Wearing a walking boot is often necessary after foot and ankle injuries or surgeries, but it can be uncomfortable to sleep with the boot on. Knowing when it’s safe to remove your walking boot for sleep is important for your recovery. In this article, we’ll go over when you can start sleeping without your walking boot after injury or surgery.
What is a walking boot?
A walking boot, also called a CAM boot, is a type of medical shoe used to protect and immobilize the foot and ankle. It is an orthopedic boot that has a sturdy sole with cushioning, straps to secure it in place, and support around the foot and lower leg. Walking boots limit mobility of the ankle to allow it to heal from injury or surgery while still allowing you to walk on the foot.
Walking boots are often used for:
- Ankle sprains or fractures
- Foot and ankle tendon and ligament tears
- Toe and metatarsal fractures
- Achilles tendon tears
- Post-surgical recovery of the foot and ankle
The rigid sole prevents rolling of the ankle and foot while the straps keep it securely in place. Walking boots allow some mobility while protecting the injured or healing area.
Why is it recommended to sleep with the boot on at first?
After getting a walking boot, doctors often recommend sleeping with it on for the first few weeks. There are several reasons for this:
- Immobilization: Keeping the boot on at night continues to immobilize and protect the injured or post-surgical ankle and foot. This allows proper healing without risk of re-injury from moving the joint at night.
- Elevation: The boot helps keep the foot and ankle elevated if pillows are placed under the boot. This reduces swelling.
- Protection: The rigid boot prevents accidental bumps or knocks to the tender ankle and foot while you sleep.
- Reduced pain: The support and immobilization of the boot can help reduce pain at night that could interrupt sleep.
For these reasons, doctors recommend sleeping in the boot until enough initial healing has taken place, often for 2-4 weeks depending on the injury.
When is it OK to remove the boot for sleep?
Your doctor will advise you on when it is safe to start sleeping without the boot based on your specific injury and progress in healing. Some general guidelines are:
- After 2 weeks for mild ankle sprains
- After 3-4 weeks for moderate ankle sprains
- After 4-6 weeks for severe ankle sprains
- After 4-6 weeks for ankle or foot fractures
- After 2-4 weeks for foot/ankle tendon/ligament tears
- After 2-4 weeks for toe or forefoot fractures
- After 2 weeks for post-op recovery without complications
Factors your doctor will consider include:
- Amount of swelling and inflammation
- Ability to bear weight on the injured foot when walking
- Amount of pain at the injury site
- Evidence of proper healing on follow-up x-rays or scans
Once pain and swelling have decreased, you are able to walk on the foot, and adequate initial healing has occurred, your doctor will likely give you the OK to sleep without the boot. This is generally between 2-6 weeks after the initial injury or surgery.
Tips for sleeping without the boot
Once your doctor says it’s safe to remove the boot at night, follow these tips for comfortable sleeping without the boot:
- Elevate the foot. Use pillows or blankets to keep the foot raised above your heart level as you sleep. This reduces swelling.
- Ice before bed. Apply ice packs to the injured or post-surgical area for 15 minutes before sleep to reduce inflammation and pain overnight.
- Take medication. If prescribed, take pain medications before bedtime to help you sleep comfortably.
- Immobilize with padding. Wrap the foot and ankle lightly with an elastic bandage or wear a compression sleeve to restrict movement.
- Stay in one position. Once comfortable, try to sleep in one position and avoid tossing and turning to prevent disturbing the injured foot and ankle.
- Use pillows for support. Place pillows under or between your legs and feet to maintain good positioning and alignment.
If pain or swelling increases without the boot, contact your doctor. You may need to go back to using the boot at night for a period of time.
Signs you still need the boot at night
In some cases, it may be too early to stop wearing the boot at night even if you meet the general timeline guidelines. Pay attention to the following signs that indicate you still need to use the walking boot when sleeping:
- Sharp or throbbing pain in the foot/ankle when the boot is off
- Inability to bear weight through the injured foot when walking
- Noticeable increase in swelling without the boot
- Bruising around the injury site
- Continued stiffness, weakness or instability in the injured joint
- Increase in pain when trying to sleep without the boot
If you notice any of these warning signs, continuing to immobilize the foot and ankle in the boot overnight will allow for further healing before going boot-free at night.
Potential complications of removing the boot too soon
Removing the walking boot too early when sleeping carries some risks of complications, including:
| Complication | Description |
|---|---|
| Re-injury | The unprotected ankle or foot rolls or is knocked while sleeping, causing re-injury of healing ligaments or bones |
| Increased swelling | Swelling and inflammation increases without the compression and elevation from the boot |
| Loss of alignment | The bones can shift slightly out of place without the boot’s support, disrupting healing |
| Delayed healing | Repeated stress and movement of the injury without the boot delays the healing process |
To avoid these types of setbacks, it is essential to follow your doctor’s instructions on when it is safe to remove the walking boot for sleep based on your specific injury and progress.
Conclusion
Wearing a walking boot helps protect injuries and surgeries on the foot and ankle, but it can disrupt normal sleep. After the initial healing phase of around 2-6 weeks depending on the specific injury, most doctors give the OK to start sleeping without the boot once swelling, inflammation and pain have reduced enough. However, some people may need to continue using the boot at night if they have warning signs like persistent swelling or pain. As long as your doctor gives the go-ahead and you take steps to elevate, immobilize and support the area, sleeping boot-free once adequate early healing has taken place lets you rest more comfortably while still promoting proper recovery.