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 boot.
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. Evenup is a fantastic device to make your walking more comfortable.
- Keep the walking boot dry. A wet boot adds weight making it more difficult to walk. Also, moisture 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, you should 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. You should wear supportive shoes such as running trainers with good mid-foot support when out of the boot. Avoid wearing poor supporting work shoes, sandals or flip-flops.
An example of weaning out of the boot over two weeks is described below. 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 4000-6000 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
Rehabilitation is essential once you start wearing shoes. You should see an experienced physiotherapist to help stabilise and strengthen the ankle and foot.
Strengthening exercises assist in reversing 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.
Examples of good exercise to maintain your heart and lung capacity include swimming (without a boot) and 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 normal shoes, you can introduce other exercises such as cycling, squats, lunges and deadlifts. But you should only wear supportive trainers while performing these exercises.
Return to running and sport should be directed by your physiotherapist. For stress fractures, we generally recommend a graduated walk/run programme. See this blog for an example of a graded return to running and sport after a distal fibula stress fracture.
Final words from Sportdoctorlondon regarding the transition from walking boot to shoe
Transitioning from a walking boot to shoe doesn’t happen overnight. It would be best if you slowly weaned into a regular shoe while working on regaining ankle and foot strength, flexibility and balance.
Thanks for the useful info, Dr. Masci. Do you have any suggestions for an intermediate type of ankle brace that can help facilitate the transition from a walking boot back to street shoes if that transition is proving unusually troublesome and/or painful?
Hi good question – most ankle braces made for ankle sprains should do the trick. I’d look at options on Amazon.
LM
Hello, thank you for your advice very helpful. I sustained a right ankle avulsion fracture or CAM boot for 8 weeks. Now in an ankle brace but not sure about which sneakers to wear. I will be starting physio shorty for about 6 weeks. I am still having some pain in both ankles, but I think that is just from wearing the boot Can I only wear sneakers? Can I wear a flat or very low heel boot?
Hi Lisa, I recommend a shoe with a supportive heel and mid-sole. So a well-fitting walking or running shoe will provide support while you’re working with a physical therapist on range of motion, strength and balance.
LM
Very good tips most important use common sense don’t rush it all takes time and patience
Great advice . I have a calcaneous fracture left foot from a high fall . I’ve had booton 8 wks. Now in 2 weeks to distribute weight . This I find hard. No physio offered advised to do it on my own . Worried I could be making foot worse . Any thoughts on my situation would help .
Hi Susan, i’d strongly advise you see a physio to help you transition to normal footwear especially after such a nasty fracture.
LM
There are a couple good support groups you could join on Facebook. Fractured Heel Fighters and Broken Hell/Calcaneus Support Group. Hope your heeling is going well!
Hi Dr. Masci. I recently sustained a third metatarsal stress fracture. I have been wearing a cam boot for eight weeks. Last x-ray showed stress fracture was almost completely healed. My question is should I transition from the Cam boot to a sneaker ( wear the boot for a few hours, and switch to the sneaker for a few hours) or just start wearing a sneaker all day?
My podiatrist did not really advise one way or the other.
I’d wean out of the boot slowly – as discussed in the blog.
LM
There are a couple good support groups you could join on FB. Fractured Heel Fighters and Broken Hell/Calcaneus Support Group. Hope your heeling is going well!
I got navicular fracture 8 weeks ago, I had a pop cast through all 8 weeks, now when I walk 50% weight bearing with the scratches there seems some swelling after I walk, I generally walk 5 minutes a day 3 times
swelling is common after POP or cam walker boot. i’d use calf compressive stops and keep your foot up when you’re resting. Swelling should settle.
LM