“Chiropractors are often like garbage men…” ~Dr. Lou

Whether you broke your leg, broke a foot, sprained an ankle, had lapiplasty for a bunion, or had some other reason to wear a “boot”, it can really affect your body’s ability to function normally, which often leads to feeling off or feeling pain. We often deal with the consequences of people having to wear a boot or a cast. Many surgeons don’t address the consequences of the immobilization that the boot or cast causes. We are here to help you understand what may happen, sometimes without you even feeling the damage being done. Remember, most of what happens in our body, we don’t feel, including problems as they are slowly manifesting.

These are 15 of the most common changes in your body after wearing a boot or cast following foot surgery:

1. Muscle atrophy: Muscles in the immobilized leg, particularly the calf muscles, often weaken and shrink due to disuse. It can take months to regain strength and stability, size and performance. With the right help though, you can return to normal faster and safer than without professional guidance. Chiropractors are often like garbage men, cleaning up the messes that are leftover from the surgical party.

2. Reduced range of motion: The ankle and foot joints may become stiff, leading to decreased flexibility. Reduced range of motion changes how your brain moves and organizes positions throughout your body. Restriction is bad and may have grave consequences within the nervous system and joints of the body.

3. Altered gait pattern: Walking mechanics change due to the boot’s bulkiness and weight, potentially causing an uneven gait. This leads back to the last point, among other things….like “secondary pain”

4. Secondary pain: Lower back, contralateral hip, and ipsilateral knee pain may develop due to gait alterations. Does secondary pain come from the boot, or the effect on your body that the boot had? Identifying the causes of what the boot “did” will help you recover quickly, safely, comfortably, and often with performance improvement.

5. Functional leg-length discrepancy: The boot typically makes the affected leg functionally longer, causing pelvic misalignment. Unresolved, spinal and pelvic misalignement leads to reduced communication between the Golgi tendon apparatus, muscle spindle mechanoreceptors and the brain. This leads to a breakdown in things like brain function and clarity, stability, reaction times, reflexes, muscle strength, heart rate variability (adaptation) and coordination.

6. Swelling: Edema in the foot and ankle is common, especially after removing the boot. Chronic swelling causes tissue damage in and around the affected area, and not only needs to be resolved, but the underlying causes of the inflammation must be eradicated for proper function over a lifetime.

7. Skin irritation: Prolonged contact with the boot or cast may cause skin issues like rashes or pressure sores. Ick. Ouch. Infection risk.

8. Decreased proprioception: The sense of joint position and movement may be impaired after prolonged immobilization. Decreased proprioception is the foundation for instability, reduced movement and biomechanics, and like above with the leg length discrepancy….confusion of the the Golgi tendon apparatus, muscle spindle mechanoreceptors and the brain. This leads to a breakdown in things like brain function and clarity, stability, reaction times, reflexes, muscle strength, heart rate variability (adaptation) and coordination.

9. Bone density changes: Weight-bearing bones may lose some density due to reduced loading.

10. Altered blood flow: Circulation in the immobilized limb may be affected, potentially leading to blood clot risks.

11. Joint stiffness: Lack of movement can cause joints to become temporarily less mobile. Joint stiffness and reduced mobility over the long term, again, leads to the Golgi tendon apparatus, muscle spindle mechanoreceptors and the brain. This leads to a breakdown in things like brain function and clarity, stability, reaction times, reflexes, muscle strength, heart rate variability (adaptation) and coordination.

12. Muscle imbalances: Compensatory movements may lead to overuse of some muscles and underuse of others. This creates spinal restriction which leads to the Golgi tendon apparatus, muscle spindle mechanoreceptors and the brain. This leads to a breakdown in things like brain function and clarity, stability, reaction times, reflexes, muscle strength, heart rate variability (adaptation) and coordination.

13. Reduced cardiovascular fitness: Overall activity levels often decrease during recovery, affecting cardiovascular health. We all know how important this is, and if you are suffering after the boot, it may further prolong your health and healing. Promoting blood flow to injured areas through cardiovascular output from exercise is actually helpful to the healing process! Without it, you are at a disadvantage!

14. Nerve sensitivity: Some patients may experience increased nerve sensitivity or altered sensation in the affected area. (No Bueno) OUCH!

15. Psychological effects: Frustration, anxiety, or depression may occur due to limited mobility and lifestyle changes. (Also no bueno!) Your mental health impacts your physical health. Neural plasticity, or your brain’s ability to adapt and create new connections within it, are possible for both good and bad.  Unhealthy thinking can reprogram your brain into a negative space that is not good for you or those around you.

These changes are generally temporary and can be addressed through proper rehabilitation, chiropractic and physical therapy before, during and after the boot or cast is removed. It’s important to follow medical advice for a safe and effective recovery but also resilience, stability and adaptive function moving forward.

Dr. Lou Jacobs sees patients all week long who have recently been in a boot to stabilize a surgical or injury site. The structural and neurological effects of longterm use seem to benefit greatly from chiropractic care, and Dr. Lou guided physiotherapy. Science tells us what the effects are and how to deal with them to attempt to minimize the harmful effects “down the line”. Make no mistake, the boot will change you, it’s just a matter of how much and for how long. 

Citations:
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC6336574/
[2] https://www.reboundsportspt.com/recovery-concerns-lower-body-casts-boots-and-braces/
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC10573441/
[4] https://remaininthegame.ca/side-effects-of-wearing-a-walking-boot/
[5] https://palermophysio.ca/what-happens-when-you-have-a-body-part-that-is-immobilized/

This is Dr. Lou!