Advice for Patients with a Walking Boot

Due to your recent lower limb injury you have been supplied with a walking boot. The support, protection and stability offered by the walking boot allows for a gradual increase in weight bearing activity on the injured limb, while providing the necessary support as it heals. Being removable, it allows for regular wound inspections and for washing of the limb.

Application of your walking boot

• Open all Velcro straps
• Undo padded liner
• Slide foot into boot, making sure the sole of the foot is touching the bottom of the boot and the heel is right back
• Tuck the padded liner in around the foot and ankle (adding extra padding if needed)
• Tighten all Velcro fastenings, making sure the foot feels secure inside the boot.

To maintain good care of your supplied walking boot

• It should be worn underneath clothing, although a thin, cotton knee high sock can be worn
• The padded lining can be hand-washed
• Extra padding supplied can be placed where needed for extra comfort
• Check regularly for pressure areas from straps. Adjust straps as swelling fluctuates.

Can I walk in my boot?

Your clinician will instruct how much, and when, weight is to be put through the injured limb during your appointment. This may gradually increase over a period of time and be pain-dependant. No weight should be put through the foot if the boot has been removed (eg when washing or sleeping). Crutches may be necessary to provide balance when walking.

Can I remove my boot?

Your clinician will instruct on when you can remove your boot. This will include for washing, sleeping and to complete physiotherapy.

Exercises

It is important to exercise all joints not immobilised in your boot and to repeat every hour until fully functional. This helps to reduce swelling, stiffness, maintain some muscle strength, and improve circulation. This can be painful and difficult to start with, but should improve within the first week.

• Wiggle your toes regularly
• Fully straighten and bend your knee
• Gently clench the muscles in the back of your calf and thigh to improve blood flow
• Move your hip.

Driving

Your insurance may not be valid whilst you are being treated within a boot. It should be stressed firmly that patients DO NOT drive whilst wearing a boot.

After your boot has been removed

Due to the long period of time your limb has been immobilised, you may experience some of the following on removal of the boot, so don’t panic:

• You may find that your leg feels thin and strange; this is normal
• You may experience swelling, discomfort and stiffness in the affected limb. This is quite normal and may continue for several weeks. You may find it helpful to keep the limb elevated
• Your skin may be dry and itchy. Do not scratch; try using baby oil or moisturiser
• Your skin will be sensitive. Be careful if going in the sun and apply a sun block
• Physical activities eg manual labour, sport etc, should be reduced or avoided during the first few weeks after your boot has been removed

On the day of your follow-up appointment

You may require several treatments during your visit to clinic, such as x-rays and dressings. This, along with varying numbers of patients, means that sometimes you may have to wait longer than we would like, so we apologise for any inconvenience in advance.

DVT signs and symptoms

Due to immobilisation and reduced mobility, there is a higher risk of developing a DVT (deep vein thrombosis). It is important to stay as active as possible, drink plenty of fluids and be aware of the signs and symptoms.

Please contact the plaster room or the Emergency Department immediately if you experience any of the following:

• Pain in the calf, thigh or chest
• Sudden onset of shortness of breath with no physical exertion
• Swelling of the leg
• Increased/decreased warmth of the leg
• Redness in the leg
• Bluish skin discoloration.

Pressure ulcer

A pressure ulcer (or sore) is a type of injury that breaks down the skin and underlying tissue. A small number of high risk patients are at increased risk of developing a pressure sore in a boot which severely reduces mobility.

• Make sure to regularly reposition your leg throughout the day so you are not constantly resting on the same area for long periods of time (every two hours)
• If you notice any discomfort or pain under the boot, most noticeably at the edges or heel, please contact the plaster room for urgent review
• Ensure the top or bottom of the boot is not rubbing and leaving red marks
• Don’t rest the leg on the heel for long periods of time and place a pillow under the leg.

Further advice and instruction

To be completed by the orthopaedic team.

Contact us if you experience any of the following

• Your toes become painful, swollen or blue
• You are unable to move the limb/joints
• You feel ‘pins and needles’ or numbness in the limb
• Any ‘burning’, ‘blister-like’ pain or severe irritation under the boot
• Discharge, blood staining or wetness
• Excessive itching

Please contact the plaster room where a booked appointment can be made for you to return for assessment. Arriving without a prior appointment may result in longer waits or having to return at a convenient time. Outside of plaster room hours, please contact your local Minor Injuries Unit or the Emergency Department if urgent.

Contact numbers

We hope that you have found this information useful. If you have any questions or are worried about anything, please speak to the following Dorset County Hospital staff:

Orthopaedic Practitioners James Vincent, Sarah Nelmes and Zara Penwell

Plaster Room: 01305 255498

About this leaflet

Authors: James Vincent, Senior Orthopaedic Practitioner and Sarah Nelmes, Orthopaedic Practitioner
Written: April 2020
Approved: September 2020
Review date: September 2023
Edition: 1

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk