7 Useful Tips about Walking Boots, from a Physical Therapist!

Walking boots are used in many different contexts

They can be purchased over-the-counter at pharmacies, but typically, when wearing a walking boot, it’s because a healthcare professional has prescribed it!

Here are the most common reasons why doctors, surgeons, and physiotherapists sometimes prescribe walking boots:

➡️ Ankle Sprain, Grade 1, 2, or 3.

One of your ligaments is stretched or torn, sometimes with associated bone avulsion.

Your healthcare professional believes it will heal better by limiting movement and impact on the ankle, thanks to the boot. Even though it’s not always prescribed systematically.

➡️ Fracture of one or more ankle malleoli.

Unlike a sprain that affects ligaments, a fracture involves bones. They often need more time to heal. Wearing a cast or a walking boot is often recommended for at least 4 to 6 weeks.

➡️ Fracture of another bone in the foot, or surgery (e.g., hallux valgus).

There are many other bones in the foot besides the ankle malleoli. The orthopedic boot is sometimes used to promote healing by limiting weight and other stresses on these bones.

➡️ Surgery or partial or total rupture of the Achilles tendon.

In the case of Achilles tendon injury, the walking boot is a way to reduce tension on the tendon for better healing.

➡️ Tibia or fibula fracture, whether operated on or not.

Here again, the boot can help limit stress on the bone for better healing while relieving your pain.

How to know if you need a short or tall walking boot?

❌ If the person who prescribed it to you didn’t mention anything about this, ask for advice from your physical therapist or pharmacist.

Generally, the more severe the injury (fracture rather than sprain, especially if the fracture is displaced), the more suitable a tall boot is.

✅ If the person who prescribed it to you recommended a specific boot height, follow their advice!

And if you find that the prescribed boot is too cumbersome or inappropriate, discuss it with your physiotherapist or pharmacist.

Where does this frequency estimation come from? I estimate that these indications are the most common based on the most frequent keywords typed into search engines by internet users, associated with “walking boot”!

Sometimes you can walk without crutches while wearing a walking boot

When a walking boot is prescribed to you, it’s generally to allow you to walk while bearing weight on the injured leg or foot.

Unlike a cast, which does not allow weight-bearing.

How do you know if you’re allowed to bear weight “as much as you want” on the leg with the boot?

✅ If you haven’t received any information about this in writing or verbally, it’s very likely that your injury allows walking with the boot.

Therefore, you can bear weight as much as you want, depending on the pain. And even without crutches if you are comfortable enough.

❌ Less commonly, a surgeon, doctor, or physiotherapist may have “prohibited” weight-bearing.

In this case, the walking boot is only there to limit leg movements and protect it from impacts, not to facilitate walking.

Therefore, you should not put weight on it, and you will need to walk with crutches without putting weight on the foot (or just lightly touching the ground).

Generally, you will have a follow-up appointment 4 to 8 weeks after your injury to assess progress and consider resuming walking with weight-bearing and eventually without crutches.

💡 Also see: how to walk with crutches with and without weight-bearing.

It may be appropriate to remove your walking boot for sleeping

If you haven’t received specific instructions about whether to keep the boot on at night or not?

✅ If you were instructed to wear it 24 hours a day, this implies wearing it at night as well.

❌ If you haven’t been given any instructions at all, feel free to seek the advice of a healthcare professional who is following your case and knows your medical history.

Generally, a walking boot can be removed at night if you are comfortable without it. In most cases, there is no risk to the healing process because you are not performing extreme movements for the ankle or leg while sleeping.

🚨 If you get up at night to use the bathroom and walk, theoretically you should put the boot back on, especially if you put weight on the leg.

Some people may prefer to sleep with the boot on even if they were told they could remove it because it’s more comfortable for them. This is not a problem.

How to sleep with a walking boot?

There is no particular risk associated with sleeping while wearing a walking boot. You can sleep in any position: on your back, stomach, or side.

Since the boot can be bulky, you may find it more comfortable to use pillows, a body pillow, or even a nursing pillow under your injured leg. It’s also best to sleep alone to avoid any disruption.

Can you work and drive (in some cases) with a walking boot?

Whether you can return to work with your walking boot depends on your specific job.

❌ If you work standing for long hours (several hours a day), taking a few weeks off work may be more appropriate. This allows for proper healing and recovery during this period.

If you have a physically demanding job where you lift heavy objects, the time off work may need to be extended even after you no longer wear the boot.

✅ If your job involves sitting, taking time off work may not be necessary. You can continue working while wearing your walking boot.

Another factor to consider for returning to work is if you need to drive to your workplace.

The law does not explicitly prohibit driving with a walking boot. However, it states that every vehicle driver must be constantly capable and positioned to conveniently and promptly carry out all maneuvers required of them.

💡 Also see: When to resume driving after an injury or surgery?

Washing with a walking boot requires some adjustments

Unless in a very specific case, you can typically remove your walking boot while showering.

If you are not allowed to put weight on your foot, you can install a non-slip plastic seat in your shower to shower while seated. These are called shower chairs.

There are also adapted seats for bathtubs: swivel chairs, bath stools.

These devices can be purchased or rented (from pharmacies or medical equipment and orthopedic stores).

If you are really afraid to remove the walking boot for washing, or if you have been strongly advised against it, you can:

• wash yourself while sitting on a non-slip seat and keep your leg outside the shower or bath;
• use a leg protector (or homemade plastic bag!) designed for legs (see on Amazon).

The connection between phlebitis, blood thinners, and a walking boot

When you have phlebitis, a blood clot forms in a vein, typically in the legs. Blood clots can be dangerous as they can detach and cause serious complications such as a pulmonary embolism.

You are more likely to develop phlebitis when you are more sedentary and walk less. Therefore, theoretically, when you wear a walking boot, you are at a higher risk of phlebitis because you are less mobile.

Depending on your health condition and medical history, you may be prescribed blood thinners, often in the form of injections. Blood thinners reduce the risk of developing phlebitis.

This is why blood thinners are sometimes prescribed when wearing a walking boot. It’s not directly related to wearing the boot itself but is associated with the injury or surgery that necessitates wearing a boot.

This is especially the case since compression stockings are generally not worn over the boot. Compression stockings are often prescribed to reduce the risk of phlebitis.

Several factors to consider when determining how long to keep the boot

There are at least 4 factors to consider when determining when you can remove your orthopedic boot:

1. the reason for wearing the boot (type of sprain, fracture, tear, or surgery);
2. your current health condition and medical history;
3. how you are recovering over the days and weeks;
4. your requirements, goals, and your own assessment of the benefit/risk of longer or shorter immobilization.

This is why your healthcare professionals are best placed to discuss relevant timelines in your case.

Generally, a walking boot is worn for between 2 and 8 weeks. There is often a follow-up assessment after a few weeks to evaluate progress and decide whether to continue wearing the boot or not.