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TTWB vs. TDWB
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TTWB vs. TDWB - February 7, 2008 6:47:56 PM
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Hitomi
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I'm confused about these terms: TTWB and TDWB. I had one PT tell me that there is no such thing as TTWB- are they synonymous (20% weight bearing)? When a doc gives a patient TTWB status, do you instruct the patient in TTWB or TDWB, or clarify with the MD?
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RE: TTWB vs. TDWB - February 7, 2008 6:52:13 PM
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Tom Reeves DPT ATC
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clarify. technically you can put all of your weight through your toes can't you? I take it as the weight of the leg but no more.
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RE: TTWB vs. TDWB - February 7, 2008 7:25:20 PM
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Hitomi
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The way I learned to instruct a patient is that basically you have an egg under your foot and you don't want to crush it, and also that TTWB is 20% of body weight. But does that mean you can teach a patient to "roll" his foot heel to toe with minimal weight bearing, or does that just mean touching down with toes? Where does Touch Down Weight Bearing fit (i.e. whole foot on the ground), as I was told that there is no difference. The patient involved is s/p surgery for ankle fx, ORIF involving tibia and navicular.
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RE: TTWB vs. TDWB - February 7, 2008 8:46:17 PM
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TexasOrtho
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I also doubt the orthopedists really make a hardline distinction. If you were to poll 100 orthos, you are likely to see some differing opinions on the issue. This is another good example of how a unified language would be helpful.
It's hard for me to see the benefit of TTWB vs NWB. Why not simply specify a percentage of body weight and do away with the use of the term TTWB? Thankfuly it doesn't come up enought to get too riled up over it.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: TTWB vs. TDWB - February 7, 2008 9:17:01 PM
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Hitomi
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TexasOrtho, that, to me is where TDWB would replace TTWB- I too see no significant difference between NWB and TTWB. On the other hand TDWB would allow (20%) weight bearing throughout the entire foot and begin neuro re-ed with WB status in mind. This patient is allowed weight bearing as tolerated in a pool, Toe Touch WB on land?
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RE: TTWB vs. TDWB - February 7, 2008 10:13:35 PM
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jma
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I personally don't like the term TTWB because it is an abnormal pattern which positions the foot in plantarflexion at the beginning of weightbearing phase of the pattern. TDWB I believe is where there is a heel stike gait or placing the foot flat with a % of weightbearing. This closely resembles a normal gait pattern.
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RE: TTWB vs. TDWB - February 7, 2008 11:22:08 PM
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Tom Reeves DPT ATC
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They might just be saying that they would rather have you bear weight than fall down
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RE: TTWB vs. TDWB - February 8, 2008 12:24:39 AM
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blast7
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quote:
ORIGINAL: Tom Reeves DPT ATC
They might just be saying that they would rather have you bear weight than fall down
The local ortho docs in our area do this. You will see them allow toe touch or TDWB on patients who would otherwise would be at a greater risk of falling if NWB. I've also found that if you have a patient who is NWB but cannot maintain it then they sometimes will switch to TTWB which illustrates the ambiguity.
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RE: TTWB vs. TDWB - February 8, 2008 11:01:16 AM
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orthotherapist
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This is all ambiguous if you really think about it -- Two people have the an ORIF of a trimalleolar fracture on the same day. At there follow-up a few weeks later the MD writes an order for outpatient therapy with restriction of 20% weightbearing for each of them because they are X weeks out from surgery. Now one patient is 300# and the other 150# - you would think this would make a difference in the order they write but it doesn't. If the weightbearing was based on the healing/ability of the stabilization to take weight and the 300# individual can actually bear 20% then the other patient should be able to bear 40% (60#).
Physicians I have run into interchange TTWB with TDWB.
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RE: TTWB vs. TDWB - February 8, 2008 2:42:49 PM
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buckeye
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I agree the TTWB is generally not a favorable gait pattern. I suggest you clarify with the orthopedic surgeon to be safe - and perhaps have a converation to see if future orders can be written TDWB to promote a better gait pattern and safety for all the right reasons.
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RE: TTWB vs. TDWB - February 11, 2008 6:00:37 PM
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ruralPT
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Our orthopods write TTWB, but really want the foot flat (to avoid plantarflexion, etc.), BUT they want them to be NWB. They say, the patient can put their foot on the floor, but not put any weight on it. We have one orthopod who will actually write the progression with # instead of %, which does help with the varying body weights of people.
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RE: TTWB vs. TDWB - February 11, 2008 8:35:19 PM
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Hitomi
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I think that is what the PT who told me that there is no such thing as TTWB was getting at. Foot flat, no weight (an egg under the pts. foot). Thanks for the replies.
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