Casts and Braces
Some of my boots and braces, including my CAM boot an two different TayCo braces.
You may never develop affection for your walking boot, but odds are you’re going to spend a lot of quality time together.
FROM THE TRENCHES
Casts and boots inspire strong opinions. People celebrate getting into them, curse them while they’re wearing them and then discover that getting out of one doesn’t necessarily mean they’re free.
I was thrilled when I got out of my hated cast, and the CAM (moonboot) that my surgeon prescribed was certainly better than it. Not that I loved the CAM boot. The day I threw that club-like monstrosity in the trash with the dead banana peels and coffee grounds was a happy one.
My fracture friends had their own experiences.
One woman was told to begin weight bearing in a walking cast, but every step was so painful and awkward that it felt as though her knee and lower leg were being pushed backward. She wondered whether this was simply something she had to push through.
It wasn’t.
She went back to the fracture clinic, where they discovered that the cast had been set at the wrong angle. After it was replaced, she described walking in the new cast as “like a dream,” with a much more natural gait.
That’s worth remembering. Casts, splints and boots are rarely comfortable, and some awkwardness is inevitable. But severe pain, pressure, rubbing, numbness, a dramatically unnatural walking position or the feeling that something simply isn’t right deserves a call to your medical team. Recovery isn’t a contest to see who can tolerate the most misery (though sometimes it seems it is).
Then there’s the emotional roller coaster of cast removal.
One patient arrived thrilled to have her hard cast taken off. Her leg was swollen, a little dry and badly in need of a shave, but otherwise looked surprisingly normal. She was delighted when her doctor told her to start walking immediately in a boot and discovered that those first steps were easier than she expected. She went to the mall the next day, probably did a little too much, then went home to ice and elevate. Just getting out of the house felt like a victory.
Another person had almost the opposite experience. She had her cast removed and was put into a hard boot—which she thought felt heavier than the cast—only to learn that she still had three more weeks of non-weight bearing ahead of her.
She went home and cried.
Both reactions make perfect sense. Getting a cast removed can feel like a giant milestone, but sometimes the next stage comes with restrictions of its own. A boot may give you more freedom, or it may simply be a different form of confinement for a while.
And boots have their own learning curve. People figure out how tightly to fasten them, what socks feel best, whether they’re allowed to remove them for sleeping or showering, and how to negotiate stairs. Once weight bearing begins, the height difference between the boot and the other shoe can also throw off your gait and aggravate your hip, knee or back; some people find a shoe-leveling device helpful.
The encouraging part is that these stages really do pass. The cast that seems endless comes off. The boot eventually goes into a closet. Crutches migrate away from the bedside.
And one day, something that consumed nearly every waking thought becomes a piece of equipment you’re very happy never to see again.
From Protection to Freedom
After an ankle fracture or surgery, you may go through several different forms of support before you’re back in a regular shoe. A splint may become a cast, a cast may give way to a walking boot, and eventually you may transition to a brace—or simply to your own two feet.
There isn’t one standard progression. The amount of protection you need depends on your fracture, the stability of the repair, associated ligament or tendon injuries, swelling, bone healing and your surgeon’s preferences.
What all these devices have in common is a changing job: first to protect healing structures, and later to provide enough support while your ankle gradually starts doing its own work again.
The Post-Surgery Splint
Many people wake up from ankle surgery in a splint rather than a full cast. A splint provides substantial immobilization but isn't rigid all the way around the leg, leaving room for the swelling that commonly occurs during the first days after surgery.
That room matters. Putting a freshly operated, rapidly swelling ankle into a completely circumferential rigid cast can create excessive pressure.
A post-operative splint is typically bulky, and it may extend from below the knee around the heel and foot. Layers of padding and bandaging hold everything together.
It isn't elegant, but it does the job: protect the surgical repair while the ankle gets through the earliest phase of healing.
Unless you've specifically been told otherwise, don't remove or alter a surgical splint yourself. Contact your medical team if it becomes wet or damaged, feels excessively tight, or you develop increasing numbness, tingling, discoloration or pain that isn't controlled as expected.
Casts: Maximum Protection
A traditional cast provides rigid immobilization. Depending on the injury and treatment plan, it may be used after surgery or for certain fractures being treated without surgery.
The advantage is obvious: you can't accidentally move an ankle that has been immobilized.
The disadvantages become equally obvious once you're living with one. Casts are bulky. You can't simply take one off for a shower. Swelling can make the fit change, and weeks of immobilization contribute to stiffness and muscle loss.
But early in recovery, comfort and convenience aren't necessarily the priority. Protection is.
Some people never have a traditional cast at all. Others spend weeks in one. Your particular fracture and surgical repair—not somebody else's recovery timeline—determine what is appropriate.
MY TAKE ON IT
After my ORIF surgery, I woke up in a splint (cast material held on with elastic bandages and gauze) and wore it until my two-week post-op. It was very painful. As my leg swelled, it was tight and created a lot of pressure. That translated into pain. At my follow-up, my surgeon said she wanted me in a similar splint/cast for four more weeks. I was successful in communicating my discomfort—I cried and explained I had barely slept in two weeks—and she let me go into the CAM boot instead.
The CAM Walking Boot
For many ankle-fracture patients, the CAM boot—often simply called a walking boot—is the device they become most intimately acquainted with.
CAM stands for controlled ankle motion. These boots typically have a rigid shell, padded liner and rocker-shaped sole. Some models also have inflatable air chambers that can be adjusted as swelling changes.
Despite the name, being placed in a “walking boot” doesn’t automatically mean you're allowed to walk on it.
You can be non-weightbearing, partial weightbearing or weightbearing as tolerated while wearing a CAM boot. Those are separate instructions from simply being told to wear the boot.
In my case, I was non-weightbearing for four weeks in my CAM boot, and then I had another four weeks where I was allowed to walk in it, though I switched to another type of boot at that point (more on that later). The advantage of the CAM boot over the splint/cast is that you can take it off to shower (with your doctor’s permission), and you can adjust it at least a little for comfort. I was also allowed to take it off when I was fully awake and sitting or lying down.
Once weightbearing begins, the boot protects the ankle while allowing progressively more normal activity. Its rocker sole helps the body move forward without requiring the recovering ankle to bend normally with every step.
That's the theory.
In practice, walking in one can feel remarkably like having a small appliance strapped to your leg.
They're bulky and often hot. Straps can rub. Liners can become uncomfortable. Swelling may make a boot that fit in the morning feel completely different by late afternoon.
While non-weightbearing, I often went on long walks with my knee scooter. The hard plastic insert on the front of the CAM boot bruised my shin terribly, even after I put extra padding on the scooter’s seat. I ended up taking that piece off, which solved the problem.
Fit matters. A boot that's causing persistent pressure, skin injury, numbness or significant pain shouldn't simply be endured because suffering seems like part of ankle recovery. Ask your surgeon, therapist or orthotist to check it.
NOBODY TOLD ME...
When the cast or splint finally comes off and you’re cleared to shower, don’t be alarmed by the truly impressive amount of dead skin your foot sheds—it’s gross, but completely normal. (It’s also oddly fascinating. Who knew how much skin you grow on your foot?)
The Lopsided Problem
There's another problem with a walking boot that has nothing to do with the injured ankle.
It makes one leg taller.
The thick sole of a CAM boot can create a temporary leg-length difference, changing the way you stand and walk. That can contribute to discomfort in the knees, hips or back—areas that may already be complaining because you've spent weeks moving abnormally.
Shoe-leveling devices such as the EvenUp attach to the shoe on the uninjured foot to help compensate for the height difference. A shoe with a thicker sole may sometimes accomplish something similar.
This isn't just about comfort. As you begin walking again, the goal is eventually to recover a more normal gait rather than replacing one abnormal walking pattern with another.
Coming Out of the Boot
Getting permission to leave the boot sounds like liberation.
Then you take it off.
After weeks of having your ankle encased in rigid protection, an ordinary shoe can feel startlingly flimsy. Your ankle may feel weak, vulnerable or simply strange. Swelling can make shoes difficult to fit, and your foot may no longer tolerate the shoes you wore before your injury.
This is also where confidence can become part of the transition. You may medically be ready for less protection while your brain remains thoroughly unconvinced.
The transition doesn't necessarily happen in a single day. Depending on your surgeon's instructions, you may gradually increase the amount of time you spend in a regular shoe or use a lighter brace for additional support.
The important point is that the boot has eventually done its job. Staying in rigid protection longer than your medical team recommends isn't automatically safer; the ankle ultimately needs movement, strength and proprioception to function normally again.
The leg I injured was definitely fatter than it used to be, so I had to get some new boots, which is very common. I still have a bunch of heels in my closet that I can’t quite bring myself to throw or give away—but that I also can’t quite bring myself to wear.
The TayCo Recovery Brace
The TayCo Recovery Brace is worn outside a regular shoe rather than replacing the shoe with a traditional CAM boot. It’s designed as a functional alternative to the Aircast walking boot. According to its website, “Clinical studies have shown that it provides similar stability and protection compared to a traditional boot, while being lighter and easier to wear. It stabilizes the ankle externally, reducing strain on healing tissues while still allowing patients to maintain a more natural gait.”
It definitely isn't a standard part of every ankle-fracture protocol, and it isn't appropriate for every injury. Your surgeon may prefer the greater immobilization and protection of a CAM boot.
But shoe-mounted external braces are worth knowing about.
My surgeon didn’t approve this boot for me, and wanted me to stay in the CAM boot for four weeks after I became weightbearing. This meant my insurance wouldn’t cover it, setting me back about $180.
But unlike the CAM boot, my legs were level when I was wearing it, and I felt less off balance and prone to falling. And since I had regular boots on with it, I could actually wear it outside without getting my socks filthy—or getting stung by fire ants. Florida has a lot of them.
For me personally, it was a win.
Ankle Braces: Support Without the Boot
Once the ankle no longer requires the immobilization of a CAM boot, some people transition to an ankle brace.
There are many varieties, and trying to cover every model would require another book.
Broadly, braces range from flexible compression-style supports to lace-up braces, semi-rigid stirrup designs and more substantial external braces. Some fit inside a shoe; others attach around or outside it.
They also provide very different amounts of support.
A soft sleeve that makes an ankle feel secure isn't equivalent to a rigid brace designed to restrict certain movements. And a brace that is appropriate several months into recovery may be completely inappropriate several weeks after surgery.
That's why “Which brace is best?” isn't really the right question.
The better question is: What does my ankle need protection from right now?
Your surgeon or physical therapist can help determine whether you need a brace, what type of movement it should control and when you can begin reducing your reliance on it.
When Your Cast, Boot or Brace Is Hurting You
Some discomfort is almost inevitable. Significant or worsening problems deserve attention.
Contact your medical team if a cast, splint, boot or brace causes increasing numbness or tingling, unusual changes in skin color or temperature, severe pressure or rubbing, skin breakdown, dramatically increasing swelling or pain that seems out of proportion to what you've been experiencing.
A device intended to protect you shouldn't quietly be creating another injury.
Don't modify a cast or post-operative splint yourself. And before removing pieces, adding padding, changing the fit or abandoning a prescribed boot or brace because it's driving you crazy, ask whether the modification is safe.
ASK YOUR SURGEON
Before leaving an appointment with a new cast, boot or brace, make sure you understand the rules that come with it.
Ask:
Am I allowed to put weight on this, and if so, how much?
Do I have to wear it all the time?
Can I remove it while sitting or resting?
Can I remove it to sleep?
Can I take it off to shower?
Should I begin ankle movement when it's removed?
How snug should it be when my ankle swells?
What symptoms mean the fit is too tight?
Do I need a shoe-leveling device on my other foot?
When should I begin transitioning out of it?
Should I use a brace after the boot?
Are there activities for which you want me to continue wearing protection?
When can I safely drive?
And if you're considering a different brace or support device than the one you've been prescribed, bring it up. Your surgeon may approve it, may want you to wait until later in recovery—or may have a very good reason for saying no.
The Goal Is Less Support
Early in recovery, protection is everything. Your ankle has been fractured, repaired or both, and the last thing it needs is an unexpected twist, fall or load it isn't ready to handle.
But the purpose of all that protection is eventually to make it unnecessary.
The splint, cast, boot and brace are temporary substitutes for things your ankle will gradually have to provide for itself again: stability, strength, balance and control.
Moving from one level of protection to the next can be unsettling. That's normal. Each transition is also evidence that you've reached another stage of recovery.
The best brace isn't the one you can wear forever.
It's the one that helps you safely reach the point when you don't need it anymore.
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