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Saturday, June 25, 2011

Gradual Process of Weaning Out Of A Cast/Removable Boot

Dr Blake's Note: This patient is recovering from a broken sesamoid bone under her big toe joint (first metatarsal) and is beginning the process of weaning out of the removable cast.

Hello, Dr. Blake,

I hope you are well! I still read your blog faithfully, even though I am getting much better.

I am resending a message from about a month ago, since I have discovered that some of my AOL account messages are not getting through to people so you may never have received this. It basically asks about how to wean out of a boot; also curious about your thoughts on rocker soles.
I also want to tell you that I think your site may have changed health care for many sufferers in Seattle and Washington; I found the "Even-Up" there, and no one here has ever seen one-- I've been introducing it to this area singlehandedly. Well, I just got a call from the Orthopedics Dept here where I work asking where I got my EvenUp! Now their patients will be told about them!

EvenUp seen on the left foot with the Removable Cast right foot

Dr Blake's Note: This is what it is all about in the evolving health care system. Spread the word when you hear of people with health issues. The internet is opening up new horizons. Bravo to this wonderful patient!!
Thanks again for everything,

Ann, Thanks and I am very proud that I can make a difference, and you too. We are a team together trying to help the health of foot sufferers.

 I think the rocker shoes, especially when you are having foot problems, are too unstable, and too unpredictable. So I would avoid them for the forseeable future.

 Golden Rule of Foot: Weaning from the cast needs to be painfree.

 Golden Rule of Foot: You can wean out of the cast if you are painfree in the cast for at least 2 weeks.

 Most people begin to wean out of the cast after work, evenings and weekends when they can think about their foot and be extra slow and careful. Many times the work environment is too busy, and you just can not think about your foot as much.

When they have accomplished this initial painfree transfer from cast to no cast, they begin weaning off at work. You begin weaning by starting with 1 hour in your shoes, inserts with accommodation, spica taping.

You gradually add 30 minutes to 1 hour per day of time out of the cast as long as there is no increase in pain.

Many patients need to level out at a certain level if pain begins after a certain amount.   Stay in the painfree zone. This is why the typical weaning process can take from 2 to 8 weeks.

Read the posts on the Magical 80% Rule and Good vs Bad Pain, since as we increase function, pain may be slightly increased.

 Do Not Experience Bad Pain (pain over level 3), pain that you would want to limp.

 Hope this helps. Email me at if i am not clear. Rich
And here is the immediate response from the patient.
Hi, Dr. Blake,

Once again, THANK YOU. These specifics and ideas and estimates of time frames are SO helpful (and very clear), and I have not gotten that level of information from my care providers here so I've sort of been making it up (and overdoing it, as it turns out). I am now thinking I'd better go to see one of the Seattle folks you recommended to me, since it's not really fair to keep asking you for specifics like this! I'll let you know how it goes.

Dr Blake's Note: It can be hard to give specifics without all the information, but I hope some the generalizations I present can be helpful to patients.

I am so grateful. And hope you have a wonderful weekend!


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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.