Walking Boot - Advice for Patients

• The healthcare professional who provided the boot will advise on whether this can be removed at rest or at night or whether it should be worn at all times.  
• Do remove the boot daily to check skin condition.  
• Do remove the boot daily to wash the foot.  
• When putting the boot back on, always ensure it fits well.  
• Ensure padding is covering any plastic to avoid this touching the skin.  
• Do not place any objects into the boot as it may cause skin damage.

How to put the boot on 

1. Place heel into the back of the boot. Ensure the liner is covering all plastic areas so that these do not touch the skin. Do not slide the foot down into the boot as this may make the liner move out of position.

2. Close the liner using the three areas of Velcro. Shin, foot and toes.

3. Place plastic front on top of liner.

4. Fasten straps across the plastic - start with the middle strap.

5. Take caps off blue pumps on the sides and press both sides. This will pump air in to cushion the ankle. You may need to press the pumps a few times and should stop when the ankle feels well supported.

If you find you’ve put too much air in, press the silver buttons under the white caps to release air (see photo 6 in “How to take the boot off”).

How to take the boot off

• Release the air by pressing the silver buttons. 
• Undo straps. 
• Remove plastic front.  
• Undo Velcro liner.  
• Lift leg from boot. 
• Check skin for any areas of redness.

If you have any or all of the following, please contact or return to the fracture clinic immediately for further advice. If not acted upon early, these can develop into more serious issues, such as pressure ulcers:  

• Feeling of rubbing or blister-like pain or discomfort when the boot is on. 
• Presence of a wet or sticky discharge/fluid. 
• A sensation like a new pair of shoes rubbing.  
• A burning feeling in a specific area. 
• Discharge or staining of the liner of the boot. 
• Offensive smell from the foot or boot. 
• The air cast boot is broken, cracked or dented. 
• Raised temperature or fever with symptoms from the foot/ankle.  
• Excessive swelling or redness that does not improve within an hour, with elevation (resting with the affected leg positioned slightly higher than your hip).  
• Change in colour, temperature or sensation of the foot, including feeling icy cold, burning hot, pins & needles, numbness or stinging - that does not improve with elevation within an hour. 

The fracture clinic department contact details are at the end of this page.

Out of hours (From 4:30pm to 8:30am) you should contact or attend the Accident and Emergency Department instead of the fracture clinic.

When wearing this type of walking boot, there is a small risk of reduced blood flow to the affected limb or developing a Deep Vein Thrombosis (blood clot in the leg) and Compartment Syndrome (extremely painful limb swelling).

If you experience any of the following symptoms, please contact or go to the Accident and Emergency Department immediately:

• Pain in the calf, thigh, or chest.
• Sudden feeling of shortness of breath with no physical exertion.
• Pain that does not respond to painkillers.
• Pain which is out of proportion to that expected by the injury.
• Intense pain on passive movement of extremities.
• You notice or experience the following in your toes:
  • they appear blue or white
  • are swollen or painful to touch
  • become numb or cold
  • you continue to experience the sensation of pins and needles.

What is a pressure ulcer?

Pressure ulcers are a type of injury that breaks down the skin and the tissue underneath the skin. A small number of high-risk patients may be at risk of developing a pressure ulcer. The information below tells you what steps can be taken to reduce the risk. 

How do pressures ulcers develop?

Pressure ulcers can develop when pressure is applied to an area of the skin over a period of time. This includes when wearing a walking boot. The extra pressure disrupts the flow of blood through the skin. Without blood supply, the affected skin becomes starved of oxygen and nutrients and begins to break down. This can lead to an ulcer forming. 

Patients that are most at risk

The risk of developing a pressure ulcer could be increased for people who are wearing a walking boot. Pressure ulcers are common in people who need to lie in bed or who have to sit for long periods of time. Patients with a loss of normal sensation (neuropathy) are at increased risk of ulceration especially when wearing a walking boot. This is most common in some patients with diabetes. 

To reduce risk, it is advised that you: 

• Remove the walking boot at least twice a day to check your skin. 
• Make sure the walking boot is not rubbing or leaving a red mark on your skin. 
• Keep moving. Change the position of your limb in the walking boot as much as possible - at least every two hours. If you are able to stand take a few steps every 15-30 minutes.  
• If you have been advised to wear the walking boot in bed - place a pillow in between the knees to prevent the walking boot rubbing your other leg. 
• Drink plenty of fluids. 
• Contact the fracture clinic if you experience any discomfort from the walking boot.  

IF IN DOUBT, CALL THE FRACTURE CLINIC

• DO NOT drive while wearing a walking boot. 
• Your insurance may not cover you while you are wearing a walking boot. 
• Please refer to the DVLA “Driving with medical conditions” section for further advice. 

Infection control is important to the wellbeing of our patients so we have infection control procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections. 

We ask our patients and any visitors to use the hand gel before coming into and leaving the clinical area/hospital. The hand gel is situated at the main door of the hospital and at the entrance of every clinical area.

If you have any concerns regarding your treatment or injury please contact: 

Fracture clinic 

Lower Ground Level 

235 Euston Road 

London 

NW1 2BU 

Direct Number: 020 3447 3612 

Monday - Friday 08:30 - 16:30 

Main hospital switchboard: 020 3456 7890 

IN AN EMERGENCY: CONTACT THE ACCIDENT AND EMERGENCY DEPARTMENT