Your physical therapist recently examined your leg and determined it was time to transition from a walking boot to a normal shoe. You’re elated at the news, but you quickly realize your foot isn’t ready for the change.
The foot muscles feel weak, the skin feels sensitive, and your body assumes an unnatural gait pattern when walking in normal shoes. It’s important to understand that your foot needs rehabilitation to restore motion and strength before resuming normal activity.
This gradual process requires giving your foot time to relearn walking in shoes. Here’s a guide to make the transition easier.Â
What is a Walking Boot?
A walking boot is an orthopedic device prescribed by doctors or physical therapists to facilitate the treatment of fractures, severe tendon tears, and sprains in the ankle or foot. It’s also known as a controlled ankle motion walking boot (CAM walker) or a walking cast.Â
Doctors prescribe it after surgery for foot, ankle, and lower leg injuries to provide stability and keep your leg as mobile as possible during recovery.
Walking boots vary by height depending on the condition being treated. The most common types are mid-calf and knee-length walking boots. Some walking boots come with a plastic shell that encloses the back and the sides to enhance the protection of the injured area.Â
Following your doctor’s advice is critical to a speedy recovery, but a few tips for wearing a walking boot also come in handy:
- Keep the walking boot dry: A wet boot creates an environment for bacteria and mold growth, exposing your foot to more infections. The boot also becomes heavier, slowing you down and aggravating the injury.
- Wear a sock liner: The sock provides extra cushion for the foot, reducing impact between the skin and the walking boot. The extra cushion also reduces pain and discomfort if walking in the boot all day.
- Avoid bending the knee when walking: Bending the knee only strains the foot and aggravates the injury. You must walk upright from the knee to avoid mounting extra pressure on the injury for long.
- Use a shoe balance: You must wear a shoe balance on the other foot to provide balance and add extra height to match the walking boot. The extra height also goes a long way in balancing both feet and reducing pain when walking.
- Use a crutch: A crutch reduces the pressure on your foot and eliminates the need to wear a high-heeled shoe on the other foot. The crutch must be sturdy enough to provide stability while walking.Â
You should avoid walking without the walking boot and keep it on at all times until you are instructed to remove it by your doctor.Â
When is the Best Time to Stop Wearing a Walking Boot?
If you’re wondering when to stop wearing your walking boot, the answer varies by the healing time and the doctor’s recommendations. Typically, the healing time for bones is 6-8 weeks; for ligaments is 6-12 weeks, while tendons take 4-8 weeks, depending on the extent of the injury.
The doctor will perform an X-ray to determine if it’s time to remove the walking boot or not. The doctor may recommend wearing the boot longer if:
- You have a fracture
- The person hasn’t healed
- Failure to rest the injured foot
- There’s significant muscle damage to the foot
How to Transition to a Normal Shoe
A common misconception is that a patient can wear a normal shoe immediately after removing the walking boot. This is a pretty rare occurrence. Orthopedics recommends gradual weaning to reduce pain and allow safe healing during the transition. Here are a few pointers to ease the transition process.
Physical Therapy
The first step in transitioning out of a walking boot is physical therapy. It’s a rehabilitation method that helps strengthen and stabilize the ankle joint after injury. Your therapist is likely to recommend non-weight-bearing exercises like ankle circles and resistance band exercises and increase the difficulty of the exercises after removing the boot.
At this point, the therapist will perform an X-ray to determine the extent of your recovery while allowing partial or full weight-bearing in an orthotic shoe. If the bones appear healed, your foot is ready to wear a normal shoe without weight-bearing support items.
However, the therapist may recommend partial weight bearing if the injury involves a foot or ankle fracture. Remember that mounting too much weight on the injury prolongs the healing process and the time you need to wear the walking boot.
Take a Foot Bath
It would help if you took a foot bath twice a day in warm water to soak off the dry, flaky skin. It would help if you avoided scrubbing or scratching it because it can break easily, increasing the risk of infection. Use a dry towel to pat it dry before applying a moisturizer.
The moisturizer must be unscented, as scented ones may have ingredients that irritate the skin. Sometimes the skin appears red after a bath because it’s accustomed to not wearing the walking boot.
You can ease the redness by wrapping it in a towel soaked in cold water for a few minutes. Also, if you want to shave, wait for three days when the skin no longer feels sensitive. Shaving right after removing the walking boot leaves the skin susceptible to cuts and infections.
Use Weight-bearing Support Items
Since your foot and ankle muscles are still weak, your doctor may limit the weight you can mount on your leg. As a result, they will likely recommend using weight-bearing support items like crutches, a wheelchair, or a knee walker.
Perform Foot Exercises
Foot exercises help strengthen the muscles and reduce stiffness and pain in the leg. Your therapist may recommend a range of foot exercises depending on your recovery progress, using items such as resistance bands to make the exercise more challenging.
Ankle Circles
You can perform this exercise sitting or standing up. Lift the heel of the injured foot off the floor and rotate the ankle clockwise in circles for 20-30 minutes.
Ankle Plantar Flexion
The exercise strengthens the foot, leg, and ankle muscles which support plantar flexion. Plantar flexion is the movement that allows pointing your foot downward, away from the body. You can wrap a resistance band around the foot and hold the ends to increase resistance when performing the exercise.
Ankle Inversion
This exercise strengthens the ankle muscles used to enhance ankle stability. You need to sit and attach the resistance band to a stable object. Then tie the other end around the injured foot and use your foot to pull the band outwards and upwards.
Ankle Eversion
It’s similar to ankle inversion exercise, except you push your foot inwards and downwards against the band. Ankle eversion exercise also helps one regain stability and movement after an injury.
Ankle Dorsiflexion
Wearing a walking boot for an extended period causes the shin bone to grow stiff. As a result, the bone gets stuck in a vertical position causing the top of the body to lean forward to make up for the immobility of the ankle when squatting.
You need to sit on the floor and stretch your legs to perform the exercise. Then secure the resistance band around a table leg or chair and wrap it around the injured foot. Next, point your toes toward you and resume the initial position. Three sets of 10 flexes, thrice a week, should restore mobility.
Ankle Alphabet
The exercise improves the range of motion at the ankle joint and helps stretch the muscles around the ankle. The muscle movements also enhance ankle strength which is critical to improving balance. You must sit in a chair and lie flat on the floor. Then lift the heel of the injured foot off the floor and use your foot to write the letter of the alphabet. Do it three times a day.
Wear an Orthopedic Brace
An orthopedic brace goes a long way in helping your foot resume normal activity. The beauty of this support item is that you don’t have to wear it all the time. You can remove it at night and during the day to perform range-of-motion exercises.
A therapist will recommend an ankle brace that unloads or offloads the ankle as it absorbs most of the impact, reducing pain. The tape and lace-up support is an excellent brace during this transition period. It has a soft bottom, and the ankle brace design doesn’t unload the weight on the ankle.
Alternatively, you use a semi-rigid hinged-cuff ankle brace with a cuff encircling the posterior of the lower leg. This design is most effective at minimizing pain because you encircle the ankle and the lower leg in a vertical and horizontal plane, providing a stable platform for absorbing impact.
Weaning From Walking Boot to Shoe
After getting full-weight-bearing status, you’re ready to wean out of the walking boot. You can add more stress to the injured area without support items. The therapist may recommend removing the boot for an hour in the morning and an hour in the afternoon or the evening, depending on your work schedule.
The weaning period differs depending on one’s recovery and severity of the injury, but most boot weaning protocols last for six weeks. Here’s an example of a six-week weaning program:
- Days 1-10: Remove the walking boot for 1-2 hours and wear a good running show
- Days 11-21: Remove the walking boot and wear the shoe for 2-3 hours. Then wear the boot for the rest of the day
- Day 22-32: Remove the walking boot and wear the shoe for 3-4 hours. You can break it into two sessions (morning and in the evening), then wear the walking boot for the rest of the day
- Day 33-43: Remove the walking boot for 4-5 hours and wear the boot for the rest of the day
- 7th week: You should be ready to remove the walking boot and wear a normal shoe longer without aids
Besides removing the walking boot, the therapist may recommend performing a range of exercises to improve balance. Exercises like standing with one foot in front of the other to train the receptors in the ankle joint or standing with your feet together come in handy.
What Happens After Removing a Walking Boot?
Your foot is likely to exhibit a range of reactions after removing the walking boot:
Stiff and Swollen Joints
For some people, the foot develops pain after removing the walking boot, while others experience stiff and swollen joints. You can place cold gel packs on the foot to ease the pain, reduce inflammation, and improve circulation or administer non-steroid anti-inflammatory drugs (NSAIDs) like ibuprofen.
Muscle Atrophy
Muscle atrophy causes the leg to appear thinner, while the ankle or knee becomes stiff because the muscles become constricted for an extended period. Walking strengthens the muscles, helping your leg to resume its normal size and function.
Skin Appears Dry and Flaky
The skin remains covered for extended periods with little or no moisturization. Also, blood flow is restricted, which means there’s little nourishment in the skin, causing it to become dry and flaky.
Best Shoes to Wear After Walking Boot
Your foot may be ready to wear a normal shoe, but it doesn’t mean you can wear standard footwear. At this point, there’s a standard room for error; even the slightest mistake could send you back to wearing the walking boot.
You want to avoid wearing high heels, sports shoes, pointy shoes, or hiking boots. A good rule of thumb is to look for a shoe that helps relieve the foot's pressure. It should also be comfortable (e.g., a square-toe design shoe) and have ample depth to accommodate swelling or dressings.Â
Here are examples of the best shoes for walking without your walking boot.
This post-op shoe gives you the support and stability you need when transitioning to a normal shoe. It has a non-skid tread for extra stability and a firm rocker sole that supports the ankle while absorbing impact to minimize pain. Moreover, the shoe is incredibly light, and its square toe box design provides ample bandage space. The shoe can be worn on the right or left foot.
It’s similar to our first pick, except it’s more padded and breathable. What stands out about this shoe is the rocker-bottom style that promotes a natural gait and reduces plantar pressure. It also has a square-toe design that acts as a buffer for your toes while providing ample lift to your ankle. Its traction tread has a non-slip groove that enhances stability when walking to prevent re-injury.
If your child needs to transition from a walking boot, or you yourself need a smaller shoe, then this pediatric post-op shoe is an excellent pick. It features a molded heel collar that secures your foot and reduces slipping. Its semi-rigid construction still provides ample comfort, and with the adjustable Velcro straps, you can find the most comfortable fit for your foot. The open style encourages airflow for maximum breathability for all day comfort and wear.
Final Thoughts
Transitioning from walking boots to normal shoes isn’t easy, but with proper guidance, you can quickly resume a normal life. Physical therapy, foot baths, and ankle braces ease the process, but you must adhere to the doctor’s instructions. Remember, the process is gradual and differs from one individual to another. You must avoid being hasty as you could re-injure your foot.
