When Might My Child Benefit From A Walking Boot?

In a recent interview, Mercy attending pediatrician Dr. Ashanti W. Woods discussed why a child might need a walking boot and what purpose they serve. Dr. Woods is board-certified in Pediatrics and earned his medical degree in 2007 at the Howard University College of Medicine in Washington, D.C. He completed his residency in 2010 at the University of Maryland Hospital for Children in Baltimore, MD

What are the basic reasons that a child would need a walking boot?

The basic reasons for a walking boot range from a severe lower extremity injury such as a broken bone (fracture) of the foot, ankle or leg to a mild injury like a sprain or strain of those aforementioned areas.  A sprain involves overstretching of ligaments or rubberband-like pieces of tissue that help attach muscles to bone.  A strain, on the other hand, is an overstretching of the muscle itself.  

What are some special considerations that you should keep in mind when your child is wearing a walking boot that perhaps an adult would not have to worry about?

Children are less conscientious to protecting an injured extremity, so, parents, teachers, coaches, and physicians must emphasize to children to avoid full pressure on the injured joint while wearing the boot.  In other words, "stay off your injured leg/foot children" except as directed by your doctor or physical therapist. Understandably, it is hard for a child to resist what appears to be a fun activity and he or she may be over-excited to get back to participation.  Also, encouraging proper hygiene should be stressed as children may forget to allow the extremity to get some fresh air or soap and water when appropriate.    

Can you give me some guidelines for taking care of your child’s feet and skin while they’re using the walking boot?

The foot should be checked each day.  The toes should naturally have a pink color which represents natural blood flow.  Therefore, its usually a good idea that if the toes are visible while the boot is on that the parent squeeze the tips of the toes and watch the pink color change pale or white once squeezed and then go back to pink after pressure is released within four seconds.  So, pink (at first) - white (when squeezed) - pink again (after pressure is released within a couple of seconds).  This ensures that circulation is appropriate.  

If, however, the toes are white/pale before squeezing, or it takes a really long time for the toes to become pink again after pressure is released, the boot may be too tight or another circulation event may have occurred, and the doctor should be notified.  Parents should also check for rashes of the skin while the child is wearing a boot.  Finally, a child's walking pattern (also known as gait) should be not too far from normal while in the boot.  So if a parent notices a significant limp, perhaps the joint needs more rest and the doctor or therapist should be notified.  Any significant swelling of the joint, that did not exist previously, should also be a cause for concern.  So to summarize, pale color, rash, pain, and swelling should all be assessed each day while your child is in a boot.     

In what situations is it okay to remove the boot?

Follow your doctor's or therapist's recommendations, but generally, at the end of the day, or during periods of immobility, the boot can be safely removed and the extremity should usually be elevated on pillows and possibly compressed with an ace wrap.  

What warning signs or concerns with your child’s boot should prompt a call to the doctor, or even immediate medical attention?

In addition to a defective boot (cracked plastic or fiberglass, improper straps, etc), pain, significant swelling, rash or ulcer formation, or if you cannot feel a pulse on the top of the foot (where the ankle and foot meet, on the top) are all reasons to contact your doctor.  Feel free to have your doctor or therapist show you where the foot pulse is located (he or she will be happy to do so). 

--Ashanti W. Woods, MD, Attending Pediatrician, Mercy Medical Center  

Dr. Woods has received a number of awards in his field, including The G. Bowers Mansdorfer Award for Primary Care presented by Mercy Medical Center, and the Primary Care Pediatrician Award, by the University of Maryland Ambulatory Center.