Before my injury, my life revolved around fashion: runway shows, camera flashes, social events, and, almost always, high heels. I wrote about the fashion industry and treated walking as something the body simply did. Then a severe ankle fracture-dislocation and surgery changed the scale of an ordinary day. The heels gave way to a wheelchair. Success became taking a few steps.
I spent about three months in a wheelchair. I expected recovery to take time, but I had not imagined how unfamiliar standing would feel. About a month after surgery, my care team started me in rehabilitation. That timing was specific to my injury and surgical plan; it was not a universal schedule. Evidence and practice have evolved, and selected patients with ankle fractures may be allowed to bear weight earlier than older protocols recommended. In the WAX randomized trial, many eligible adults assigned to begin weight-bearing two weeks after surgery had outcomes at four months that were at least as good as those who waited six weeks. The trial did not make early loading right for everyone: The surgeon’s assessment of the fracture, fixation, wound, and individual risks still determines the plan.
That distinction matters. Early movement can help limit the effects of disuse and rebuild strength and function, but “start early” does not mean “load every injury early.” A surgeon’s clearance sets the boundary. The work within it may include range of motion, transfers, standing, balance, and gait practice, each introduced at the right time.
My first experiences in traditional rehabilitation settings left me with a question. I sometimes heard advice that sounded like: If it hurts, do not do it; if you are afraid, stop. Caution is essential after surgery. Pain can signal a problem, and no one should be urged to jeopardize a repair. But after months without normal walking, almost any new movement can feel threatening. If fear alone becomes the stop sign, how does a patient learn which sensations are expected and which require a pause?
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Dmytro Bezpamiatnyi, a movement and neuromuscular connections specialist who later worked with me, describes prolonged inactivity as affecting more than muscle size. The stabilizing muscles around the hip and lower leg can weaken; balance and proprioception (the body’s sense of where it is in space) can become less reliable. Standing again also asks the visual, vestibular, and sensory systems to coordinate in a way that wheelchair life did not. Research on bed rest similarly finds that balance control can decline after prolonged inactivity, alongside physical deconditioning.
Bezpamiatnyi described gait as an automatic skill that may need to be rebuilt alongside weight acceptance, balance, and coordination. It felt that way to me: My legs did not seem to respond automatically; I wobbled, sometimes felt lightheaded, and did not always trust my crutches. A surgeon can clear a person for full weight-bearing while that person still feels psychologically braced for danger.
Pain and fear need more careful conversations than a simple instruction to push through or stop. Bezpamiatnyi says mild or moderate discomfort that settles during a session or over the day may be tolerable within the treating team’s restrictions. Sharp, localized, or escalating pain, or increasing swelling and symptoms that worsen after activity, should prompt a stop and a check-in with the surgeon or clinical team. These are not diagnostic rules, and an individual plan takes precedence. If I feel weak or dizzy while walking, the safe response is to stop, sit somewhere secure, and tell the supervising clinician, not to prove I can continue.
Fear avoidance is one way clinicians and researchers describe the cycle in which movement is interpreted as dangerous, leading a person to avoid it. Avoidance can reduce activity and confidence; the resulting deconditioning may make the next attempt feel even less safe. Studies after lower-extremity fractures have found associations between early pain-related distress and later limb loading and walking outcomes, although that does not mean fear is the only cause of a difficult recovery.
The alternative is not bravery at any cost. It is graded, supervised exposure: A clinician helps the patient try a manageable movement, notice what happens, and build from there while respecting the surgeon’s restrictions. A safe progression might move from supported weight shifts to steady standing, then balance tasks, step practice, and gradually less reliance on an assistive device. The sequence and pace depend on the injury, healing, balance, medications, and the patient’s response. A physical therapist or other licensed clinician should guide medical rehabilitation and gait safety.
Bezpamiatnyi’s work with me was distinct from that medical role. He describes it as restoring movement patterns and neuromuscular strength after an injury, once the surgeon has cleared movement. His approach includes sensory and proprioceptive exercises, sometimes reducing visual cues under supervision. That is his practice, not a replacement for postoperative care or a universal prescription. What I valued was the steady attention to how I shifted my weight and where my fear appeared, alongside clear respect for the limits set by my surgical team.
Before the injury, I learned to walk confidently in high heels in front of cameras. Now I am learning to walk again, slowly, deliberately, without knowing whether the next step will frighten me. Perhaps the work begins in the gap between medical clearance and felt safety: when movement has been allowed, but the body and brain have not yet accepted that danger has passed.
Anna Estrin is a fashion journalist, writer, and media contributor whose work and personal style have been featured in Vogue Italia, Marie Claire, Harper’s Bazaar, and The Wall Street Journal.
For more than fifteen years, she has worked within the fashion industry, covering runway shows, industry events, and the people behind one of the world’s most visible and influential businesses. Her reporting has taken her between New York, Miami, and international fashion destinations, where she has spent years exploring the intersection of image, ambition, culture, and success.
She shares her work and style on Instagram.
