Unfortunately with some ankle injuries, the joint needs to be immobilized. If it’s possible to be weight bearing while your ankle heals, your doctor might prescribe an ankle immobilizer, or walking boot. In some cases you might need an assistive device such as a cane, crutches or walker. After spending weeks to months in an ankle immobilizer, how do you safely wean out of the boot? Hopefully after an ankle injury you are working with a physical therapist (PT). Under the supervision of your doctor and physical therapist, you can safely wean from the immobilizer and assistive devices without injuring other areas of your body such as your low back or hips.
If at all possible, health care providers try to avoid immobilizing a joint if at all possible. Immobilization is never ideal as it leads to stiffness and weakness of a joint. However in some cases, in order for the joint to heal properly without further damage, the joint must be immobilized. The length of time that you are immobilized may depend on a couple factors such as the severity of the injury, or the patient’s age for example. The longer a patient is immobilized, the greater the risk for developing stiffness or weakness of the injured joint, adopting poor gait mechanics, and ultimately developing pain in other areas due to compensation. Such areas that are at risk are the hips and low back.
While the ankle immobilizer is necessary in some cases, the bottom of the boot or immobilizer is often built up, when compared to the foot ware being used on the uninvolved lower extremity. This leads to an imbalance at the hips and spine. The patient should try to obtain a heal lift for the uninvolved leg, or try wearing a shoe with a higher heal. This will help level the hips, reducing stress on the spine. Consult with your doctor or physical therapist about the need for assistive devices during your time in the immobilizer. It is impossible to have a normal gait pattern while using an ankle immobilizer. An assistive device such as a crutch or cane might be necessary to normalize your gait pattern as much as possible, reducing stress on the hips and low back.
At some point you will be asked to wean from the ankle immobilizer. There might be different strategies when attempting to wean from the boot. You should consult with the doctor or therapist as to what strategy is best for you. Very rarely can someone stop using the immobilizer and assistive devices “cold turkey”. One simple way to start this process is to walk at home without the immobilizer using one or two crutches for example. As you continue to rehabilitate you might be able to start walking out doors without the immobilizer if you’ve been cleared by your doctor or therapist to do so. In short, if you are comfortable at home without any braces or devices, you could potentially start community ambulation with one crutch for example.
In summary, if you encounter any low back pain or hip pain during your time in the ankle immobilizer, talk to your doctor or therapist immediately. If caught early, the pain could be easily managed conservatively.
About The Author: Jeremy W. Przybylo, PT, DPT, DMT is the Prairie Spine and Pain Institute’s lead physical therapist. He is a key component of our integrated care program. Jeremy works one-on-one with patients to perform an initial evaluation that allows him to design a comprehensive treatment program tailored to each individual. He typically works with patients weekly, utilizing a combination of hands on manual therapeutic techniques and a scientific approach to rehabilitative exercise.