Transition from Walking Boot to Shoe: Tips and Guidelines

We use walking boots to heal ankle and foot injuries like stress fractures. The walking boot allows your injury to heal. But equally important is the transition from a walking boot to a shoe. You can’t expect to return to wearing regular shoes immediately. So, this blog will outline how to safely transition from a walking boot to a shoe. 

What is a walking boot?  

A walking boot is a prosthetic device prescribed by a doctor or physiotherapist to protect your ankle and foot after injuries or surgery. These boots are also known as CAM walker-controlled ankle motion walking boots.

These boots can be tricky to wear comfortably. Some tips to make your life easier while wearing a walking boot include:

• Wearing a sock liner. The sock liner protects your skin and provides extra cushioning for your foot.

• Use a heel lift or shoe balance. A heel lift on the other foot adds extra height to balance the walking boot, reducing pain and making walking more comfortable. Even up is a fantastic device that makes your walking more comfortable.

• Keep the walking boot dry. A wet boot adds weight, making it more difficult to walk. Moisture also creates a better environment for bacteria, increasing the risk of infection.

What happens after we use a walking boot? 

Although a walking boot protects the foot and encourages healing, it also has adverse effects. First, your ankle and foot joints become stiff and swollen. Second, the muscles in your calf and foot undergo atrophy from disuse. Finally, your skin loses moisture, becoming dry and flaky.

The transition from walking boot to shoe: step by step 

How to transition from a walking boot

When you first get out of a boot, resist the temptation to wear shoes for the entire day. It would be best if you gradually weaned out of your boot over a short period. Your doctor should direct the length of time you wean out of the boot. When out of the boot, you should wear supportive shoes, such as running trainers with good mid-foot support. Avoid wearing poorly supportive work shoes, sandals, or flip-flops.

Below is an example of weaning out of the boot over two weeks. This protocol is suitable for fractures or stress fractures.

Day 1-4:  out of the boot for an hour in the morning and an hour in the afternoon

Days 5-7: out of the boot for 2 hours in the morning and 2 hours in the afternoon

Days 8-12: out of the boot for 3 hours in the morning and 3 hours in the afternoon

Days 13-15: out of the boot for 4 hours in the morning and 4 hours in the afternoon

Day 16: entirely out of the boot

You must carefully control your total step count for the first two weeks while you wean out of your boot. We suggest aiming for a 50% reduction in your normal step count. So, if you average 8000 steps per day, you should aim to keep the step count between 4000 and 6000 steps.

If you develop pain during this weaning period, slow your progression and wait for your pain to settle before moving on to the next stage. Sometimes, you may need to wean out of a boot over four weeks. 

Physiotherapy 

Once you start wearing shoes, rehabilitation is essential. You should see an experienced physiotherapist to help stabilise and strengthen the ankle and foot.

Strengthening exercises help reverse muscle atrophy from immobilisation. Examples include ankle circle exercises, theraband strengthening, and calf raises. Calf and mid-foot stretching and mobility exercises also help. You need to work on your balance by standing on a single leg with your eyes open and then closed. You can make these exercises harder by balancing one foot on an uneven surface or a bosu ball. 

Cross-training while wearing a walking boot

Continuing cross-training activities to maintain your aerobic conditioning and upper and lower body strength is also essential.

A good exercise to maintain your heart and lung capacity includes swimming (without a boot) and using an upper body grinder machine. Upper body strength training is allowed. Lower body strength training is also acceptable, but you should avoid exercises that load your calf and ankle. The rule of thumb is to avoid exercises where the foot is in contact with the ground, such as calf raises, squats and deadlifts. Machine knee extensions and machine knee curls are acceptable alternatives.

Once you wear regular shoes, you can introduce other exercises, such as cycling, squats, lunges, and deadlifts. However, you should only wear supportive trainers while performing these exercises.

Your physiotherapist should direct your return to running and sport. For stress fractures, we generally recommend a graduated walk/run programme. See this blog for an example of a graded return to running and sports after a distal fibula stress fracture.

Another device that may assist end-stage rehab and your return to running is the anti-gravity machine, also known as Alter-G. An anti-gravity treadmill uses air pressure technology to reduce body weight load on the lower limbs while allowing the user to walk or run. The most well-known version is the Alter G training. The machine consists of a standard treadmill enclosed in a pressurised air chamber. The user wears a compression garment that zips into the chamber, creating an airtight seal around the lower body. Once secured, the treadmill can reduce body weight by up to 80%, allowing for low-impact movement. 

Final words from Sportdoctorlondon regarding the transition from walking boot to shoe

Transitioning from a walking boot to a shoe doesn’t happen overnight. It would be best to slowly wean yourself into regular shoes while working on regaining ankle and foot strength, flexibility, and balance.

Related conditions:

• Stress fracture of navicular 
• Stress fracture of the fibula 
• Stress fracture of the calcaneus 
• Talar stress fracture
• Jones stress fracture 
• Stress fracture management
• Anti-gravity treadmill