CAM Boot / Walker Fittings

Controlled Ankle Movement, CAM boots, CAM Walkers – or the more commonly known ‘Moon Boots’ – are orthopaedic devices often worn after a patient has experienced a bony injury to the foot or lower leg. They are prescribed to help immobilise the ankle and foot whilst the patient continues to move around, as an aid to healing and recovery.

They are most effective when fitted by a trained professional such as a Podiatrist who can make the appropriate selection of which type and size best suits the patient; and demonstrate how to correctly fit the device.

At Your Foot Clinic, our Podiatrists will:

• Select the most appropriate boot for the injury and patient
• Fit the boot comfortably whilst maximally limiting ankle and foot movement
• Train the patient to manage their device at home
• Fit a heel raise for the opposite foot to avoid secondary issues developing as a result of having an uneven hip height caused by wearing the device

When are CAM Boots Worn?

CAM boots are usually worn when a patient has suffered a bony injury or undergone a surgical operation to the foot or ankle. Here are some examples of the injuries and conditions where a CAM boot might be part of the treatment:

• Fractures of the foot, ankle or lower leg
• Ligament strains and sprains of the foot or ankle
• Tendon tears, ruptures or soft tissue injuries
• Plantar heel pain and plantar fasciitis
• Plantar fascia or Achilles tears.

Sometimes a patient has already been diagnosed with an injury when they make an appointment to see us; other times we make the diagnosis and then may also recommend specific investigations or scans to properly assess the severity of the injury and the exact treatment needed.

Here are the two scenarios explained in a little more detail:

• A patient presents at one of our Clinics and we suspect there’s an injury. If this is the case, we’ll send the patient for scans (xray, CT, ultrasound or an MRI) to provide a clear picture of the nature of the injury
• A patient has been told they have a fracture by a hospital, their GP or Physiotherapist and it’s been recommended  that they see a Podiatrist to have the injury managed and a CAM boot professionally fitted.

The purpose of wearing the CAM boot is to promote proper healing of the injury. Because the boot immobiles the foot, patients can still move around but the foot is held in place. The stiff ‘rocker’ sole means patients don’t need to use the muscles and ligaments in the foot when they move. In the case of a fracture, holding the foot in place and taking this pressure off, gives the bones the best chance of fusing back together in the correct position. When this does not happen, the bones tend to develop calluses as they heal which makes them ‘bulky’ and can cause arthritis.

Alongside the CAM boot, we’ll also make other recommendations as part of a patients’ treatment regime to help with recovery. These might include using ice, pain medication, rest and elevation alongside specifics about the number of hours per day the device should be worn for.

Important Considerations When Wearing a CAM Boot

Selecting a Boot

Once we’ve diagnosed, assessed and discussed the course of treatment with a patient, we will choose the appropriate type and size of boot for the patient. Then we’ll demonstrate how to fit it, and take it on and off.

Selecting a Boot – Size 

The base plate (i.e. the bottom of the boot) is specific to foot sizes so we’ll select the boot that fits the foot the best.

Selecting a Boot – Type

We’ll choose either an ankle (low top) or knee-height (lower leg) CAM boot depending on both the injury and what feels more comfortable for the patient. We’ll make sure the CAM boot is offloading pressure through the foot which, in turn, provides the greatest support and immobilisation for promoting healing whilst allowing the patient to move around. We discuss with patients which option is the most suitable for them because we want the boot to be practical whilst also reducing pain and movement.

Fitting a CAM boot

CAM boots have a pumping mechanism to inflate the inner layer of the boot. This inflation provides compression around the foot and leg so that it fits snugly to hold the joints and ligaments in place while they heal properly. This inflation can be adjusted to accommodate any reduction in swelling as the injury heals.

We show patients how to fit the boot themselves using the inflation mechanism and Velcro straps to achieve a comfortable and effective fit. The Velcro straps along the foot and leg section of the boot ensure a close fit around the area for optimal support so it’s important that patients leave the Clinic feeling confident about how to manage their device at home.

The CAM boot has a thick sole to offer the support needed for immobilising and healing. This means that the leg wearing the boot is higher off the ground than the unaffected foot which can lead to the hips being uneven and an altered walking style. We often fit a heel raise for the patient’s other foot to level out the hips and avoid secondary issues (such as back problems) arising as a result of wearing the CAM boot.

Wearing a CAM Boot

There’s no denying it, CAM boots can be a little cumbersome to walk in! This in itself, assists the area to heal as patients are usually deterred from undertaking their usual amount of activity. During the selection and fitting of the boot, our Podiatrists try to be realistic so that patients feel comfortable in their day to day whilst getting the best support for their injury.

Usually patients will need to wear the CAM boot for 6 – 8 weeks until the bones are healed completely. Managing the change in lifestyle during this time is important and here are some things we advise patients to consider:

Sleep
Depending on the nature of their injury, some patients will need to wear the CAM boot 24/7 and therefore sleep with the moon boot on. As much as the foot can be immobilised the better. We can move around a lot in our sleep so wearing the boot during the night ensures the foot is protected. This needs to be balanced with comfort however, and if wearing the boot at night prevents a patient getting good quality sleep then we may advise to remove it.

Driving
CAM boots – whether ankle or knee-height are larger than a shoe. This can mean that normal tasks are not possible. Patients should check with their insurance companies as to whether it is deemed safe to drive if they have a CAM boot on their left foot. Driving is impossible if the device is fitted on the right foot.

Crutches
Depending on the severity of the injury, some patients will be given crutches to assist their movement in the first few days or weeks of injury.

Once the CAM walker fitting is no longer needed, we offer ongoing support for patients’ rehabilitation. If the injury has required the patient to wear the CAM oot for many weeks then it can cause the muscles in that foot and leg to begin to deteriorate and weaken. We try to avoid these secondary problems by making sure the boot isn’t worn for any longer than necessary. A program of exercise to strengthen and rebuild the muscles around the foot, ankle and leg can help patients once they’re fully mobile again, to get back to their usual routines.