Majority Of Patients Prescribed Rocker Boots Do Not Need Them

Picture from Orthomed.ca

My patient came in to our clinic with a rocker boot recently. My opinion was that she should never have been prescribed one. She just had a very mild ankle sprain. Actually, the majority of patients that I have seen coming in to our clinics in a rocker boot do not actually need them. When patients are immobilized, there are side effects from wearing the boot. 

Have a look at how quickly another patient's leg had lost its size and, of course, strength after wearing a rocker boot pictured below.

See the size difference?

Rocker boots are often over prescribed. And patients who do not know better use them for way too long. I have a cupboard in our clinic with a collection of expensive boots, donated by patients so we can loan them to patients who actually need them.

These rocker boots are also known as controlled ankle motion (CAM) boots in published studies. They are below knee devices prescribed for managing foot and ankle injuries when there is a need to reduce ankle range of motion (ROM) and to take load off the foot and ankle while allowing ambulation during recovery. 

What's good with the CAM boots are that they can be prescribed as an alternative to plaster cast bacause they cabn be removed to allowed the fracture/ wound site to be cleaned and regularly checked. When used correctly, CAM boots improved mobility, decreased hospital stays and allows for earlier return to work.

There is still a lack of clarity within the current literature over biomechanics and the effectiveness of CAM boots.

A systematic review (Stolycia et al, 2024) published last year found that compensatory mechanisms occur at the hip and knee joint during CAM usage. This is a result of the incurred leg length discrepancy (LLD) caused by the thickness of the CAM boot sole when used with standard footwear on the non injured side.

This has been found to cause secondary site pain specifically at the ipsilateral (same side of ankle injury) knee and contralateral (opposite) hip and lower back with 1 out of 3 patients reporting new or worsened pain 3 months post CAM boot wear.

There was actually a study (Harvey et al, 2010) that suggested that the incurred LLD can also cause development of knee and hip osteoarthritis later in life. This may be true for older patients who may have an early onset or worsening of osteoarthritis at the knee and hip due to overuse caused by the increased load.

Of course there are occasions where they are needed. The findings of this systematic review (Stolycia et al, 2024) show that CAM boots are useful when needed to decrease pressure from the forefoot. but not the hindfoot. This can be useful for diabetic patients for treating plantar ulcerations or in patients with a toe fracture(s) in the forefoot.

The review (Stolycia et al, 2024) also found that tall (compared to short) CAM boots (pictured above) are more effective at restricting ankle ROM. So unless you have a fracture there, wearing the boot will severly reduce your ankle ROM. For those who do, as as soon as the fracture heals, you need to stop wearing it.

So, if you have been prescribed to wear a rocker boot, please understand the rationale for it, the plan, and the timeline that you need to be in it. For many patients, they stay in their rocker boot way too long for their condition. 

To sum up, question your healthcare professional if you are asked to use one. Very often they are not necessary.

Reference

Stolycia ML, Lunn DE, Stanier W et al (2024). Biomechanical Effectiveness Of Controlled Ankle Motion Boots: A Systematic Review And Narative Synthesis. J Foot Ankle Res. 17(3): e12044. DOI: 10.1002/jfa2.12044