Overview
- Balances early loading against fixation failure
- Categories are non, touch, partial and as tolerated weight bearing
- Older adults often cannot follow restrictions, leading to immobility, deconditioning and falls
- Weight bearing as tolerated is safe after many hip, ankle and periarticular fractures with stable fixation
- Consider fracture pattern, fixation stability, bone quality and compliance
To Weight Bear or Not to Weight Bear by Dr Andy Ang
Definition
- NWB keeps the foot off the ground, touch weight-bearing rests it for balance only
- PWB is a stated load, commonly 10 to 20 kg
- WBAT is limited by pain, FWB is unrestricted
Management
- Hip joint reaction force is several times body weight from abductor action
- Crutch NWB gait still loads the hip, more than touch weight-bearing
- Bed to chair transfers and straight leg raises can exceed walking loads
- Load sharing nails and arthroplasty tolerate early loading better than plates bridging comminution
- Hip fracture, immediate unrestricted weight-bearing, as restriction raises mortality and length of stay
- Ankle fracture, early boot weight-bearing after stable fixation shows no excess fixation failure
- Caution with syndesmotic injury, neuropathic diabetes, poor bone and uncertain posterior malleolar fixation
- Tibial plateau, earlier loading after stable fixation may not increase subsidence
- Even young adults estimate partial loads poorly on instrumented insoles
- Choose fixation for the expected weight-bearing ability of the patient
- Document instructions with a planned duration and review point
- Progress on clinical and radiographic union, not time alone
Complications
- Deconditioning, falls and loss of independence
- Venous thromboembolism
- Disuse osteopenia and muscle atrophy
- Joint stiffness and delayed return to work
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.