You’ve just been given the green light to gradually resume walking after 6 weeks without bearing weight?
I’m here with some tips to support you through this phase, in addition to the guidance from your physical therapist, doctor, or surgeon.
Based on my experience as a physical therapist!
Take-Home Message: Even though it may seem unusual, it’s common to experience pain or discomfort when resuming weight-bearing. This will gradually diminish over the weeks. Start slowly, increasing the duration and frequency of your walking sessions each day.
Happy reading 🙂!
Last update: October 2023
Disclaimer: Affiliate links. Complete disclosure in legal notices.
1. Clearance from Your Medical Team
Whether you are treated conservatively or surgically for your fracture, you will normally receive clear instructions on weight-bearing and walking allowances in your case.
One of these two types of walking and weight-bearing has normally been recommended for resuming walking after being non-weight-bearing for a few weeks:
1️⃣ Full weight-bearing: You have the right to put as much weight as you want on your fractured leg. You should adjust based on pain and discomfort and gradually return to normal walking and weight-bearing.
2️⃣ Partial weight-bearing: You have the right to put some weight while walking and standing, but not too much. In this case, you have been given a specific percentage of weight-bearing relative to your body weight.
For example, something like “partial weight-bearing at 40% of body weight.” In theory, you should follow this prescribed amount, regardless of how you feel, and therefore, you may need to use crutches while walking.
The type of weight-bearing allowed in your case should have been communicated to you:
🗣️ Verbally, by the doctor or surgeon overseeing your care.
📝 In writing, on your consultation, hospitalization, or operation reports, as well as in letters to your physical therapist or primary care physician.
How to survive 6 weeks non weight bearing?
In some cases, you may question whether you should really avoid weight-bearing for such a long time, or on the contrary, you might be afraid to put weight on your leg when you’ve been told it’s allowed.
In such situations, I recommend:
1️⃣ Discussing this with the healthcare professionals (physical therapists, physiotherapists, doctors) who are supervising your treatment and are familiar with your complete medical history.
2️⃣ Doing some research on your own and reflecting on how you assess the benefit-risk ratio in your specific case.
In the following part of the article, I will provide information on what current international scientific publications say about weight-bearing and walking restrictions after a fracture.
The medical or surgical team that diagnosed your condition and prescribed the treatment should have informed you orally and/or in writing whether weight-bearing and putting weight on your leg were allowed, which in turn determines whether you can walk by putting your foot on the ground or not.
Here’s a video of me showing you how to walk in these different ways, with crutches ⬇️:
What does weight bearing as tolerated mean?
Weight bearing as tolerated is a medical term used to describe your ability to put weight on your limb, based on your own comfort and pain tolerance.
This indicates that you should use your own judgment and comfort level as a guide.
You can gradually increase the amount of weight they put on the area as your pain decreases and their healing progresses.
It allows for a personalized approach to recovery, as each people may have a different level of tolerance and healing rate.
2. Understanding Common Post-Non Weight Bearing Pain
When you begin the transition from non-weight bearing to weight-bearing after an injury, it’s entirely normal to experience some level of discomfort and even pain.
Firstly, your body has been adapting to a non-weight bearing state for some time. During this period, your muscles, tendons, and ligaments may have weakened or stiffened due to lack of use.
When you start bearing weight again, these structures are called upon to support your body, which can lead to discomfort.
Secondly, the injured area itself might still be in the process of healing. Fractured bones, injured joints, or surgical sites undergo various stages of repair.
As you introduce weight-bearing, it can put stress on these healing tissues, causing sensations of pain or discomfort.
Additionally, your nervous system plays a role in how you perceive pain and discomfort.
It may become more sensitive during the recovery process, amplifying your perception of any sensations.
The key to a successful transition lies in finding the right balance between pushing your limits and allowing for adequate healing. Gradual progress is essential.
Start with light weight-bearing, following the guidelines provided by your healthcare professionals. As you adapt, you can slowly increase the load.
3. Choosing the Right Walking Device
During the first few days or weeks, you will likely need some material assistance to resume walking. Here are some tips on this matter.
Is it better to walk with or without crutches?
Regardless of the level of weight-bearing you decide on (partial or full), you will very likely need crutches (or a walker) for at least a few days, often a few weeks, after the non-weight-bearing period.
Crutches will allow you to put a little less weight on your legs. You’ll be able to adjust the amount of weight you bear according to your comfort.
They can also enable you to walk faster or farther, for example, to carry out your daily activities or engage in physical exercises.
You will gradually feel when you can do without them completely. For some people, this may happen within a few days, more commonly within 3 to 4 weeks. For others, it may take several months.
In any case, the key is to make this transition gradually. During the transition, you can use hiking/nordic walking poles, for example.
Crutches are often essential, at least for a few days or weeks.
See also: How to Learn Walking after a Broken Leg?
Do you need to wear a walking boot?
If you’ve had a fracture in your ankle, heel bone, tibial plafond, metatarsal, or another part of your foot, you may be advised to walk with a walking boot.
We do not have high-quality studies that definitively state whether it is better to wear a walking boot or any other brace.
Here are situations where it may be relevant.
For instance, if you have:
- Young children (or a pet) who may accidentally bump into your ankle when you walk.
- The need to quickly resume outdoor activities in crowded places.
- Difficulty putting weight on your foot and walking with crutches, especially if you need or want to start walking with support rapidly.
In my experience, some orthopedic surgeons routinely prescribe walking boots, while others never do.
Walking boots can be appropriate in certain situations, but they are not necessarily essential.
4. How Long and How Often to Walk?
After six weeks of non-weight bearing due to an injury or surgery, the duration and frequency of walking should be approached gradually and in consultation with your healthcare provider.
Here’s a general guideline to get you started:
Duration: Begin with short walks, around 5 to 10 minutes at a slow pace, on flat surfaces. Focus on maintaining proper form and minimizing discomfort.
It’s normal to sometimes experience nighttime discomfort or even a throbbing sensation after exertion. In such cases, it may be a sign that you’ve pushed yourself a bit too hard. The next day, reduce your activity level slightly, then gradually increase it again over time.
Frequency: Start with walking sessions 2 to 3 times a day. Ensure you have ample rest between sessions to avoid overexertion.
Progression: As you become more comfortable, gradually increase both the duration and frequency of your walks. Aim to reach 30 minutes of walking per session, at least 3 to 5 days a week. Monitor your body’s response and adjust accordingly.
Examples of gradual progress
Here are two illustrative examples of patients I have cared for and assisted during their walking rehabilitation.
Patient 1: The Athletic Young Man 🏋️♂️🏃♂️
Day 1 – Authorization for Weight-Bearing: After getting the green light for weight-bearing following his surgery for a tibia-fibula fracture, this young athletic man wasted no time. On the very first day, he cautiously started putting weight on his healing legs with the support of crutches. The process was slightly uncomfortable, but he remained determined.
Week 2: Just two weeks after receiving the go-ahead, he found himself confidently walking without crutches, albeit with a slight limp. His rapid progress was partly due to his excellent physical condition before the injury.
Week 4: By the end of week four, he surprised everyone by resuming his jogging routine, taking it easy but steadily building up his stamina. His body’s resilience allowed him to regain his active lifestyle relatively quickly.
Months Later: Several months down the line, this young man is back to his athletic self, engaging in vigorous physical activities without any major issues.
Patient 2: The Apprehensive 70-Year-Old Woman 👵🚶♀️
Day 1 – Authorization for Weight-Bearing: The 70-year-old woman, having suffered an ankle fracture without displacement, was initially quite apprehensive about the idea of bearing weight on her injured leg. On the first day, she cautiously began with just a few steps using a walker, feeling anxious but determined.
Week 2: Progress was slower for her, but by the end of the second week, she was able to walk short distances around her home with her walker, though still very uncertain about her stability.
Week 4: At the one-month mark, she found the confidence to transition to using a single crutch for support, although walking remained a slow and cautious process. Her age and concerns about reinjury made her recovery journey more gradual.
Months Later: Several months later, she was able to walk independently, though still with a slight limp. While her recovery was slower compared to the young man, her persistence and gradual approach allowed her to regain her mobility safely and improve her confidence over time.
5. Setting Realistic Goals
It’s entirely natural to want to know when you’ll finally be able to walk again as you did before your fracture, without pain, discomfort, instability, or apprehension.
However, it’s impossible to provide you with a precise timeframe. It will depend on numerous factors, such as:
- Your physical condition before and since the operation.
- The type of fracture and treatment you’ve received.
- What you do during the rest and rehabilitation period.
- Your personal criteria for “walking normally as before.”
Here’s a chart that illustrates the average progression of individuals who have had an ankle fracture (whether operated on or not):
This graph shows that people who have had a broken ankle, whether operated on or not, usually recover well within the first three months after the fracture.
What can we conclude?
- You will likely recover quite well during the first three months.
- Six months after the fracture, you should have regained approximately 80% of your pre-injury capabilities. This is an average figure, as some individuals report recovering 90% of their abilities within three months.
If you’ve had a different type of fracture, these timeframes also appear reasonable to keep in mind. However, remember that there is significant variability among individuals!
Here’s what I wanted to tell you about this! I wish you a very good recovery! Do you have any comments or questions? Your comments are welcome 🙂 !
If you feel the need to learn more about the recovery period after a fracture, I wrote this guide in eBook format:
You may also like:
Khojaly R, Rowan FE, Hassan M, Hanna S, Mac Niocail R. Weight-bearing Allowed Following Internal Fixation of Ankle Fractures, a Systematic Literature Review and Meta-Analysis. Foot Ankle Int. 2022 Sep;43(9):1143-1156. doi: 10.1177/10711007221102142. Epub 2022 Jul 21. PMID: 35861219.
Khojaly, R., Mac Niocaill, R., Shahab, M. et al. Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture. Trials 22, 369 (2021). https://doi.org/10.1186/s13063-021-05319-0
EARLY ROUTINE WEIGHT BEARING IS SAFE IN PATIENTS WITH ANKLE FRACTURES. Bugler K.E. and White T.O. Orthopaedic Proceedings 2015 97-B:SUPP_4, 14-14
Written by Nelly Darbois
I love writing articles based on my experience as a physiotherapist (since 2012), scientific writer, and extensive researcher in international scientific literature.
I live in the French Alps 🌞❄️, where I work as a scientific editor for my own website, which is where you are right now.