We use walking boots to treat ankle and foot injuries, such as stress fractures — the boot allows the injury to heal. But the transition from a walking boot back to a shoe is just as important. You can’t expect to return to regular shoes overnight. This guide outlines how to transition from a walking boot to a shoe safely.
What is a walking boot?
A walking boot is an orthotic device prescribed by a doctor or physiotherapist to protect your ankle and foot after an injury or surgery. These boots are also known as CAM (controlled ankle motion) walker boots.
Walking boots can be tricky to wear comfortably. A few tips make life easier:
- Wear a sock liner. It protects your skin and adds cushioning.
- Use a heel lift or shoe balancer on the other foot. Adding height to the non-boot side evens up your leg length, which reduces hip and back pain and makes walking more comfortable. The Evenup is a good device for this.
- Keep the boot dry. A wet boot is heavier and harder to walk in, and moisture encourages bacterial growth and increases the risk of infection.
What happens after wearing a walking boot?
A walking boot protects the foot and helps healing, but it has downsides. Your ankle and foot joints become stiff and swollen, the calf and foot muscles waste from disuse, and the skin can become dry and flaky. This is exactly why a gradual transition — and rehab — matters.
How to transition from a walking boot to a shoe, step by step
[KEEP THE EXISTING rehab image here.]
When you first come out of the boot, resist the urge to wear shoes all day. Wean out of the boot gradually, guided by your doctor. When out of the boot, wear supportive shoes — running trainers with good midfoot support — and avoid unsupportive work shoes, sandals, or flip-flops.
Below is an example of weaning out of the boot over two weeks, suitable for fractures and stress fractures:
- Days 1–4: out of the boot for one hour in the morning and one hour in the afternoon
- Days 5–7: out of the boot for two hours in the morning and two hours in the afternoon
- Days 8–12: out of the boot for three hours in the morning and three hours in the afternoon
- Days 13–15: out of the boot for four hours in the morning and four hours in the afternoon
- Day 16: fully out of the boot
Carefully control your total step count for the first two weeks. Aim for about a 50% reduction from your normal step count — so if you usually do 8,000 steps a day, keep it between 4,000 and 6,000.
If pain develops during weaning, slow the progression and wait for it to settle before moving on. After a long period in a boot, you may need to wean over a period of four weeks rather than two.
Physiotherapy
Once you’re wearing shoes, rehabilitation is essential — see an experienced physiotherapist to stabilise and strengthen the ankle and foot.
Strengthening exercises reverse the muscle wasting from immobilisation: ankle circles, theraband strengthening, and calf raises. Calf and midfoot stretching and mobility work also help. For balance, stand on one leg with your eyes open, then closed, progressing to an uneven surface or a Bosu ball.
Cross-training while wearing a walking boot
Keep up cross-training to maintain your aerobic fitness and strength. Swimming (without the boot) and an upper-body grinder machine maintain heart and lung fitness. Upper-body strength training is fine. Lower-body strength training is acceptable too, but avoid exercises that load the 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 knee curls are good alternatives.
Once you’re comfortable in regular shoes, reintroduce cycling, squats, lunges, and deadlifts — wearing supportive trainers.
Your physiotherapist should guide your return to running and sport. For stress fractures, we generally use a graduated walk/run programme — see our graded return-to-running after a fibula stress fracture for an example. An anti-gravity treadmill (Alter-G), which reduces body weight by up to 80%, can also help with end-stage rehab and the return to running.
Frequently asked questions about transitioning from a walking boot
How long does it take to wean out of a walking boot?
For most fractures and stress fractures, about two weeks, following a graded schedule like the one above. After a long period in a boot (for example, many weeks or after surgery), you’re more deconditioned. You should wean more slowly — often over four weeks — under the guidance of your doctor and physiotherapist.
What shoes should I wear coming out of a walking boot?
A stable, supportive running or walking shoe that supports the midfoot arch and forefoot. Avoid unsupportive work shoes, sandals, flip-flops, and high heels early on. Well-fitting trainers are ideal while you work on range of motion, strength, and balance.
Is it normal to have swelling after a walking boot?
Yes — swelling is common after a cast or CAM boot and can take a while to settle. It helps to wear compression socks, elevate the foot when resting, and ice the area. If swelling is worsening or associated with significant pain or redness, get it checked.
Can I use an ankle brace to help with the transition?
Yes. If the transition is proving painful, a standard ankle brace (of the type used for ankle sprains) can bridge the gap between the boot and normal shoes. It offers support while you build strength and balance.
When can I drive after being in a walking boot?
Only once you’re safely out of the boot, in a supportive shoe, and can control the pedals comfortably and safely — including an emergency stop. For the right foot or a manual car, be cautious and check with your doctor and insurer before driving.
Do I really need physiotherapy after a walking boot?
Strongly recommended — especially after a longer period of immobilisation or after surgery. Physiotherapy reverses the stiffness and muscle wasting the boot causes, and guides a safe return to walking, running, and sport.
Final word from Sport Doctor London about transitioning from a walking boot to a shoe
Transitioning from a walking boot to a shoe doesn’t happen overnight. Wean out of the boot slowly while regaining ankle and foot strength, flexibility, and balance — and let pain guide the pace. When in doubt, work with a physiotherapist.
If you’re recovering from a foot or ankle injury and want a structured plan, Dr Masci can assess you in London and guide your rehab. Contact the team here or call +44 (0) 203 488 0350.
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
Thank you for this information. I fractured 4 metatarsals 6 weeks ago. I am currently slowly transitioning from the boot on doctor’s advice. I am due to see a physio next week and I have started simple, gentle stretching exercises. I still have a fair amount of swelling and my foot looks red in the morning. Some pain in the mid foot but not acute pain, more of an ache. I still have my foot elevated above my heart at night.
I note about still elevating my foot while resting. I had not been doing that. Is this keeping foot above the heart, e.g. is it OK to lie on floor and have my legs up on the sofa?
I am starting work again shortly. I am wondering how I am best setting up a work station/desks/chair for transitioning back to work. Thank you for any advice
Hi Christine, It will take a while for the swelling to settle. You don’t have to keep your foot about your heart necessarily. Perhaps use a chair with a pillow while sitting on the sofa.
You should do simple things at work to reduce your swelling – I’d wear compression socks. If you have access to ice, you can ice your foot in your break. Your physio will give you more practical instructions. Good luck.
lorenzo
Hello, my fibular was fractured during a surgical procedure not related to my ankle. It didn’t heal wearing a moon boot and after I requested an MRI at 5 weeks it was found to be 3mm displaced and there was * Diffuse marrow oedema throughout the lateral malleolus across the fracture line. * Split tear peroneus brevis at the junction of retromalleolar and inframalleolar segment. * Non insertional Achilles tendinosis. * Syndesmotic ligaments intact. * Moderate sprain of the
ATFL and CFL. * Immature scarring of the deep deltoid ligament complex.
Surgery followed 3 weeks later with a 13cm Arthrex Fibulock nail and 3 screws to stabilize the fracture and an ankle arthroscopy. I have now been in a moon boot for 15 weeks in total since the fracture first occurred. I am due to have x-rays in 2 weeks time. This will mean I have been in the moon boot for 15 weeks. How long should the boot weaning process be in this situation, 2 weeks or longer?
Hi Catriona,
!5 week in a boot is a long time, which means you’ll be more deconditioned and will need more therapy before you return to regular walking and other activities. You’ll need to transition out of the boot over a longer period of time – probably at least 4 weeks but you’ll need to be guided by your doctors and physiotherapists. The general principles will be the same assuming the fracture has healed appropriately. All the best. Lorenzo
I did two feet when i fell at easter only had o e boot on weber b fracture other foot 5th metatorsal my 6 weeks of boot wearing is in 3 days It still hurts when i walk How do u think i should do the transation on my feet
I think you should transition out of a boot over 2 weeks, although you should speak to your doctor first.
Lorenzo
Hi… I had a trimalleolar ankle fracture, 6 weeks in a cast and now in a boot for weigh bearing… this is going well and can manage few steps without crutches, mostly using just 1 crutch for walking… when not walking I’m icing and elevating ankle and doing ankle excersises… still have a lot of swelling of ankle… can’t get to physio appointment for 3 more weeks, and wondering if I’ll be able to wear shoes and drive a manual car soon… not too much pain
hi Emma, Given it is over 6 weeks since you sustained the fracture, I’d start transitioning out of the boot as discussed in the blog. However, i’d be a little more conservative with the transitioning leading up to your physiotherapy appointment in 3 weeks. Continue with anti-inflammatory measures to reduce the swelling.
LM
Hi I am 6 weeks post op surgeon suggested coming out of vaco cast boot and I am walking small steps indoors my ankle is still very much swelled am doing ankle exercises and have had 3 physio sessions I don’t know what shoe is ideal to wear when I am able to start walking.
Hi Lorraine, I’d suggest a stable running or walking shoe that provides stability to the mid-arch and forefoot – although you should speak to your doctor or therapist to discuss.
LM
Hi
I have a Weber B fibula fracture and have been in moonboot now for 5 weeks. Been re xrayed after 4 weeks and told it has/is healed well. Have been doing some exercises and have no ankle pain but have developed pain above patella due I guess to stairs in house and unevenness of moonboot v shoe height. To mitigate after 5 weeks in moonboot and increasing knee pain I’ve chosen to transition into my trainers for half days around home.
Is this appropriate?
Thank you for getting in touch and for such a clear account of your progress.
The short answer is yes — what you are doing sounds entirely reasonable. A Weber B fracture that has healed well on X-ray at four weeks, with no ankle pain and a good range of movement, is generally ready to begin transitioning out of the boot around this stage. The anterior knee pain you describe is a very common consequence of prolonged moonboot use — the leg length discrepancy and altered gait pattern place additional load through the knee, particularly on stairs, and it is sensible to address that rather than persevere unnecessarily with the boot.
Transitioning into supportive trainers for half days at home is a satisfactory approach. Just build the time gradually and be guided by your symptoms — some soreness around the ankle as it readjusts to normal footwear is to be expected, but sharp or worsening ankle pain would be a reason to ease back. As always, you should ask your doctor as to whether this treatment is appropriate.