Weight bearing is how much of your body weight your surgeon allows through the operated leg. There are five common levels, from none at all to full:
- Non-weight bearing (NWB): the foot doesn’t touch the ground at all
- Toe-touch or touch-down weight bearing: the foot rests on the floor for balance only, with almost no weight through it
- Partial weight bearing (PWB): some weight, often given as a percentage of your body weight or a number on a scale
- Weight bearing as tolerated (WBAT): as much as pain and balance allow, up to your full weight
- Full weight bearing (FWB): no limit
Your surgeon’s instruction is the one that counts. It’s set for YOUR bone, your fixation and your repair. If it isn’t written on your discharge paperwork, ask before you leave hospital.
Why it matters
- Too much, too early: after a fracture fixed with plates or screws, or a tendon or cartilage repair, extra load can shift the fixation or stretch the repair before it has healed
- Too little, when you’re allowed more: muscles weaken, joints stiffen and bone loses strength. After most hip and knee replacements you’re allowed weight as tolerated from day one for this reason
- It changes over time: most restrictions step up at follow-up visits, often after an X-ray. Check at every review, because timelines vary from a couple of weeks to three months or more
Each level in practice
- Non-weight bearing: keep the operated foot off the floor, knee slightly bent. You move by hopping on the good leg between crutches or a frame. It’s tiring, so plan your day around fewer trips. A knee scooter is an option for some foot and ankle patients if your surgeon agrees
- Toe-touch: imagine an egg under your foot that mustn’t crack. The foot touches down to help your balance, but your hands and good leg take the weight
- Partial: stand on a bathroom scale with the operated leg to feel what the allowed amount is like, then practice matching it. It’s hard to judge accurately, so recheck on the scale now and then
- As tolerated: put down as much weight as feels manageable. Some pain is expected. Use crutches or a frame until you can walk without limping, then wean off
- Full: no restriction from the surgeon, though you may still need a stick for balance or confidence for a while
Your surgeon sets the limit. Your job is to use every bit of it they allow.
Fitting your crutches
- Top of the crutch: about 1 to 2 inches below your armpit. Take weight through your hands, not your armpits, to protect the nerves there
- Handgrips: level with the top of your hip, so your arms are slightly bent
- Forearm crutches: the same rule for the handgrips. Your physio will set the height before you go home
Walking on the flat
- With crutches: move both crutches forward about a foot. Step the operated leg forward level with them, putting down only as much weight as you’re allowed. Push through your hands and step the good leg through
- Non-weight bearing on crutches: same pattern, but keep the operated foot off the floor and swing the good leg through
- With a frame: move the frame a step ahead with all four legs on the floor. Step the operated leg into the middle, press down on the handgrips, then bring the good leg to meet it
- Turning: take small steps. Don’t pivot on the operated leg
- Sitting down: back up until you feel the chair behind your legs, hold both crutches in one hand, reach back for the armrest with the other, then lower yourself slowly
Stairs: up with the good, down with the bad
The good leg leads going up because it’s the one strong enough to lift you. The operated leg leads going down so the good leg does the lowering. Use a rail whenever there is one.
- Going up with a rail: hold the rail with one hand and both crutches, or one crutch, in the other. Step up with the good leg, then bring up the operated leg and the crutch
- Going down with a rail: put the crutch down on the step below first, then the operated leg, then step down with the good leg
- Non-weight bearing: hold the operated foot off the step. Hop up on the good leg, and going down lower the crutch first, then hop down
- If stairs feel unsafe: sit and bump up or down on your bottom, one step at a time, with someone carrying the crutches
- Practice first: a physio will usually check you on stairs before you go home. Ask for another go if you’re not confident
The American Academy of Orthopaedic Surgeons has a good illustrated guide to using crutches, canes and walkers.
How it looks after common operations
- Hip or knee replacement: usually as tolerated from day one. See exercises after hip replacement
- Hip fracture: often as tolerated straight after surgery, which helps older patients get moving. See hip fracture surgery recovery
- Broken ankle with plates and screws: often non-weight bearing or protected in a boot for several weeks. See broken ankle surgery recovery
- Achilles repair or rupture: usually a boot with heel wedges, with weight increased step by step. See Achilles rupture recovery
Go to the emergency department if
- You have chest pain or sudden shortness of breath. Call emergency services
- You fall and can’t put any weight on the operated leg, or it looks bent or out of shape
Call your surgeon today if
- You put full weight down by accident and now have new pain, swelling or a clunk
- You fall onto the operated leg
- Your calf becomes painful, swollen or warm
Mention it at your next review if
- You’re not sure what level you’re on or when it will change
- Crutches are making your arms or shoulders sore
- You’re finding stairs or getting around your home unsafe
The rule protects the repair, and using every bit of weight you’re allowed gets you off crutches sooner.