What is a walking boot?
A medical walking boot is a device used for severe ankle injuries and post-surgical protocols that require protection and immobilization. The most common type of walking boot is an Aircast boot, which consists of a rigid plastic shell along the back and sides of the ankle, and a hard but somewhat flexible plastic shell along the front of the ankle.
The inside of the medical walking boot is coated with a soft fabric for comfort and the sole is a thick foam used to dissipate ground reaction forces during walking. Between the hard exterior and soft interior are air cells, which are basically just plastic bags that can be easily adjusted to fill with a custom amount of air for a snug fit, improved comfort, and further protection.
When do you get a walking boot?
Walking boots are typically prescribed by the healthcare professional that is directly involved in your ankle rehabilitation and/or post-surgical recovery. For example, a physiotherapist may assess your ankle injury and recommend the purchase of a walking boot from their clinic or another resource if they feel that substantial immobilization is required to protect the sprained ankle.
Similarly, following ankle surgeries that require a high level of protection and immobilization, the surgeon’s office may provide you with a walking boot on site. Unfortunately, the acquisition of a walking boot usually comes at a cost, so it’s recommended that you explore various options ahead of time if possible, as this may help you find something suitable for your needs within your budget.
Sprained Ankle Walking Boot
Whether or not you will need a walking boot for a sprained ankle will depend on the extent of your injury and phase of rehabilitation. We will list some of the more common situations in which patients will often use a walking boot for their sprained ankle.
What type of sprained ankle will require a walking boot?
High Ankle Sprains
Also known as syndesmotic ankle sprains, these are very common types of ankle sprains, particularly in sports, and refers to damage of the ligaments that stabilize the upper portion of the ankle joint. A high ankle sprain will usually result in the recommendation to protect and immobilize the sprained ankle in a walking boot for approximately 6 weeks.
A high ankle sprain involves injury to the anterior inferior tibiofibular ligament (not to be confused with the anterior talofibular ligament in a low ankle sprain), posterior inferior tibiofibular ligament, and/or the interosseous membrane between the tibia and fibula. For this reason, a short walking boot usually won’t suffice, and it’s usually recommended to purchase a tall boot, which is the more standard size.
These ligaments each have their own specific functions, but generally speaking, they stabilize the tibia and fibula (two shin bones) in the higher-up region of the ankle joint and prevent them from separating.
Movements that stress this part of the ankle joint and result in a high ankle sprain include general weight bearing, forced dorsiflexion especially in weight bearing positions, and forced external rotation of the ankle especially in weight bearing positions.
Given that a sprained ankle refers to stretching a ligament beyond its limits, it’s typically the ankle ligaments listed above that are stretched and damaged with these movements.
Provided that many of these mechanisms can occur in normal walking, doctors and physical therapists will often recommend immediate protection and immobilization of the sprained ankle in a tall boot for up to 6 weeks in order to protect from excessive and/or repeated stress to these ligaments. This may a little bit if any other ankle injuries are present.
While this may feel like a slow and frustrating start to the recovery process, it ensures proper healing and structural integrity of the aforementioned ligaments, which is important for any ankle injury, especially a severe ankle sprain, and will ultimately allow for safe and effective rehab specifically for the sprained ankle thereafter.
Additionally, your physical therapist can guide you on movements and exercises that can be performed safely without the walking boot, but these are generally limited to rehab-specific exercises and will vary based on the type of the sprained ankle, which is one of the reasons that seeking professional assistance is highly recommended.
Ankle, Foot, and Toe Fractures
Ankle fractures can happen in isolation, but they can also occur in combination with ankle sprains. For example, if severe enough, lateral ankle sprains that happen from rolling the ankle can lead to a fracture of the distal fibula (lower portion of the outside shine bone), compaction fractures to the medial malleous (lower portion of the bigger inside shin bone), or a combination of fractures if the ankle injury is very severe.
Ankle fractures themselves come in different types and levels of severity. If it is deemed that a fracture is stable and does not require surgical repair, then it will be highly likely that some form of external protection and immobilization will still be required, and in this case, walking boots are a go-to item.
To provide an example of one of the more common toe fractures that may occur completely separate from a sprained ankle, a 5th metatarsal fracture is highly susceptible to disruption both in weight bearing and non-weight bearing positions, and as such, a walking boot may represent a comfortable form of immobilization, assuming a full cast is not required.
In terms of timelines for using a walking boot after a fracture, this will be highly dependent on the extent of injury and associated clinical recommendations from your doctor, surgeon, or physiotherapist. This may also very if there is a sprained ankle in combination with the fracture.
Additionally, it’s worth repeating that while these devices are commonly called “walking boots”, there may be the additional requirement of non-weight bearing, especially with severe displaced fractures or severe high ankle sprains. In this case, the walking boot still serves a purpose to protect and immobilize the ankle joint, and when appropriate, will provide a safer avenue for gradual and progressive return to full weight bearing when the fracture or sprained ankle has healed an appropriate amount.
Low Ankle Sprains
Low ankle sprains, both of the medial and lateral variety, may benefit from a walking boot, but this is more often the case with more severe Grade 2 or 3 ankle sprains. Similar to other ankle injuries that require a walking boot, the timeline for use will depend on the severity of the sprained ankle and will be determined by the healthcare professional responsible for your care.
In the case of medial or lateral ankle sprains, the walking boot would be used during the initial stages of recovery, allowing the affected ligaments to heal properly in a neutral position while protecting the entire ankle joint complex. Given the lower part of the ankle joint is the area that needs to be stabilized, sometimes people can get away with a short walking boot, which may be a little more comfortable.
Even with a short walking boot, the user may be able to walk in a safer manner during this timeframe with or without crutches, or in more severe sprains, will be combined with a knee scooter or some other non-weight bearing protocol to maximize protection and immobilization while reducing the risk of a secondary ankle injury.
Post-Surgical Protocols
Many different types of injuries can require surgical intervention, but what people often overlook is that post-surgical recovery and subsequent rehabilitation is just as important as the actual surgery, if not more important.
Whether it’s fixating a fracture site, repairing a ligament or tendon subsequent to an ankle sprain, replacing an ankle joint, or any other form of surgical repair, some form of protection will likely be required in the initial stages of recovery, which can include a walking boot or any other form of assistive device, such as crutches or a knee scooter.
Additionally, as one progresses through their post-surgical rehabilitation, a walking boot can often be used to facilitate gradual return to weight bearing when appropriate, or to limit the chances of aggravating the surgical site during riskier activities like commuting to the clinic or to work.
How to Put On a Walking Boot
These instructions are general and are more in line with an Aircast. Before donning a walking boot, ensure that the walking boot itself is clean, especially on the inside. Similarly, cleaning the skin as thoroughly as possible is also recommended to avoid any possible sources of infection or generalized skin irritation. Additionally, if possible, it’s often recommended to wear some form of covering over the skin like a long comfortable sock while wearing a walking boot.
When putting on the walking boot, gently place your foot and ankle into the posterior (back) portion, which is the bulkier part of the walking boot. From there, you can apply the front cover, ensuring the plastic sides fit snugly in the grooves of the posterior portion without digging into your foot and ankle. The straps can be pulled through their respective loops and fastened to the velcro strips.
At this point, the walking boot can be “pumped up” so the air cells expand to provide a snug comfortable fit. You may see values around a dial near the pump, usually 1, 2, and 3. These refer to the different areas of the walking boot (left side, back, and right side). Most people start with 2-3 pumps in reach area, then 1 pump through each area thereafter until a snug and comfortable fit is achieved.
By rotating through the different areas with each pump, this will help prevent a concentration of stress building up on one area too much. In other words, the same amount of pressure on each side of the ankle is preferred, as opposed to pumping up just one side only until the walking boot doesn’t move anymore, which may result in too much stress in one area of the ankle.
Where can you get a walking boot?
Given that many people will require a walking boot at some point in time for an ankle sprain or fracture, they are actually pretty easy to track down. Here are some common places you can find a walking boot:
Pharmacies
Many pharmacies keep walking boots in stock, as well as other items you may need for an ankle sprain, such as crutches, canes, tensor bandages, and compression socks. If you want to ensure the highest possibility of finding a walking boot at a pharmacy, try looking at pharmacies located in hospitals or profession buildings close to hospitals.
Physical Therapy Clinics
Given that many people seek care for an ankle sprain through physical therapy, many clinics will have walking boots available, especially for those who have come in for an initial assessment and are diagnosed with a high ankle sprain.
The added benefit to purchasing a walking boot at a physical therapy clinic is that the physical therapist can usually help show you how to put it on, and also practice walking with it and/or crutches, either in a non-weight bearing fashion, or in a weight bearing fashion, whatever is required for the injured ankle.
Online
Medical supply websites, or more general online shopping websites such as Amazon, will often have a pretty good selection of good walking boots. There is an added convenience factor here, and sometimes you can find better deals, but the downside is that you don’t really receive personalized guidance on what you need for a particular ankle sprain.
Difference Between an Ankle Brace and a Walking Boot
Both ankle braces and walking boots provide significant support to the ankle joint, but simply put, a walking boot will provide even more support and physical protection than an ankle brace.
Lace-up ankle braces are often used when there is a history of ankle sprains or chronic ankle instability, or in the advanced phased of rehab for an ankle sprain. For example, a basketball player who is coming off an ankle sprain and returning to the court, but would like a safety net while they continue to build ankle strength and stability, an ankle brace could be a very suitable option.
Conversely, in the cases listed above, particularly with a high ankle sprain or ankle fracture, a walking boot will provide much more rigid stability and a tougher exterior to help soften direct forces from contact with the ground or objects. For this reason, walking boots are more often recommended for severe ankle injuries and post-surgical recovery.
Summary
Walking boots are common devices used for ankle injuries, including ankle sprains, fractures, and post-surgical procedures. Walking boots can be acquired through various means, but often come at a cost, so it’s a good idea to ask questions ahead of time if you suspect you may benefit from a walking boot.
Also, don’t let the word “walking” fool you, as it’s possible that a non-weight bearing phase of rehabilitation protocol may need to be followed simultaneously. In order to gain a better understanding of the appropriateness of a walking boot for your injury, including specific timelines for wearing a walking boot, it is highly recommended to seek advice from a healthcare professional, such as a doctor or physiotherapist, for recommendation on the best walking boot for you.
References
Jiayong Liu, Daniel Valentine & Nabil A Ebraheim (2022) Management of Syndesmosis Injury: A Narrative Review, Orthopedic Research and Reviews, 14:, 471-475, DOI: 10.2147/ORR.S340533
Christopher Valkier, Lawrence M. Fallat, Robert Jarski (2020). Conservative Versus Surgical Management of Fifth Metatarsal Avulsion Fractures. The Journal of Foot and Ankle Surgery. Volume 59, Issue 5, Pages 988-992, ISSN 1067-2516, https://doi.org/10.1053/j.jfas.2020.05.003.
Disclaimer:
The content here is designed for information & education purposes only and is not intended for medical advice.
