Controlled ankle motion (CAM) Walker boots

NewsBot · Dec 28, 2023

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Acute biomechanical responses to wearing a controlled ankle motion (CAM) Walker boot during walking
Josh Walker et al
Gait & Posture; Volume 108, February 2024, Pages 208-214

Highlights
•CAM boots reduce preferred gait speed, which reduces mechanical work requirements.
•CAM boots do require compensatory mechanisms in ipsilateral hip and knee joints.
•Compensatory mechanisms can be reduced with the implementation of an even-up walker.
•CAM boot wear with and without even-up walkers affects contralateral limb function.
•Prolonged CAM boot wear could lead to secondary site injury (e.g., lower-back pain).
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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.
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NewsBot · Jul 28, 2024

Biomechanical effectiveness of controlled ankle motion boots: A systematic review and narrative synthesis
Mason L Stolycia et al
J Foot Ankle Res. 2024 Sep;17(3):e12044

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.
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NewsBot · Sep 28, 2024

Walking in a controlled ankle motion (CAM) boot: In-boot measurement of joint kinematics and kinetics
Mason L Stolycia et al
J Biomech. 2024 Sep 16:176:112327

Research investigating ankle function during walking in a controlled ankle motion (CAM) boot has either placed markers on the outside of the boot or made major alterations to the structure of the CAM boot to uncover key landmarks. The aim of this study was to quantify joint kinematics and kinetics using "in-boot" skin markers whilst making only minimal structural alterations. Seventeen healthy participants walked at their preferred walking speed in two conditions: (1) in standard athletic trainers (ASICS patriot 8, ASICS Oceania Pty Ltd, USA), and (2) using a hard-cased CAM boot (Rebound® Air Walker, Össur, Iceland) fitted on the right foot. Kinematic measurements revealed that CAM boots restrict sagittal plane ankle range of motion to less than 5°, and to ∼3° in the frontal plane, which is a reduction of 85% and 73% compared to standard footwear, respectively (p < 0.001). This ankle restriction resulted in a reduction of ankle joint total limb work contribution from 38 ± 5% in normal footwear to 13 ± 4% in the CAM boot (p < 0.001). This study suggests that CAM boots do restrict the ankle joint's ability to effectively perform work during walking, which leads to compensatory mechanisms at the ipsilateral and contralateral hip and knee joints. Our findings align with previous research that employed "on-boot" kinematic measurements, so we conclude that in-boot approaches do not offer any benefit to the researcher and instead, on-boot measurements are suitable.
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NewsBot · Nov 4, 2024

The Difference in Achilles Tendon Loading within Immobilizing Boots Based on Ankle Angle, Boot Type, and Walking Speed
Todd J Hullfish et al
Orthop J Sports Med. 2024 Oct 16;12(10)

Background: Achilles tendon rupture is an increasingly common injury treated with progressive rehabilitation in an immobilizing boot. However, it is poorly understood how ankle angle, boot type, and walking speed affect Achilles tendon loading.

Hypothesis: These different parameters would affect Achilles tendon loading in terms of (from greatest to least) ankle angle constraint, immobilization style, boot construction, and walking speed.

Study design: Descriptive laboratory study.

Methods: Ten healthy young adults (8 women and 2 men; age, 21 ± 2 years; body mass index, 21.5 ± 3.0 kg/m2) walked in 3 different immobilizing boots at self-selected slow, medium, and fast walking speeds. The authors estimated Achilles tendon loading using a 3-part instrumented insole within the immobilizing boot. The authors averaged tendon load across every stride for each condition and calculated 2-sided bootstrap confidence intervals. Peak tendon loading was compared across all boots, ankle angles, and walking speeds.

Results: All boots and immobilization styles decreased tendon loading with respect to shod walking. Immobilization angle had the largest effect on tendon loading, followed by boot construction, and finally walking speed.

Conclusion: Ankle angle, boot type, and walking speed can be modified to change loading progression during rehabilitation.

Clinical relevance: Understanding how immobilization affects tendon loading will enable clinicians to modify rehabilitation to improve functional outcomes
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Controlled ankle motion (CAM) Walker boots

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Controlled ankle motion (CAM) Walker boots

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

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