Biomechanical effectiveness of controlled ankle motion boots: A systematic review and narrative synthesis.

INTRODUCTION: Controlled ankle motion (CAM) boots are a below-knee orthotic device prescribed for the management of foot and ankle injuries to reduce ankle range of motion (RoM) and offload the foot and ankle whilst allowing continued ambulation during recovery. There is a lack of clarity within the current literature surrounding the biomechanical understanding and effectiveness of CAM boots. AIMS: To summarise the biomechanical effects of CAM boot wear as an orthotic for restricting ankle RoM and offloading the foot. METHODS: A systematic literature review was conducted in accordance with the PRISMA 2020 guidelines. All papers were independently screened by two authors for inclusion. Methodological quality was appraised using Joanna Briggs Critical Appraisal checklists. A narrative synthesis of all eligible papers was produced. RESULTS: Thirteen studies involving 197 participants (113 male and 84 female) were included. All studies were quasi-randomised and employed a within-study design, of which 12 studies included a control group and a range of CAM boots were investigated. CAM boots can be seen to restrict ankle RoM, however, neighboring joints such as the knee and hip do have kinetic and kinematic compensatory alterations. Plantar pressure of the forefoot is effectively redistributed to the hindfoot by CAM boots. CONCLUSION: The compensatory mechanisms at the hip and knee joint during CAM boot wear could explain the secondary site pain often reported in patients, specifically at the ipsilateral knee and contralateral hip. Although CAM boots can be used to restrict ankle motion, this review has highlighted a lack of in-boot kinematic analyses during CAM boot use, where tracking markers are placed on the anatomical structure rather than on the boot, or through video fluoroscopy, urging the need for a more robust methodological approach to achieve this. There is a need for studies to assess the biomechanical alterations caused by CAM boots in populations living with foot and ankle pathologies. Future research, adopting a longitudinal study design, is required to fully understand the effectiveness of CAM boots for rehabilitation.

Acute biomechanical responses to wearing a controlled ankle motion (CAM) Walker boot during walking.

BACKGROUND: Controlled ankle motion (CAM) boots are often prescribed during the rehabilitation of lower limb injuries and pathologies to reduce foot and ankle movement and loading whilst allowing the patient to maintain normal daily function. RESEARCH QUESTION: The aim of this study was to quantify the compensatory biomechanical mechanisms undergone by the ipsilateral hip and knee joints during walking. In addition, the compensatory mechanisms displayed by the contralateral limb were also considered. METHODS: Twelve healthy participants walked on an instrumented treadmill at their preferred walking speed. They underwent kinematic and kinetic analysis during four footwear conditions: normal shoes (NORM), a Malleo Immobil Air Walker on the right leg (OTTO), a Rebound® Air Walker on the right leg with (EVEN) and without (OSS) an Evenup Shoelift™ on the contralateral leg. RESULTS: CAM boot wear increased the relative joint contribution to total mechanical work from the ipsilateral hip and knee joints (p < 0.05), which was characterised by increased hip and knee abduction during the swing phase of the gait cycle. EVEN increased the absolute work done and relative contribution of the contralateral limb. CAM boot wear reduced walking speed (p < 0.05), which was partially compensated for during EVEN. SIGNIFICANCE: The increased hip abduction in the ipsilateral leg was likely caused by the increase in effective leg length and limb mass, which could lead to secondary site complications following prolonged CAM boot wear. Although prescribing an even-up walker partially mitigates these compensatory mechanisms, adverse effects to contralateral limb kinematics and kinetics (e.g., elevated knee joint work) should be considered.