For decades, patients who had surgery for a broken ankle were told one strict rule: no weight on the leg for six weeks.

Crutches. Boots. Frustration. Slower return to normal life.

But a landmark study published in The Lancet challenges that tradition — and could quietly reshape recovery advice worldwide.

Researchers across the United Kingdom asked a simple but powerful question:

What if walking earlier is not only safe — but actually better?

The WAX Trial: Early vs Delayed Weight-Bearing

The study, called the WAX trial (Weight-bearing in Ankle Fracture), was a large, carefully designed randomised controlled trial across 23 NHS hospitals in the UK.

A total of 561 adults who had surgery for unstable ankle fractures were randomly assigned to:

• Early weight-bearing (start walking at 2 weeks after surgery)

• Delayed weight-bearing (wait 6 weeks before walking)

Patients were followed for 12 months, with the main outcome measured at 4 months.

What Did They Find?

At 4 months:

• Patients who walked early had better ankle function scores

• The improvement was statistically significant

• Complication rates were similar between both groups

• Early walkers were highly likely to be more cost-effective for the healthcare system

Key Functional Score (OMAS)

• Early group mean score: 65.9

• Delayed group mean score: 61.2

• Adjusted difference: +4.47 points in favour of early walking

Importantly:

• No meaningful increase in major complications

• Similar rates of further surgery

• Early walking reduced overall healthcare and societal costs

From a cost perspective:

• Early weight-bearing saved about £60 per patient for the NHS

• From a societal perspective (including work losses), savings increased to £722 per patient

The probability that early walking was cost-effective exceeded 80%.

Why Might Early Walking Help?

Immobilisation has known downsides:

• Muscle wasting

• Joint stiffness

• Delayed return to work

• Loss of independence

Allowing safe movement earlier may reduce these issues without increasing surgical risk.

Study Summary Table

What This Means

This is one of the largest ankle fracture rehabilitation trials ever conducted.

It suggests that, in appropriately selected patients:

• Walking earlier after surgery may be safe

• It may improve early function

• It may reduce healthcare costs

• It does not meaningfully increase complications

However, decisions must always be individualised based on fracture stability, surgical fixation, and surgeon assessment.

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 Disclaimer

This article is for educational and informational purposes only.
It summarises findings from a published clinical study.

It does not provide medical advice, diagnosis, or treatment recommendations.

Weight-bearing decisions after surgery must be made by a qualified healthcare professional based on individual medical assessment.

ORIEMS FIT does not claim that any product replaces medical care, physiotherapy, or orthopaedic advice.

Always consult your surgeon, doctor, or registered health professional before changing your rehabilitation plan.