight bearing, 4 weeks, 6 weeks. For me, it was 7.5 weeks. Regardless of how long this seemingly endless saga on your back is, the news is overwhelming and inconvenient and sad.
Eventually we get home, settle in, and move through our stages of grief, ultimately accepting that the only way out is through. Whatever it takes — crutches, scooters, wheelchairs — Hulu, takeout, sobbing—is what we’ll do. All in the name of bearing weight on our pathetic little ankles once again (jk we love our ankles!!).
Before I get too far into my weight-bearing guidance, I want to show you a visual of my journey — getting from my first weight-bearing steps to walking unassisted.
Since I started creating content about broken ankles 8 years ago, I’ve gotten a lot of weight-bearing questions. Below I’ve answered the top 10. Like always, please know that every injury, body, and journey will of course have differences.
Ok let’s do this!
When did you start weight-bearing?
7.5 weeks after surgery. According to my doc, a typical range is 2–8 weeks, depending on the type of fracture and healing process.
Did it hurt when you started weight-bearing?
I wouldn’t say I had pain pain — more like sore muscles, weird tingling, pressure, and unfamiliar sensations. As well as some swelling, so icing/elevating was key! But any pain or weirdness was definitely overshadowed by the joys of being able to practice and make progress!
Was weight-bearing a progression or did you just start?
It was completely a progression for me, as instructed by my PT. My phases were:
The boot + 2 crutches
The boot + 1 crutch
The boot and no crutches
Then it was time to take the boot off and I brought the crutches back for 2 sneakers + 2 crutches
2 sneakers + 1 crutch
And then I was fully weaned off the boot and the crutches and just had two sneakers
I spent about 3–5 days in each phase.
How do I get past my phobia/anxiety of starting to walk again?
Of course there’s not just one answer for that. In my experience, once the doctor/PT has says it’s ok, you just have to start. It’s hard and scary, and you might doubt yourself or find it hard to trust your instincts, but go slowly and have patience with yourself. You’ll get there.
Did you have a limp?
I didn’t limp, but that’s not because I couldn’t have. My PT told me early on that if I felt the need to limp, then I was doing too much too soon— meaning, that I should go back to the previous stage in my progression. My PT said that limps can become habitual, so just don’t ever start. You can find a great conversation on limping with physical therapist Ellen Grover when you join WeBroken.
Did your ankle start swelling again when you started walking?
It sure did, nothing a little ice and a compression sock couldn’t control though. But it’s a good thing! It means new muscles and parts of your ankle are working and blood is flowing. If you’re concerned though, call your doc/PT.
When you were learning how to walk again, how long did you practice each day? How often?
I didn’t have a set amount of time or cadence. I walked as much as I could indoors — around my apartment and around the carpeted hallways of my building. I went for as long as I could until I felt like I’d challenged myself enough, then I’d stop and ice/elevate. Maybe one session was it for the day, or maybe I rested and then went a few more times. It also totally depended on which stage I was at in the progression — those early days of bearing weight had me breaking a sweat in like 5 minutes. In my experience, the most active I could be without over-doing it, the better. And there might be some days when maybe you push too much, that’s ok, just rest and ice even more. It’s good to play with your limits within reason.
I’m not weight bearing yet, and my foot turns blue/purple when it’s not elevated, then goes back to normal when I elevate again. Is this normal?
Ha! It is normal! Gross and painful, but normal. When you’re not walking or putting pressure on the muscles down there, the blood just sort of pools and stagnates. I asked Dr. Richard Gellman about this in our interview and he shared tons of detail and the science behind it. Don’t worry, it fixes itself when you start weight-bearing. But if you’re concerned definitely call your doc.
How long did it take you to walk up and down stairs?
Because of the building I lived in, I was going up and down stairs from the beginning while I was freshly on crutches (carefully, because it definitely takes coordination!). Once I got rid of the crutches, stairs were definitely hardest to tackle but I used them as part of my walking practice. Going up stairs was relatively easy to cheat because I could avoid putting all the pressure on the healing foot by leading with the other one. But to cheat going down wasn’t possible — it either required leading with the injured foot, or leading with the normal foot and having good range of motion in the achilles/calf of the injured foot. So getting comfortable going downstairs definitely took more time. Stairs were sort of the last frontier to tackle, even after I was in two sneakers.
How long did it take you to be able to walk down stairs with your bad leg taking the first step? My dorsiflexion feels like it will never come back.
First of all, don’t call it a bad leg! It’s healing for you and that’s so, so good of it. That said, it definitely takes time to be comfortable with regular walking/pressure on that foot before leading with it on stairs — I was definitely in 2 sneakers by that point. It takes practice, trust, and mobility. For the dorsiflexion issue, take a few mins each day to walk up and down stairs slowly. I also highly recommend massage to work on that achilles and calf.
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Hope you find this helpful! If you want tons more free broken ankle stuff, you can head to WeBroken, and you’ll also find some amazing exclusive content. And hey, if you just need to feel part of a community of other broken ankle peeps, you can join us on IG or on Reddit.
Happy healing to you!
When Will I Feel Normal After Breaking My Ankle?
I broke my ankle in April of 2013. It sucked. It sucked so completely, and for so long. Back then we didn’t have global pandemics or orange presidents or TikTok (hell, not even IG stories!) — so it was easy for this injury to feel like the actual worst thing in the world. I was in bed with my leg up for nearly 8 weeks, with all my pain, paranoia, and self-pity.
I know it seems ridiculous to say, given all the real, big problems that exist in the world. But the truth is, when you do it badly enough, breaking your ankle forces so many tiny inconvenient things into your life, so unexpectedly and urgently. And it’s all those tiny things, along with all the big things, that create palpable, overwhelming despair.
Surgery is scary — it’s drugs and IVs, it’s metal screwed to the inside of your body. Then it’s needing help to pee, needing every single thing brought to you, learning how to balance on one leg, ice on constant rotation, elevating nonstop even when you sleep. It’s bathing with your leg up and out, nausea, constipation, narcotics, full-body discomfort. Sharp pains, dull pains, numb pains, tingling pains. Day after day after day after day. Oh, and you’re not allowed to walk for weeks or months.
To all my broken ankle people reading this — I see y’all. And to the rest of you, watch where and how you step! Nobody is safe.
In my first few weeks of being non-weight-bearing and bed-ridden, I was a googling monster. We all are. And when I couldn’t find helpful, thorough, empathetic, patient-centered information, I decided to create my own. Over time, this blog + these YouTube videos led to me creating the ultimate broken ankle resource, WeBroken. But this isn’t an ad for the best broken ankle destination in the world! Nay, this is an answer to the most asked question in the world…from ankle breakers:
“When will I feel normal again?”
In the hundreds (thousands?) of emails, YouTube comments, blog comments, and DMs I’ve received over the years, this is by far the most common question. So I’m going to answer it here and now. It’s not a short read, because as you might imagine, “normal” means something different to everyone. And more importantly, normalcy is a journey, not a destination; you simply don’t go from being “not normal” to being “normal” from one day to the next.
So here we go, when you *might* start feeling normal, broken down by normalcy sub-topics — walking, emotions, and the ankle itself:
Walking: I can’t tell you when you’re going to walk again — that’s between you, your doc, and your PT. It has everything to do with your injury, your surgery, your fitness level, your ability to heal, your determination, your resources, your attitude, and so on. I broke the end of my tibia on the inside and the back, as well as my fibula, which is called a trimalleolar fracture. I got 2 plates and 9 screws with an ORIF surgery. I was non-weight-bearing for about 7.5 weeks, and was “walking” within about a month of taking my first steps. You can see that progression here.
As we all come to find out, though, just because you look good walking on the outside, it doesn’t necessarily mean you feel well walking on the inside. Those first few weeks of walking without crutches or the boot are unstable, tight, and achy. You still get swollen and have to ice and elevate, you may still have to hold railings on stairs, and you’ll likely still find times when you’re aware of every step.
But I’ll say this, at 16 weeks post-op, I basically did all the normal things I needed and wanted to, and felt relatively normal doing them. I drove to work, walked around all day, drove back, made a birthday dinner, went to a gathering with friends, visited a new baby at a hospital, I did pilates and yoga, and I took a trip to San Francisco.
Still though, my ankle was super tight, my range of motion felt frustratingly unsatisfying, and my hardware constantly bothered me. I was also still icing regularly, and started incorporating ankle ice baths.
So there you have it on the walking front — the normal and not-normal paradox.
Emotions: When it comes to your emotions and mental health, there’s a lot that doesn’t feel normal after an ankle trauma. The rollercoaster of emotions can continue to feel heavy and unpredictable for weeks and months. Even though I had a support system, I felt lonely, uncomfortable, pathetic, and bored. Every time I went from not being able to do something to suddenly being able to, I felt happy and unstoppable. But that happiness was fleeting and I inevitably felt defeated by something else. There were huge surges of hope, accompanied by sad plateaus and setbacks.
That said, I found my first emotional equilibrium about 6 months post-op, when nothing really rattled me too much. Then I had my hardware removal surgery at 9 months post-op, and went through the unpredictable emotions all over, but found my equilibrium once again about a month after.
How the ankle feels: Last but not least, the most basic way to answer this question is on a physical level — when will my ankle feel normal again? And even though this one has the most simple answer, I saved it for last because it’s likely not the news you want. From the experts I’ve spoken to (you can find those videos on WeBroken) and my own personal experience, a broken ankle that has undergone surgery will likely never feel the same — not the same as it once did, and not the same as the other ankle. Because while your bone can heal perfectly, even stronger than it once was, bone heals differently than muscle.
Bone heals to bone with bone, while muscle heals to muscle with “foreign” substances. In basic terms, the muscle heals with scar tissue, which is tight, weak, and less stretchy than muscle. And when the muscle experiences trauma and then gets immobilized, it gets super stubborn and cranky — your body has created these patches of scar tissue all around your foot/ankle/calf, and it won’t just go away on its own.
You have work to do in the short-term, and you’ll likely have to continue that work in an ongoing way. How? Well, lots of different ways: massage, acupuncture, cupping, gua sha, graston…there’s also a million ways to regain strength. There are too many healing approaches to name and all are valid to try. I feel like I’ve tried basically all of them.
That said, it’s not a “one-and-done” — ankle maintenance is an ongoing practice. When I stop, everything gets tight. My other ankle doesn’t do that.
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So my answer to this one is: I believe my ankle will never be normal, which means there’s a chance yours won’t be either. But as a wise physical therapist once told me, you brush your teeth every day and don’t question regular dental hygiene. It’s the same with your ankle — you now must consider your ankle as regular physical maintenance and hygiene, along with the rest of your glorious body.
We all want to live long and well, and your ankle will likely need a little bit of extra love forever. So give your ankle some love today, and send it my love too.
Mihal, out.