A Leg To Stand On

At the end of last year, I rolled my ankle hiking and broke my fifth metatarsal and my fibula. As my world temporarily receded to just the four walls of my home, I got a quick crash course on how to deal with it that I want to pass along. 

This is a challenging post to write because not only is every injury (and manifestation of that injury) different, so are people’s living situations, work situations, quality of medical care, and so on. I’ve tried to write this as broadly as possible, but these are my own thoughts and experiences which may not echo yours, so, in the words of Bruce Lee, please absorb what is useful, discard what is useless, and add what is specifically your own.

Because this post is a long and winding road with lots of extraneous (but truly deserved) complaints about Banner Health, I have bolded the important parts for easier skimming.

Initial Care and Diagnosis

You were injured and struggling to put weight on your foot and have to figure out if you broke something, sprained something, or did something else entirely. You probably need an X-ray.

Figuring out how to get X-rays

There are different regulations in each state about who, exactly, can order an X-ray. Obviously, physicians can, but some states also allow nurse practitioners and physician assistants to do so, and in some states, chiropractors and physical therapists can, too. Knowing the laws in your state can be useful if you are struggling to get a timely doctor’s appointment.

Once, years ago, I was paying an annual fee for the honor of same or next-day care, but the doctor wasn’t available for three days, and neither was a nurse practitioner. I had to have a chiropractor write me an order. (If you do this, make sure to get a copy of the order to carry in with you, as imaging centers sometimes have difficulty getting their fax machines to work, and will say they are very confused because they don't know which limb to X-ray, even when one is five times as large as the other. When they lose the X-ray, they will call to verify the order, but often don't pick up their phone for the call back because they are busy looking for other people's paperwork. It's all very messy.) 

Most urgent care facilities have X-ray services on site, though they may not always have an X-ray tech on hand. And, of course, you may not even go to urgent care. If you have a non-emergency fracture, urgent care will likely send you to an orthopedist to determine whether you need surgery, a cast, an orthopedic boot, etc. In some cases, especially if you can get in quickly, it might make more sense to go to the orthopedist directly to save yourself the extra trip.

That said, there are situations that are true emergencies where you better get yourself to the ER, such as acute compartment syndrome. If you have significant pain, numbness, tingling, tightness with excessive swelling, and skin that is pale, shiny and tight (like a drum), get thee to an ER right away. There are many other scenarios that warrant an ER; please use your best judgement and don't skip urgent care if you think you need it--even though I wish I would have.

Getting into the building

For some reason, places that treat people who are unable to walk are often located in buildings that are inaccessible for the people they’re trying to treat. It is extremely helpful to have someone with you. Many of these places will lend you a wheelchair, if you ask, but of course you have to get inside the building that has these wheelchairs, impossible to do with your injury. Having someone go in and get it for you and wheel you in can make it a lot easier.

Even when you already get crutches or an orthopedic boot, having someone with you is invaluable because they can help you carry your things, open glass doors that you can’t open with crutches, press a button on an elevator, and ask questions you’ve forgotten about.

And even if places are accessible, they often have many sets of steep walkways that can be challenging to navigate.  Make sure to give yourself tons of extra time to get in and out of the buildings.

Those X-rays...

If you do go to urgent care, or are otherwise getting X-rays taken somewhere other than when you'll be returning for additional care, try to take a copy of your x-rays with you when you leave.

One thing I learned after a truly horrendous experience at an urgent care (one where the X-rays hurt more than the initial injury itself) is that some healthcare systems (*cough* Banner Health *cough*) make it incredibly difficult to get your X-rays, will not upload it to a patient portal, take weeks to send it by mail (if they send it at all) in an incorrect format, and often don’t send the complete X-rays even when requested by another physician. (They will still send you a bill for it, though.) The urgent care I went to really wants people to come back in person, which is very difficult when you can’t walk or drive. To save yourself many many hours on the phone, try to get a copy of the X-rays before you leave. 

Also, make sure they take an X-ray on the correct side of your body and that the paperwork has the correct side of your body written down (something Banner Health also struggles with), which will save you hassles with health insurance later.

Working with the X-ray tech

My silver lining when Banner Health made it impossible to get my X-rays and didn’t send the complete set to the ortho is that not all X-ray technicians are terrible at their jobs. I didn’t want to repeat X-rays because it was excruciatingly painful when the Banner Health X-ray tech forcefully jerked my foot and ankle into position, but the X-ray techs at the orthopedist were more professional. They talked me into rotating my foot into position myself to get the exact ankle for the diagnostic image. I don’t think there’s anything I could have said to avoid foot/ankle torture at Banner, but I did make it a point to let the new X-ray techs know I'd prefer to move my foot into position myself.

The orthopedic consultation

If you do go to an urgent care or your regular physician and they send you to an orthopedist, you may get very different instructions from the ortho after they analyze your X-rays. This is where you can find out how long you have to be on crutches and/or in an orthopedic boot, how much weight you can put on your injured foot, how you’re supposed to shower, whether you should cancel that trip you had planned, etc. 

Make sure to come with your questions written down in case you forget. It can be difficult to communicate with the office after the appointment, and the answers are often slow in coming.

Another important thing to bring along with your list of questions is a form for a temporary handicapped placard if you intend to use one. Your state will likely require it to be signed by a physician, and this is a lot easier to do when they're right there than to be on hold forever or send emails into a portal or a void.

Gear

Whether you go to the ER, urgent care, an orthopedist, your regular doctor, or some combination of these, you will likely leave your appointment with a set of crutches and an orthopedic boot. If your urgent care is as bad as the one I went to, they won’t really give you instructions (or complete instructions) on how to use it, which you’ll either get from friends with a lot of experience with crutches, the PTs at your orthopedist office, some of the many articles and videos online, or a combination of these. Here are a few pointers.

Crutches

In the U.S., you will likely be given under-arm crutches, also called axilla crutches.

Some of them tell you what settings to put them on for your height, but these often need to be adjusted. You want around two inches between your armpit and the top of the crutch when your hands are relaxed. You want the hand grips to be at the level of your wrist. You want your elbows to be bent slightly.

Walking with crutches is quite tricky. You want to take small steps and keep the crutches very narrow. You don’t want to put all of your weight on your armpit, which puts weight on your axillary nerve and can be incredibly painful. 

Steps are also very difficult, especially when you’re not weight-bearing. I preferred avoiding them altogether, but also resorted to jumping with my other foot, which I definitely do not recommend. There are a lot of videos, but having a friend get on a call with me and demonstrate and answer questions was the most helpful of all for me.

There are other types of crutches available, beyond the one that was (likely) given to you. There are other options that may hurt less or even allow you to walk without using your arms. There are forearm crutches (also called Lofstand or elbow crutches) that go around your forearm and have handles for you to grip.

There are forearm support crutches (also called adjustable arthritic crutches, gutter crutches, or platform crutches) that have padded forearms and adjustable handles. And there are leg support crutches like iWalkFree that allow you to move without tying up your hands or arms–you bend your injured leg and rest it on a knee pad, and secure straps going up your thigh and around your calf. These don’t work for every body type, and I was curious to see whether they would work for me…but by the time the one I borrowed arrived at my house, I was already off crutches.

On top of crutches, there are also knee scooters, where you walk with your good foot while taking the weight off of the injured one. The only issue is that they can’t really do stairs. 

All this to say that you have many options, depending on your budget.

Blinging Up Your Crutches

I bought a few things for my crutches that I thought were useful.

I got crutch pad and hand grip covers, which then caused me to have to readjust the crutches so they fit properly. THIS WAS SO MUCH BETTER. And I got a little crutch bag so I could carry my phone from room to room without throwing it or carrying it under my chin. (You can also use a backpack or a small shoulder bag.)

I read about these in a crutch survival article on Greatist, which also recommends rain tips and has recommendations for public transit, and more. Definitely worth reading, especially if you live alone and are trying to figure out how to eat, or if you have to navigate streets and cars and subways to get around for work even while injured. 

Orthopedic boots

Orthopedic boots, also known as air boots or CAM (controlled ankle mobility) boots, can take some weight off of your foot and are used instead of casts for some conditions. There are short orthopedic boots that are about mid-calf, and long ones that go up right below your knee. 

Orthopedic boots have an inner lining, a rigid frame, a hard plastic shell, and adjustable velcro closures. They also have an air pump so you can inflate the boot to give it added support. There are tons of videos on how to use these, and they’re a little different depending on the brand. The most important things I learned were to adjust the velcro from the bottom up, and to release the air when sitting.

Blinging up your boot

Okay, you’re not really blinging your boot, but this is what you’ll want to wear with the boot. 

Usually you’ll either wear an ace bandage on your injured foot or a compression sock. I used Bombas because they don’t go up all the way to the knee, which I liked, but they were expensive.

I also got an EvenUp Shoe Lift, which you wear on the sole of the shoe of your uninjured foot to adjust for the height difference of the walking boot. This makes sure you are aligned while walking.

Acquiring Medical Equipment

It can be frustrating to have to buy medical equipment that you’re only going to need for a few weeks or months, and health insurance often won’t cover it.  Check to see if there are any lending closets for medical equipment in your area.  I borrowed a knee scooter and a bathtub rail for 90 days from a lending closet that also loans out walkers, wheelchairs, canes, reachers, shower stools and chairs, and much more. 

If a lending closet isn’t an option, and you don’t have any friends you can borrow equipment from, you can buy (and later resell) used items on sites like OfferUp, and there’s always eBay and Craigslist.

Lights

To get to and from the bathroom at night, I mostly used the flashlight on my watch, but Apple Watches don’t always hold a charge, so I also got a headlamp. Night lights can serve a similar purpose, as can voice-activated lights. (I joked that I wanted to get a dumpster fire night light, but they are touch activated.) 

Baths

I mentioned using a lending closet to borrow a bathtub rail, which clamps onto the side of the tub and can help assist you when getting in and out. There are also bath benches and chairs, but they can be difficult to use if you don’t have a handheld showerhead. 

Because bathing can be difficult and time-consuming, and because this doesn’t fit on fiberglass tubs, you may find yourself bathing or showering less often, at least at first.I bought some XL shower wipes–the body vibes you use for traveling and camping or if you’re in a gym that doesn’t have showers and don’t want to get staph, or if you are bed ridden. These worked pretty well.

I also bought no water rinse free shampoo caps, that are supposed to shampoo and condition your hair. These did not work well on my thick and curly hair. I’ve had bad luck with dry shampoo in the past, but what did work amazingly well was Innersense Refresh dry shampoo. YMMV, though, and it is expensive.  

Working From Bed

In the first week or so after my fractures, I really didn’t want to get out of bed very much because it was so much work and because then I’d have to crutch back and forth to the bathroom, which would take longer. So I worked from bed.

I always use a background image from video calls, so it wasn’t unusual. I recommend using one now, at least from time to time, in case it’s needed in the future as you probably won’t want to explain your injury to everyone in every meeting. 

I also bought the cheapest compact lap desk I could find, and wish I’d gotten a better one, since I do sometimes work from couch because my dog sits on me and I could never disturb her slumber. So while I have no recommendations for products, I think splurging for one that’s not a $10 plastic thing for elementary school students would be okay, especially if you’ll reuse it after you recover. 

Travelling

I took a trip to D.C. for a conference about four weeks after hurting myself. By then I was off crutches, and could walk in the airboot. Standing actually felt better than sitting at times. Still, there were a lot of things to keep in mind.

Getting In and Out of Cars

There's so much we take for granted when we're uninjured. With a fractured foot, ankle, leg, etc., getting in and out of cars is a lot harder. I recommend opening the car door, turning around so you’re facing away from it, backing up slowly until the back of your legs touch the door frame, sitting, and then swinging your legs over. It is slow.

Airports

Even if you can walk pretty well, airports are probably a lot bigger than you remember, and you can actually get wheeled around, which is awesome. Simply sign into your ticket and say you need extra assistance with steps, as well as a wheelchair to get onto the plane.

Unfortunately, this can be slow, and you have to figure out exactly where to go to wait. Or, if you’re like me, you can just start walking and hope to find someone with a wheelchair along the way. Getting off of a plane is much easier as there will be people with wheelchairs waiting, especially if you have requested wheelchair assistance in advance. 

Airplanes

A reader also reminded me that it's important to deflate your orthopedic boot fully and open the valve cap once you're seated to avoid any issues with cabin pressurization.

Accessible Rooms 

Make sure to ask for an accessible room at your hotel, and then double-check that this is for mobility as they will often try to put you in a room that’s hearing-accessible. Accessible rooms often have bathrooms and showers with grab bars, shower chairs, handheld shower heads, and other features. 

I will say that using an accessible shower takes a bit of trial and error to avoid getting water literally everywhere. Because these are roll-in showers, there is a low or absent threshold between the shower and bathroom floor. Using a handheld showerhead can minimize slashes, but it’s hard to eliminate them, especially at first. I simply used a lot of towels to clean up spills (and to remind myself the floor was slippery.)

Packing

I recommend having a few extra things on hand.

Of course you’ll remember to pack your  compression socks for use during the day, but did you bring socks to wear at night? If you’re traveling somewhere colder, these are a must-bring. I was lucky enough to be at a conference where someone got socks as swag and regifted them to me, but had a lot of trouble falling asleep with frozen feet the first night. 

It’s also good to have entertainment options and easy-to-eat food, so you don’t have to get up more than necessary.

Social Considerations

The biggest thing to remember when injured is that people are amazing but also annoying.

Traveling with an injury is hard because people are not mind readers and therefore tend to act as if you’re either more or less injured than you are. When I traveled I was in week 4 of my injury and people kept telling me how worried they were about me, getting upset if I wasn't sitting, or asking me about pain when I basically didn’t have any.

On the flight I had one person “help” me by putting up my arm rest, which I needed to steady myself. He must have thought that having an injured foot meant I did not have hands or ears. I had to put the arm rest down immediately after he put it up. It would’ve been helpful if he had asked first.

Then on the flip side, some people are completely oblivious. There were people who rudely ran past me into an elevator as I was trying to get off (as if that would speed things up). I also sat in the middle seat on a flight and kept having to get up to  let the person in the window seat out. The dude in the aisle seat made no effort to move his large bag under the seat in front of him, which made it a little difficult to walk past in an airboot. Some people just aren’t paying attention.

I was extremely lucky with my injury because I work from home and live with my husband. He cooked tons of meals and did all the dishes and brought me water and snacks and carried a million things from room to room. When he was out for a work trip, my brother came to visit. So nice. 

Ideally, you'll have someone to help with household tasks like cooking. (The crutch survival article on Greatist has tips on containers and water bottles with lids, rolling tables, and so forth, but this isn't ideal.) If you live alone (or even if you don't), you might find it more difficult to find someone (or let someone) take care of you while you're injured. In fact, this experience made me realize that while I have dozens of friends who would get drinks with me, there were very few I’d feel comfortable asking to hang out at my house with me while I recovered, or even to come sit on my couch with me eating takeout. And there were very few people who would offer to adjust plans to include me, like taking a car somewhere instead of a half-mile walk. (A notable exception was a friend who carried tea down a flight of stairs for me–even bringing out a menu when they didn’t have genmaicha.)

In retrospect I could’ve been more vocal about what how people could adjust plans to include me, though it can be tough in the moment to navigate social considerations, and sometimes I'd rather not ask someone to go out of their way for something so temporary. When things went well, it was when I spent time thinking about ideal (and less-than-ideal) accommodations in advance, so I'd be prepared to ask for things that people could, of course, always decide against doing. But this extends beyond social situations– you can ask a rideshare driver to pick me you up at the door you are at (in the airport) rather the one that was assigned.

People will often ask if there is anything they can do to help. This is tricky one for those of us who are privacy advocates but also want a few people around us to be mind readers.. but are ourselves not well-versed enough at reading minds to know whether people really want to help or are just being polite. I don’t really want to ask people to do things, but if someone offered to send me their favorite comic book or those cookies they really like, I would have been ecstatic. It's a good reminder for me to offer things that people can say yes or no to when I want to help. (Of course, I often ask people who are injured or sick if I can send things, and they typically think I'm very weird, because of the usual error--assuming others are exactly like us. Still, I've found that throwing out options is better than expecting someone who's probably relying on others more than they're accustomed to, to come up with something for you to do.