I know it is a little bit weird, but I am always watching the way people walk. It’s like a game I play with myself: guess the injury, name the solution. I like to think that this funny habit keeps my brain active and stops me from being bored. Last week I saw a couple of people walk by who had major problems. You have heard the expression “The cure is worse than the disease”? Both girls were in the process of recovering from an injury but at the same time were setting themselves up for further damage because they forgot to consider the rest of their body. I am sharing these pictures to encourage you to avoid “tunnel vision” next time you have an injury. Don’t just focus on the things your injury needs in order to heal – think about the rest of you; make sure you are not creating a second problem.

Problem #1: Aircast Abuse

                              

This girl is wearing an Aircast on her Right ankle.

Aircasts are very frequently used to recover from an ankle sprain, usually only during the acuteStage (The term acute means that the injury just happened recently and is still getting better…it does not refer to an injury that is adorable). The whole purpose of an Aircast is to support the ankle and provide a little bit of compression at the joint to reduce swelling. The sides of the brace are hard plastic cushioned by soft pockets of air that conform to the shape of the person’s leg. The girl in the picture is wearing her Aircast with flip flops.

This is a grave error.

Two major problems occur when you wear an Aircast with flip flops:

–          Aircast braces rely on the sides of the shoe to stabilize the brace. If there is no shoe, the Aircast is literally useless. The whole point of wearing an ankle brace is to provide support to the ankle, but you have to remember that the brace works as part of a System. It’s like a peanut butter and jelly sandwich: you need bread, peanut butter and jelly. If you are missing any one of these three components, you won’t have a PB&J.

–          Even if the Aircast was able to magically support this girl’s ankle without the help a shoe, a flip flop is still not an acceptable rehabilitation footwear choice. Here is why: When one part of your body is injured, your entire system is under stress. Think about if you have a back porch with one rotten board in it. You are going to step around the rotten spot because you know that it is weak. This will put more stress on the other parts of the structure, possibly causing strange wear patterns or weakening adjoining areas.

The same thing happens when you hurt a part of your body. This girl has injured her Right ankle, so the chances are good that she will try to compensate by putting more weight on her Left foot. Now ask yourself: is that foot well supported? No. That flat flip-flop is doing precisely nothing to ensure that she has proper body alignment from the ground up.  She is not only neglecting her injured ankle, but she is also setting up the rest of her body for a compensation injury.

Problem #2: The (not really) walking cast

The girl above was spotted hobbling though a store with her Right foot in a nearly knee high cast. The cast had a protective “shoe” that was intended to preserve the plaster.  In order to walk through the store, she had to turn her Right leg so that her toes pointed outward (Abduction of the hip) and lean her body weight forward so that she could fall heavily onto her Left foot. She would then swing her Right leg around and forward to get ready for the next step. It was a painful process to watch.

There are a lot of issues here, but let’s just name a few.

–          She is wearing a loafer on her Left foot. (See the above rant about flip flops not being supportive – loafers are just about the same) You can actually see her Left foot pronating in this picture as she struggles to balance most of her weight on her un-injured leg.

–          I am going to assume/ hope that she was not actually supposed to be walking on her cast yet. The reason for this is because she is not properly equipped to walk in that cast. When your foot and ankle are “locked” in a 90° position (the way this cast is splinting her leg) it is almost impossible to have a smooth gait pattern. You actually need to be able to dorsiflex (bend your ankle so that the top of your foot gets closer to the front of your lower leg) at least 10° in order to walk normally.

–          Because it is so hard to walk without bending your ankle, a cool innovation called a “rocker sole boot” has evolved over the years. There are several types, ranging from the kind that Velcro over the existing cast to a type of boot with an external shell that works instead of a cast. This same rocker sole effect can also be built into the cast by inserting a rounded metal plate into the bottom of the plaster. If this girl was supposed to be walking around, I expect that the Doctor would have provided her with a rocker sole so that she could have a smooth gait.

–          If this girl continues limping along with her incorrect gait, she shouldn’t be surprised if the following  compensation issues begin to arise: (in order of likelihood and occurrence)

  • That same day – she will start getting a tension headache/ sore neck from holding her head at a weird angle all day without realizing it. Her Right hip flexors will also start to become really tired.
  • The next day – she will feel a knot developing behind her Left shoulder. This is because she is having to use her upper body to gain enough momentum to swing her injured leg forward at the beginning of each step.
  • Later that week – Her Left arch and or shin will begin to cramp and burn at the end of the day. This is caused by her perpetually shifting her body weight to her uninjured side. If she does not begin to wear supportive footwear and stretch her calves, her Left foot will become a prime candidate for plantar fasciitis within the month.
  • For months after getting rid of her cast – she will notice a mysterious ache in her lower back/ Right hip area. This is because her Right leg has essentially been acting like it is longer than her Left leg (because of both the thickness of the cast and the lack of ankle motion). This functional leg length discrepancy stresses her hip and lower-back because she is trying to control her balance so that she does not fall onto her Left leg with excessive force.

You can see that if the above problems are not addressed, the girls in the pictures could become vulnerable to a wide variety of ailments, aches and pains. These sorts of compensation injuries creep up slowly and often can significantly complicate and prolong the rehabilitation period. Don’t let that happen to you. The next time you are limping along because of a recent injury, take a look at yourself: Are you wearing good shoes? Are you walking as naturally as possible? Remember that your body works as an entire system, when one part is broken all the other pieces are also stressed. Take care of yourself from the ground up and give your body every advantage while you are recovering from injury.

Walk well.

Photos From:

Concord Market Days, Concord, NH. Photo credit: Colin Widhu

http://prohealthcareproducts.com/images/aircast-leg-brace.jpg

LL Bean, Freeport ME. Photo Credit: Bob Smalley

http://www.bearmountainpainting.com/wp-content/uploads/2012/04/rotted-deck-replacement-wood.jpg

Advertisements