As a diagnostic radiographer I see and x-ray many adults and children being rehabilitated using a walker shoe (walking boot).
Here I answer some of the questions I am always asked by patients who have been prescribed a walker shoe (orthopaedic or orthoses shoe).
For this article I have consulted physiotherapists who rehabilitate patients with walking shoes, I have also relied on my knowledge as a radiographer and scientific studies.
Happy reading!😀 and feel free to ask questions in the comments or share your own experience.🙏
Last updated: June, 2025. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: Amazon affiliate links, full disclosure in the legal section.
▶️Why have I been given a walking boot rather than a plaster cast?
I normally hear patients ask this question when they come for x-ray, before I go ahead to give an answer to this question, let’s first understand the difference and benefits between a walking boot and a plaster cast.
⚪A leg plaster cast
A leg cast is normally needed to help heal unstable broken bones or severe lower limb injuries.
The main reason why you are given a cast in the beginning of the injury, it’s a protective covering that immobilises the leg to allow the bones to mend properly.
It means with a cast your broken bones are unlikely to move around
⚪A walking boot or shoe
A walking boot or shoe is normally given to you when you have a stable injury to help stabilize the injured area, helps prevent further damage and allows the bone to heal properly.
In this case you do not have to wear a cast, a boot will let you put your weight on to your injured foot.
You’ll need a walking boot or shoe if you have a broken bone, severe sprain, tendon injury, or need foot immobilization after surgery.
The decision to wear a boot or cast will depend on the type of injury you have got and the type of treatment your doctor decides to give you.
A table below shows the difference between a walking boot and a walking cast.
| Difference : Walking boot (short or long) | |
| Material | Lightweight breathable fabric, leather or synthetic materials |
| Immobilisation | Provides more complete immobilisation allowing for some controlled movement |
| Weight-bearing | Allows weight-bearing with varying levels of support and protection. |
| Removable | Removable for showering, cleaning and hygiene. |
| Patient preference | May be preferred by patients for comfort, ease of removal and hygiene. But the choice will depend on so many factors. |
| Difference : Walking plaster cast | |
| Material | Plaster or fiberglass. |
| Immobilisation | Provides more complete immobilization of the foot and ankle. |
| Weight-bearing | Allows weight-bearing with the added stirrup and sole |
| Removable | Non-removable, requiring a saw for removal. |
| Patient preference | May be less preferred by patients due to discomfort and limited hygiene options. |
▶️Walker shoes or boots are used in many different contexts.
When you have had an injury to your lower leg you may be prescribed a walking shoe or boot to help with your healing.
The different types of injuries that may require a walking boot or shoe may include:
🟠 Fractures such as ankle and tibial or fibula may require a walking boot whether operated or not.
🟠Severe ankle sprains especially those that cause significant swelling, bruising and ankle instability.
🟠Tendon injuries such as Achilles tendon injuries.
🟠Avulsion fractures of the base of the fifth metatarsal on the foot.
🟠Ankle sprains that can cause a ligament injury or bone tear.
🟠Foot immobilisation especially after surgery or to protect the foot during recovery.
▶️What are the five common orthoses used for foot and ankle when you have had an injury.
Images of the five common orthoses used in postoperative shoe: Relief, Forefoot relief shoe, short walker boot, High walker boot and Calcaneus fracture boot (Image from Ehrnthaller,2023)
1️⃣Postoperative shoe relief: Aims to reduce the pressure of the metatarsal region.
2️⃣Forefoot relief shoe: Has a step -shaped sole which helps to eliminate forces to the forefoot.
3️⃣Short walker boot: Comprises a plastic shell with an inner vacuum cushion which is used for forefoot injuries.
4️⃣High walker boot: Helps to immobilise the ankle which helps reduce plantar pressure by redistribution.
5️⃣Calcaneus fracture orthosis consists of a polyethylene frame designed to unload the calcaneus and is used for the early functional treatment of calcaneus fractures
Ehrnthaller et al 2023
▶️How to tell which shoe or boot is best for your injury
As we have seen the benefits of these commonly used shoes, the choice will normally depend on what your doctor decides in your own case.
This is normally based on the type of fracture you have got and the treatment options.
⚫The boot helps to protect your injured area.
⚫It allows the foot to be stable and in the proper position so that it can heal properly.
⚫Most walking boots have two to five adjustable straps that hold the boot in place over the injured leg.
▶️When deciding how long to keep the boot, several factors must be considered.
There are four factors usually considered:
1️⃣What was the reason you were given a walker boot?
2️⃣Your current health status and medical history.
3️⃣How well your recovery in the next few days and weeks
4️⃣Your requirements, goals and your own assessment of benefits and risks of longer or shorter immobilisation.
Always your doctor will be able to tell you how long you should keep the walker boot or shoe on.
Normally when you have had a post x-ray check after 4 to 6 weeks to see how well your fracture is healing then your doctor will be able to decide.
▶️How do you know if you need a short or a high walker boot?
The type of injury you have got, and the treatment options you receive will determine which kind of boot you need.
If the person who prescribed the boot did not tell you, ask your physiotherapist or doctor for advice.
The choice of boot is normally made on how well it helps with the injury healing, function and level of pain management.
In general, the more severe the injury, especially if the fracture is displaced, the better a high boot is suitable.
Normally your doctor or physiotherapist will prescribe the right boot for your injury and when you find that the prescribed shoe or boot is too bulky or unsuitable, discuss it with your physiotherapist or pharmacist.
A study done by Shahid,2013, Between May 6 and December 22, 2010, 43 patients with an avulsion fracture of the fifth metatarsal who were treated with either a short walking boot or a short-leg cast,
of the 43 patients who met the study criteria, 39 participated ,23 patients received a short leg cast and 16 a walking boot for 5 weeks
⚫The study aimed to determine time taken to reach preinjury level of pain and function for the 2 methods of immobilization.
⚫Time taken off work, cost of the boot or casting material, and ability to drive a vehicle.
| Conclusion from the study |
| Time taken to achieve preinjury level of pain and function was 9 weeks using the walking boot and 12 weeks with the short-leg cast |
There has been no previous comparison study investigating pain and functional outcome following treatment with a short leg cast and a walking boot, and this is the first study to use a validated foot specific outcome measure.
There is a need for more studies to provide what options are best for quick recovery for different injuries, whether a short boat or long boot will depend on what your doctor decides.
▶️ Do you sleep with a fracture boot on?
Unless in your case your doctor has instructed you to wear a walking boot 24 hours a day, that means you must wear it at night as well.
In this case when you have been instructed to sleep with it, this will depend on the nature of your injury, the type of boot and your over-role of recovery progress.
Here are some of the tips for sleeping with a walking boot if you have been told to leave it.
There are no risks associated with sleeping in a walking boot. You can sleep in any position, on your back, stomach or side.
🟣Try to elevate your foot by placing a pillow under the boot to help reduce swelling.
🟣Consider sleeping on your back. It is more comfortable with the boot on, if you sleep on your side use a pillow between your legs for comfort.
If you have not received any instructions at all, you can contact a medical professional who is following your case and knows your medical history.
It is normally advisable to remove a walking boot when you are going to bed. Most people I have seen normally take it off when they are going to bed.
In most cases there’s no risk to the healing process because you do not perform any extreme movements of the ankle or leg while sleeping.
Reason being:
🟣 For comfort it is normally good to take it off when you are going to sleep because it may feel uncomfortable as you sleep disturbing your rest.
🟣Flexibility: when resting without the boot, you may want to gently move your leg to maintain flexibility and it also allows the injury to breathe and potentially reduce swelling.
🟣Help in blood circulation: removing your boot while sleeping may help with blood circulating well which helps to speed up recovery.
However, some people prefer to sleep with their boots on, even if they have been told they can remove them, because it’s more comfortable. This is not a problem.
▶️Can you walk with a boot without crutches?
Yes, it is possible to walk in a walking boot without crutches, but normally in the beginning it is crucial to use crutches for balance and support to help with your healing.
You may be able to gradually transition to walking without crutches.
The main reason why you are advised to use crutches in the beginning is to prevent full weight bearing on the injured limb and prevent extra pressure from getting added to the walking boot.
If you are prescribed a walking boot, it is usually intended to allow you to walk while putting weight on the injured leg or foot. Unlike a cast, which does not allow any weight bearing.
If you have not received any written or verbal information from your doctor, it is very likely that your injury allows you to walk with the boot.
I have seen patients scared to only move with a walking boot in the initial stages of the fracture, normally they worry about re injuring the foot again..
In such cases a wheelchair may be used to help you move around in the initial stages of healing especially for elderly patients, walking with crutches can be a little bit scary.
Remember you have not been using a walking boot, unless you are very confident, and your injury is stable.
Some people find using a walking aid such as a cane or hand free crutch more stable than crutches.
Always prioritise safety: try walking safely and only under the guidance of your physiotherapist, if need be, until you regain your weight bearing and mobility.
▶️Can you drive and work with a fractured walker boot?
The driver vehicle licensing agency does not say anything particle or specific in the United Kingdom regarding not to drive with a walking boot but the national health system (NHS) in the UK highlights:
Is it legal to drive with a cast or walking boot or immediately when it has been removed?
Having a cast or walking boot on or having it removed may not enable you to drive as soon as you may want.
Here are some of their reasons why you are not allowed to drive with a cast or walking boot on or immediately when it is removed.
🔵You may not be fit to control the vehicle; the boot can interfere with your ability to use the pedals making it difficult to break.
🔵After your boot has been removed due to the long period of time your limb has been immobilised, you may find that your leg feels thin and strange which is normal but not ok yet to drive.
🔵You may experience swelling, discomfort and stiffness in the affected limb. This is quite normal and may continue for several weeks.
🔵You may find it helpful to keep the limb elevated to allow quick recovery.
🔵Driving should be avoided during the first few weeks after your boot has been removed.
This article may interest you as well When to drive after a fracture or injury to the lower limb with or without surgery?
▶️Washing with a walker shoe requires some adjustments.
Except in very specific cases, you can take off your walker shoe when showering
If you’re not comfortable putting weight on your foot, you can install a non-slip plastic seat in your shower to shower while sitting. These are called shower chairs.
There are also adapted seats for bathtubs: swivel chairs, bath stools. These devices can be purchased or rented (in pharmacies, medical supply stores or orthopaedic shops).
If you are afraid to take off the Walker shoe to wash it, or if you have been strongly advised not to do so, you can do this:
♦️Wash while sitting on a non-slip seat and keep your leg outside the shower or bathtub.
♦️Use a leg protector or a homemade plastic bag designed for the leg see on Amazon (Waterproof cast protector for legs or feet)
We have come to the end of this article and I hope I have answered some of your questions about wearing walking boots.
Wishing you a quick recovery!💁 Any questions leave in the comments questions, references used are below.
♦️Walking after 6 weeks or more of non-weight bearing: A guide to help you:
📚Sources:
Shahid MK, Punwar S, Boulind C, Bannister G. Aircast walking boot and below-knee walking cast for avulsion fractures of the base of the fifth metatarsal: a comparative cohort study. Foot Ankle Int. 2013 Jan;34(1):75-9. doi: 10.1177/1071100712460197. PMID: 23386764.
Ehrnthaller C, Rellensmann K, Baumbach SF, Wuehr M, Schniepp R, Saller MM, Böcker W, Polzer H. Pedobarographic evaluation of five commonly used orthoses for the lower extremity. Arch Orthop Trauma Surg. 2023 Jul;143(7):4249-4256. doi: 10.1007/s00402-022-04729-2. Epub 2022 Dec 26. PMID: 36571629; PMCID: PMC10293377.