The transition from crutches to full weight-bearing in a boot
Following time on crutches from an injury or surgery, getting back to full weight bearing will most likely be a gradual process. How gradual and how much weight bearing is allowed varies greatly depending on, among other things, whether or not bone repair was involved (fusion, broken bone, bunion repair) or just soft tissue (ligament, tendon, cartilage). It also depends on each physician’s protocols and preferences. The usual process following my foot/ankle surgeries has been to start with 25% weight bearing, then gradually increase to 50%, 75%, and eventually 100%. That day, the day of full weight bearing, is always like Christmas! The ability to walk, even in a boot, greatly expands the available options for hiking and exploring in my favorite environment, the great outdoors.
This post covers things I’ve learned from extensive boot-hiking — some cautions, and lots of practical tips that make this activity fun and very doable. While it mostly applies to being in a boot while fully walking, the section on Boot Care applies any time you strike boot to ground, crutches or no crutches.
About the boot
The boot my foot surgeon prefers is made by Top Shelf Orthopedics, and it’s called the Solar Walker. I love the name! I have been through two of these boots in three years. It’s quite sturdy, although during this round of post-op I have really put it to the test. Hopefully, the boot can hang in there with me until we are done with each other!
Boot Hiking Strategies
- Wear a long sock underneath. Hands down, the best thing I have found to wear under the boot is long, over-the-knee socks. I purchased two pairs of Hue knee high socks at Macy’s three years ago, and those four socks have been a total win. The sock obviously covers my toes, and comes up over my knee. Sometimes it slips down, but never so far that it doesn’t reach above the top of the boot. When it is particularly cold outside, I wear an extra regular sock over the knee-high to keep my toes warm.
- Inflate the boot fully when walking for exercise. My boot has an inflate/deflate mechanism, which pumps air into all the padding surrounding the front of the leg and top of the foot. When hiking, I inflate it fully to add extra protection in those areas. Walking in a boot automatically throws your weight forward, and without extra padding on the shin this can be uncomfortable over a long period of time.
- Wear a shoe on the alternate foot that is of similar height to the boot. This is challenging, as the boot sole is quite thick. To normalize my gait as much as possible, I have tried various different shoes and insoles in my shoes. The Altra Olympus (as opposed to the Altra Lone Peak that I usually wear) has a higher sole, and I have used that shoe some. Hoka’s also have a higher sole. I know many trail runners love those, although I have not tried them. I have tried using two insoles in a Lone Peak, and that seems to help too. It’s a balancing act here, in more ways than one. I have to make sure the right foot is supported and comfortable while dealing with the left (in boot) and trying to walk as evenly as possible. My advice? Experiment with lifts in the shoe, or higher and thicker soles, to see what works best for you.
- ALWAYS USE POLES! After my first foot/ankle surgery in January 2015, I was talking to the PA during that magical check up that gave me the OK to fully weight bear. He suggested walking with a cane to help with balance and lessen the intensity and awkwardness of walking any distance in the boot. Somehow, I couldn’t see myself out on the local trails with a cane. I asked him about hiking poles. He said yes, that would be a good alternative. In that moment, I became a complete and total hiking-with-poles advocate! I had owned poles for a few years, but rarely used them to hike. I (ignorantly and incorrectly) assumed poles were “just for old people” and therefore I didn’t need them. I could count on one hand the number of times I had used them before this conversation. Now, suddenly, they were an ally that would allow me to get out and about much sooner! I started using poles for each and every walk/hike I take with the boot. Even on a simple trail like Lake Padden I use them (at least in the beginning). Poles help generate the extra support necessary to get up hills in a boot that offers no ankle flexion. And they help slow and control downhill motion by acting as brakes. Numerous studies show that using poles reduces impact on joints by 20%, as well as dispersing the load off of the lower body by incorporating in the upper. And it goes without saying that using poles helps with balance. I can’t say enough about these advantages of using poles both in a boot and not. I simply would not be able to do the amount of post-op hiking, or hiking and backpacking in general with foot/ankle/knee surgical history, without them.
Here is the reality of winter hiking on trails in and around Bellingham — it’s muddy! I have tried various methods in an attempt to keep the boot clean while hiking in wet and muddy conditions — among them a garbage bag over the boot, and a thick sock over the boot. In my experience, I have yet to find a solution that works, as the action of walking has destroyed any cover I’ve put on the boot, and I end up walking in mud anyway. Hence, I now skip the covers, and deal with mud and pine needles on a daily basis. Here are some things that DO work for helping fight dirty-boot syndrome:
- Keep towels in the car. Some people have dog towels in their car, I have boot towels. And a water source to get one wet. I always take the boot off and shake it out and clean it as thoroughly as possible after a walk. It’s never perfect, but allows me to go on with my day without tracking mud and such to my post-hike activities.
- Shake the boot over a throw carpet at home. When I remove the boot, I do so over something I can shake outside. Even with meticulous cleaning, needles and dirt remain, and I can better contain the mess if I can shake it outside and not get it all over the house.
- Sleep in a pillow case! This is a new strategy learned this year. At the end of this round, I will have been over four weeks in the boot — day and night. With all the hiking, I kept encountering small pebbles, pine needles, and other particulate in the bed despite my best efforts. The PA suggested sleeping with a pillow case over the boot, and VOILA! I have no more trail debris in bed with me at night. 🙂
Some cautions about hiking with a boot:
- Start slowly! Like crutching for exercise, don’t go out three miles on your first boot hike! Start with a manageable distance that you KNOW you can do. Build from there. It takes different muscles and taxes the body differently to hike in a boot. Feeling good for two miles doesn’t mean you will feel good for four. Build up slowly to both more distance and more challenging terrain.
- Remember, you have no ankle flexion. Walking in a boot reminds me of what my dad went through for the last 20 years of his life. By the age of 63, after numerous failed ankle surgeries, my dad had both ankles completely fused. This left him with no ability to flex his foot up (dorsiflex) or down (plantar flex). I remember trying to take him rock climbing at Joshua Tree National Park in California back when I was really into that. What was an easy route for my then husband and me was simply not doable for him, as he could not dorsiflex his ankles enough to ascend even an easy climb. That is what walking in a boot is like. The normal heel/toe rock of walking all takes place in a stiff boot with no ability to flex the ankle. On flat ground, it’s not too bad, but add in some elevation, and it gets really challenging. Add in elevation AND obstacles or uneven terrain (like roots, rocks, or a slanted trail), and it definitely requires full focus to make it happen. Here is where poles and caution really come in. The surface of the boot is much broader (and stiffer) than a normal shoe, so wedging it in or angling it with agility is not going to happen. Conquering hills requires slowing down, using poles, and leaning in a bit more to use the tip of my boot. Caution must be used with the latter if your ailment is in the forefoot, as putting too much pressure here can be painful and, worse, detrimental to healing.
- Common areas of pain to watch for. In addition to the obvious ones from your particular surgery, the most common types of pain I experience specific to the boot are the back of the knee (where the hamstrings connect — because all the walking, especially up hill, is with a more or less straight leg, and the hamstrings have to pick up the slack on this). The calf muscle in a boot is rendered useless, as anyone can tell you if they have ever been in a boot or cast and viewed their withered calf at the end of it. And, in the boot itself, the muscles responsible for dorsiflexion are constantly stressed inside the boot in an effort to stabilize and simply to make the action of going uphill happen. Those muscles are the ones most likely to cry out during a long hike and for awhile afterwards. I always see how recovery goes overnight…if I feel fine in the morning, I am OK for another round.
- Take breaks to elevate the foot on long hikes. Much foot and ankle surgery involves long periods of time sitting with an elevated foot. To go out on a long walk (or back to work all day standing up) takes easing back into. Take breaks during your hike to stop and elevate your foot. I try to prop my foot up at lunch and at regular intervals on long hikes.
- Too much hiking causes the boot to fall apart! This post-operative round is the first time my boot has disintegrated significantly on the bottom. Either this boot is less well made the previous, or I have just used it more. Regardless of the reason, I have struggled immensely with the heel portion of the boot falling apart and coming off. The reason I mention it here under cautions, is because the only time I have fallen in the boot was when I slipped, on dry pavement, with the heel of the boot that is worn down to metal. Metal on pavement and me not expecting it led to a rather spectacular fall, with both feet flying out from under me! No injuries, but now I am acutely aware of walking on a hard flat surface. And I am still trying to figure out how to get duct tape to hold together for a long hike.
What constitutes a long hike in a boot?
With this being my third (and hopefully last!) year of surgeries, I have started to expand what I thought was previously possible hiking in a boot. I have added in Galbraith Mountain, a mountain bikers mecca with an extensive, never-ending array of trails. I have also hiked to Oyster Dome, via Lily and Lizard Lakes and the Samish Overlook, a total of about 11 miles. I have also taken the boot for a spin up on Chuckanut Ridge Trail, which offered the most challenging terrain so far. This hike on Chuckanut inspired me, for various reasons, to consider doing the Fragrance Lake Half Marathon route…not the race itself, as I could not make the cut off time and would feel very silly doing it in a boot, but the designated 13.1 mile route. I have done it several times before, and love where goes — including Chuckanut Ridge, Fragrance Lake, and the Rock Trail. I hope to do that on Monday, 1/31, a final boot hurrah before getting out of it (I hope) on 2/6.
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