The Truth about the CAM Boot and Moon Boot: What are they, and what do they really do?
What is a CAM Boot?
A camboot, also known as a walking boot or medical walking shoe, is a type of orthopedic footwear used to immobilise the foot and ankle after an injury or surgery. It is designed to provide support, stability, and protection to the foot and lower leg during the healing process. Cam boots are typically used for conditions such as fractures, sprains, Achilles tendon injuries, and post-surgical recovery.
These boots are made of a rigid sole, which prevents the foot from flexing, and adjustable straps or Velcro closures allow for a customised and secure fit. Camboots are usually bulkier and more supportive than regular shoes, and they come in various styles and designs to accommodate different types of injuries and foot shapes.
What does a CAM Boot do?
The primary purpose of a cam boot is to reduce weight-bearing on the affected foot or ankle, promoting proper healing and preventing further damage. Patients are often advised to wear the boot for a specific period, depending on the severity of their condition and their healthcare provider's recommendation. Following the healthcare provider's instructions regarding wearing and removing the boot is essential to ensure optimal recovery.
CamBoot vs Moon Boot: Is there a difference?
When it comes to types of foot and ankle braces, many name variants refer to the same brace (or boot). You might have heard of the names Camboot, CAM Boot (controlled ankle movement boot), CAM walker, moon boot, below-knee walking boot, etc. – these are all inherently the same thing, just described by their location and purpose of the brace. This purpose is to control and limit any lower leg, foot, or ankle movement and take pressure away from the area's bones, muscles, ligaments, and tendons, allowing an injury to heal.
The ankle and foot are capable of movements in different directions. This allows you to walk, run, jump, stand on one leg, play sports, etc., with power and control. The ankle can be pulled back towards the body (dorsiflexion) or pointed away from you (plantar flexion). The soles of the feet can also face slightly towards or away from one other (inversion and eversion). The foot itself is controlled by many small muscle groups and other connective tissues that form the arch structure in the sole. This arch can flatten (pronation) or lift, creating space underfoot (supinate) during walking. This is an elementary description of how the foot and ankle function; however, the main takeaway here is that when you’re on your feet and doing activity, a lot of movement continually occurs.
Depending on the type and extent of injury, you might need to wear a CAM boot to offload the injured site, reduce pain and swelling, and help speed up recovery. Sometimes, they are a more practical, comfortable, and hygienic alternative to crutches or plaster casts. They have a standard in-built ‘rocker’ sole that intrinsically allows you to continue walking with little limb movement.
A brief mention of fibreglass and plaster casts, which are used in hospital settings, usually following surgery for displaced fractures or an Achilles rupture. These are more supportive and initially prevent all ankle and foot movements. At some point in your early recovery stage, you may transition into a Camboot or CAM Walker, as it is being recognised that regaining function as early as possible provides better long-term outcomes following injury.
Do I leave a Camboot or Moon Boot on all the time?
The short answer is yes. If you need to be in a CAM boot or moon boot at all, then it is likely that you will need to be wearing it 24/7 to start with. Some rough timeframe estimates for how long you might be in a boot could range from 2 weeks to 2 months. Throughout this time, though, you will gradually phase out of the boot depending on how you progress until your ankle/foot is strong, stable, and functional enough to rely less on it. This will be guided by your physiotherapist, sports doctor, and surgeon collaboratively alongside other approaches to return to full function.
For example, you might start in a Camboot full-time for 3-4 weeks, then go part-time for 2-3 weeks, then spend progressively more time out of the boot with a stronger focus on rehabilitative exercises and minimal/no bracing, such as the use of an ankle guard or Kinesio tape. A gradual build-up in exercise demand and intensity must be done consistently to re-strengthen the joint during this time. Suppose you are returning to sport/activity. In that case, you may play as an ankle guard for a while – this comes down to individual preference, usually based on what is most comfortable and gives you the most confidence to play without guarding the area.
How long should you wear a cam boot or moon boot?
The length of time a CAM boot or moon boot needs to be worn depends on the location of injury, the severity of your injury, whether you’ve got a fracture or whether your injury is ligament and soft tissue damage.
1. Location of injury: Usually, this is based on how much load is put through that site. In standing, bones, and ligaments of the foot and ankle will all carry some gear, however, certain areas will carry more. For example, structures that give the arch of the foot its integrity are placed under more load, as they control how the foot functions first, which determines how everything else responds after that. Injury to any of these areas must be protected. For example, a navicular fracture or Lisfranc Injury allows smooth walking.
2. Severity of injury: Injuries can be described as mild through to severe. They are also classified based on whether the damage occurs during a one-off incident (acute injury), was developed over a more extended period (chronic injury), or has been an issue in the past but recently worsened after a particular event (acute on regular). All information gathered will be considered when recommending timeframes for CAM boot use. It might take a chronic or an acute or chronic injury longer to heal. In these cases, multiple factors may need to be addressed. This will take time. There may also be lingering inflammation or build-up of scar tissue in the area, both of which delay healing.
3. Foot Fracture: A fracture, depending on location, type of fracture, and whether it is classified as stable (does not require surgery) or unstable (requires surgery first). Depending on how quickly they respond, these must be in a Camboot for at least 4-6 weeks.
4. Ligament & Soft Tissue Injuries: There is naturally more movement in these tissues, so it can be challenging to immobilise completely; plus, there is a delicate balance between moving too much and not enough at the right stage during the recovery process. Because there is less blood oxygen supply to these tissues, they are slower to recover, roughly 6-8 weeks or more.
What injuries will need to be in a CAM boot or Moon boot?
High-grade ankle sprains, Achilles tears or ruptures, high ankle sprains and syndesmosis injuries, foot fractures, a lisfranc injury, foot surgery and tibia or fibula stress fractures should all be placed in a cam boot or moon boot.
Ankle sprains: There has been moderate to severe damage to one or more ligaments in the ankle. A CAM boot is helpful in these cases because there has been damage to one or more ligaments in the ankle. These will be painful and feel unstable to stand/walk on.
Achille’s tears: Grade 2 tears might indicate using a CAM boot without surgery. Otherwise, a grade 3 (or complete) tear will require surgery first, followed by time in a CAM boot.
High ankle sprains and syndesmosis injuries: These are classified as either stable or unstable injuries. If there is no associated fracture and damage to the ligaments of the ankle and lower leg is very mild, it can usually be managed in a CAM boot without surgery as they are classified as ‘stable’. Otherwise, these will require surgery followed by a period of CAM boot use.
Foot fractures: Some common fracture sites include those in the midfoot area and lower end of the shin bone (tibia and fibula). Bones take around six weeks to heal.
Following surgery: Anywhere between 6-8 weeks, depending on the injury and how well the surgery went.
Severe Plantar Fasciitis: Severe inflammation and tears in the plantar fascia.
Lisfranc Injury: Involves the ligaments and bones of the big toe, which give the arch of the foot its integrity.
Should I sleep with a Camboot on?
As detailed above, you will likely need to wear a moon boot 24/7. This includes throughout the nighttime as well. The boot should protect the joint so that while you are asleep and unaware of how the ankle/foot is positioned, it doesn’t risk further irritation. Say, for example, you’ve badly sprained your ankle; you want to limit the amount of stretch that goes through that ankle’s front and outer side. While you’re asleep and in a relaxed state without being in a boot, the ankle is then vulnerable to naturally moving into a position of stretch, plus/minus the additional pressure of the sheets. This could cause further pain and delay healing.
Is it OK to walk in a Camboot?
Yes, continuing walking while you are in a Camboot is fine. These were initially designed as a more practical option to a cast so that you can safely continue working and participating in other social commitments as you recover. A good thing to remember is you will want to try and find the right shoe to wear on the other foot to match the height of the CAM boot. This will prevent any issues elsewhere in the body. The opposite hip and lower back are common areas that tend to become affected by discrepancies in shoe height.
Is it OK to walk in a CAM boot without crutches?
Surgeons or a specialist usually recommends that surgeries for injuries like an Achilles rupture, syndesmosis injury, or ankle fractures be offloaded entirely for a short duration – you might have heard of the term ‘non-weight bearing?’ In these cases, you may need to be in a CAM boot to support the leg while using crutches to remove all external loads. Once your surgeon or specialist clears you that it is safe to bear weight, yes it is okay to walk in a CAM boot without crutches.
What is a camboot made out of?
Camboots, or camwalker boots, are typically constructed from a combination of materials to provide optimal comfort, stability, and protection. The outer shell of camboots is commonly made from hard plastic, offering a sturdy and protective layer around the foot and ankle. Inside, they feature a foam liner that provides cushioning and comfort, ensuring that the injured area is adequately padded and supported during the healing process. Additionally, camboots are equipped with adjustable straps and fasteners, often made of Velcro, allowing for a secure and customised fit. These straps are crucial in immobilising the foot and ankle effectively, promoting proper healing.
Furthermore, camboots come with a durable rubber or sturdy material soles, providing traction and support while walking. Some models may include removable innersoles, which can be customised or replaced to enhance comfort and support. In some instances, metal supports or hinges might be integrated into the design to offer additional stability to the ankle joint. Combining these materials ensures that cam boots provide the support, protection, and comfort required for individuals recovering from foot or ankle injuries, allowing them to move around safely during the healing process.
