Partial weight-bearing is prescribed in kilograms or percentages and delivered by feel. Patients discharged on 20 kg have no way of knowing what 20 kg is, and the instruction quietly becomes either full weight-bearing on a fixation that cannot take it, or complete offloading with the deconditioning and stiffness that follow.
Calibrate it before discharge rather than describing it. Stand the patient on a bathroom scale with the operated limb and have them load it until the needle reads the target, then have them hold that sensation and repeat it three times. Most patients are surprised by how much pressure the target actually represents. Then watch them walk with the crutches and correct the pattern, because the number is useless if the gait is not one that can deliver it.
At each follow-up, ask what they are doing rather than whether they are complying — 'how much weight do you think you are putting through it now?' gets a usable answer where 'are you keeping off it?' does not.
- Calibrate the target load on a bathroom scale before discharge, not verbally.
- Have the patient reproduce the sensation three times so it is learned rather than demonstrated.
- Watch the crutch gait and correct it; the load target depends on the pattern.
- Ask open questions at follow-up about what they are actually doing.
- Re-calibrate at each change in the prescribed load rather than assuming it transfers.
Why it matters
A weight-bearing instruction that has never been calibrated is a number the patient cannot act on, in either direction.
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