🦶 CAM Walker Boot Protocol (Non-Operative Ankle Injuries)

✅ Indications

• Grade 2–3 lateral ankle sprains
• Stable distal fibula fractures
• Talus or navicular stress injuries
• Post-immobilisation transition phase (e.g., post-cast)
• Acute pain limiting weight-bearing

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📆 Phase-Based Boot Protocol

Phase 1: Acute Protection (Days 0–7)

• Goals: Reduce pain, inflammation, and allow early healing
• Boot Use: Full-time (24/7), including sleep if significant pain
• Weight-Bearing: As tolerated unless contraindicated
• Rehab:
  • R.I.C.E. (rest, ice, compression, elevation)
  • Avoid unnecessary walking
  • Crutches if antalgic gait is present
• Risks to Monitor:
  • Leg-length discrepancy → Use shoe lift on contralateral foot
  • Monitor for signs of DVT (swelling, calf pain)

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Phase 2: Controlled Mobilisation (Weeks 2–4)

• Goals: Begin gradual loading, prevent stiffness and atrophy
• Boot Use: Daytime only (~6–8 hrs/day), removed for sleep
• Weight-Bearing: Encourage full weight-bearing as tolerated
• Rehab:
  • Gentle AROM exercises (ankle pumps, circles)
  • Isometric strength (e.g., dorsiflexion against resistance)
  • Begin proprioceptive training (e.g., single-leg balance with boot off)

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Phase 3: Weaning Off Boot (Weeks 4–6)

• Goals: Transition to normal footwear and gait
• Boot Use: Alternate with supportive footwear; wean off over 7–10 days
• Weight-Bearing: Full
• Rehab:
  • Active strengthening (resistance band exercises)
  • Gait retraining (check for compensatory hip/knee patterns)
  • Dynamic balance work (e.g., wobble board)
• Monitor: Persistent pain at other joints → consider re-assessment

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Phase 4: Functional Reintegration (Weeks 6–8+)

• Goals: Return to normal activities and sport if applicable
• Boot Use: Discontinued
• Rehab:
  • Plyometric drills (if athletic)
  • Return-to-sport tests (hop test, agility drills)
  • High-load strength and proprioceptive exercises

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⚠️ Precautions & Red Flags

• Persistent secondary site pain (hip, back, knee)
• Signs of DVT
• Gait asymmetry beyond 2–3 weeks
• Skin irritation or pressure sores from the boot

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💡 Other considerations

• Use even-up shoe lifts or orthotics on the contralateral foot to reduce gait asymmetry
• Boot donning/doffing for regular skin checks
• High-risk patients (e.g., older adults) may require referral for mobility aids or falls risk assessment