A few weeks ago I was watching a press conference with Seahawks quarterback Russell Wilson who was commenting on how the ankle injury he sustained in the previous game was progressing. When explaining his ankle situation the day after the injury he said the first thing he did was to take off the walking boot, because “You can’t play in a boot.”
As athletic trainers we often use a walking boot to calm down a recently injured ankle, but we all know the sooner you transition out of a walking boot the better. But the real question is, transition out of a walking boot to what?
What comes after wearing a walking boot is where athletic trainers earn their money. The transition from the safety and security of a walking boot to the next phase of returning the athlete to competition is critical. The ankle will need some sort of external ankle brace support because tape alone is not enough. But what kind of ankle brace would provide a good transition from a walking boot?
If the athlete has weight bearing pain, then you will need an ankle brace that unloads or offloads the ankle. Meaning the brace will absorb most of the impact, not the sore ankle, thus reducing weight bearing pain. Tape and lace-up supports have a soft bottom and cannot unload the ankle. The ankle brace design that is the most efficient at unloading the ankle is a semi-rigid hinged-cuff ankle brace. 'Hinged-cuff' means it’s a hinged ankle brace but with a cuff that encircles the posterior of the lower leg. What makes this design the most effective is because you encircle the ankle/foot and lower leg in both the vertical and horizontal plane which provides a stable platform to absorb impact and control movement.
Now that you solved the weight bearing pain issue, the next focus is providing sufficient ankle stability to secure the injured ankle and prevent further injury. Yes, you can tape the ankle for stability, but tape loosens the longer you wear it. We have ruled out lace-ups because they can’t unload the ankle. Once again, a semi-rigid hinged-cuff ankle brace is the best option because it can provide more initial and long-lasting ankle support. Because the brace is hinged, it moves with normal ankle range of motion which keeps the straps securely in place maintaining long lasting ankle stabilization. Every knee brace is designed upon that same principle. Also, the cuff portion of the hinged-cuff design helps to restrict excessive ankle rotation which causes syndesmotic ankle injuries.
To sum things up, when you come out of a boot it’s important to unload the ankle to reduce weight bearing pain and stabilize the lower leg and ankle to prevent further injury. The hinged-cuff ankle brace design is the most effective when transitioning from a walking boot back to competition, because you can't play in a walking boot.