Post-Cast Walking Pain: Is Your Foot Positioning Correct?

Experiencing pain while walking after removing a cast may indicate improper posture or gait?

On August 18, I slipped and sustained closed fractures of the first, second, and third metatarsals in my left foot.
My foot was immobilized with a cast and secured with an elastic bandage on top.
During my follow-up appointment on October 8, an X-ray was taken, and the doctor said the bones had healed enough to remove the cast.
However, the strength is still insufficient, and I need to use crutches for another month.
The doctor advised me to move my joints more and apply heat, as walking will help increase bone strength.

After returning home, I noticed that the top of my ankle and foot felt very tight, and the angle of my toes at the base was very small.
Stretching the tendons is quite painful, and I have been diligently applying heat.
I bought a pair of athletic sandals with Velcro straps for the top and sides of my foot, which allowed me to get my foot inside.
I started using crutches to walk indoors with a more normal gait, but I experience pain at the base of my toes while walking.
After a short time, the area around the base of my toes becomes quite swollen.
Is this normal? Should I be walking on the base of my foot like I did when I was in the cast? If I continue to walk on the base, won't that limit the movement of my joints? My next follow-up appointment is in four weeks, and I'm worried that I might be doing something wrong that could affect my recovery.
I am very grateful for Dr.
Shi's patient assistance since my injury.

Ms. Hsieh, 50~59 year old female. Ask Date: 2015/10/12

Dr. Shi Guozheng reply Orthopedics

Swelling in the foot after a fracture is normal because the bones are filled with blood vessels.
After a fracture, the blood vessels will reconnect, and once healing occurs, the swelling will naturally subside.
Currently, if there is significant swelling, elevating the affected area can improve blood circulation.
Additionally, applying mild heat can enhance blood flow.
It is also important to move the foot, including the ankle joint and all the toe joints, as this will help reduce swelling.

Reply Date: 2015/10/12

More Info

Post-cast walking pain can be a common experience for individuals recovering from foot injuries, particularly after a period of immobilization due to a cast. In your case, having sustained a closed fracture of the first, second, and third metatarsals, it is crucial to approach your rehabilitation carefully to ensure proper healing and regain function.

Firstly, it is important to understand that after being in a cast, your foot may experience stiffness and discomfort due to prolonged immobility. The tightness you feel in your ankle and the limited range of motion at the base of your toes are expected as your muscles, tendons, and ligaments have adapted to the immobilized position. The pain you experience at the base of your toes while walking may be attributed to several factors, including:
1. Muscle Weakness and Atrophy: After being immobilized, the muscles in your foot and ankle may have weakened, leading to discomfort when you start to use them again. This is a normal part of the recovery process.

2. Joint Stiffness: The joints in your foot, particularly the metatarsophalangeal joints (where your toes meet your foot), may be stiff from lack of movement. This stiffness can cause pain when you attempt to walk normally.

3. Improper Footwear: While you have chosen a pair of sandals with adjustable straps, it is essential to ensure that they provide adequate support and cushioning. Footwear that does not properly support your arch or distribute weight evenly can exacerbate pain and swelling.

4. Overuse: As you begin to walk more, it is possible to overdo it, especially if you are eager to regain your normal activity level. Gradually increasing your walking distance and frequency is key to avoiding excessive strain on your recovering foot.

To address your concerns and improve your recovery, consider the following recommendations:
- Gradual Increase in Activity: Start with short distances and gradually increase as tolerated. Listen to your body; if you experience significant pain or swelling, it may be a sign to reduce your activity level.

- Footwear: Ensure that your shoes provide proper arch support and cushioning. You may also consider using orthotic inserts to help with alignment and reduce pressure on painful areas.

- Range of Motion Exercises: Engage in gentle stretching and range of motion exercises for your toes and ankle as recommended by your physician or physical therapist. This can help improve flexibility and reduce stiffness.

- Ice and Elevation: If you experience swelling, applying ice and elevating your foot can help manage inflammation. This is particularly important after walking or exercising.

- Consultation with a Physical Therapist: If you continue to experience pain or have concerns about your recovery, consider consulting a physical therapist. They can provide tailored exercises and strategies to improve your strength, flexibility, and walking mechanics.

- Follow-Up Appointments: Keep your follow-up appointments with your physician to monitor your healing progress. They can provide guidance on when to transition from using crutches to walking unaided.

In conclusion, while some discomfort is normal as you transition from a cast to weight-bearing activities, it is essential to approach your rehabilitation thoughtfully. By gradually increasing your activity level, ensuring proper footwear, and engaging in appropriate exercises, you can help facilitate your recovery and minimize pain. If you have any ongoing concerns, do not hesitate to reach out to your healthcare provider for further evaluation and support.

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