3.5 weeks post ORIF - can I take off the camwalker/orthopaedic boot when sleeping?

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I broke my tibia and fibula (comminuted spiral fracture of right tibia and comminuted midshaft fracture of right fibula, no damage to my ankle) falling awkwardly from a 2m height on 5 March. 

I waited in hospital for three days until I had ORIF surgery to insert titanium screws and plates on Thursday 8 March.  When I woke up I was wearing a camboot (orthopaedic walking boot / moon boot) and was told that it was to stay on full time for two weeks, then over the next four weeks I can take it off to shower and to rotate my ankle five times a day. After those four weeks, I can partial weight bear (50%) for three weeks, using crutches, and I don't need to wear the boot at all.  

On my two week check up I asked the doctor if I could also take the boot off when I'm just lying in bed and not moving, which he said was ok.  I asked if I could take it off when I was sleeping, and he kind of pulled a face and said I should sleep in the boot, in case I move in my sleep.

I'm lucky enough to have moved back in with family who are taking great care of me, so I'm in bed elevating my leg without the boot on most of the time, frequently flexing my ankle (probably too much - I'm a big fidgeter - but I have seen so much improvement in how far my ankle can move without pain or tightness). 

I'm not in any pain, except when I put the boot back on.  With the boot on, I start to have pain on the inside of my ankle, or sharp pain from the heavy base of the boot pulling my foot sideways when I move.  I try to wear the boot until it gets too uncomfortable, and of course I put it on whenever I get out of bed.

I feel like the heavy weight of the boot puts strain and stress on my leg and ankle that isn't there when the boot is off.  I've been taking the boot off to sleep, and just wearing the internal sleeve, because I find it so annoying.  I normally sleep on my side, which is nearly impossible with the boot on - but when the boot is off I can prop my legs between pillows and have wonderful sleep, and because of the pillows I've been waking up before I need to move.  I tried to sleep in the boot last night but just couldn't bear it past 2am and took it off again - it was causing a lot of discomfort and pain in my ankle and painkillers don't do much to help.  I'm about to start working from home and need to be well rested.

My question is - has anyone else had experience with taking the boot off to sleep?  How much of a risk am I posing to my recovery?  Should I be wearing the boot more often when I'm in resting in bed?  If everything is feeling ok, am I probably ok? Or am I doing damage without knowing it? 

Also - am I justified in my frustration at the heavy weight of the bottom of this boot when I'll never actually walk/weight bear while wearing it, or does it serve some other purpose? 

I can't find many other posts from people who had a camwalker rather than a cast the whole time they were NWB, and I don't have a particular doctor I can ask.

Thanks!

 

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9 Replies

  • Posted

    Jessica,

    Yes, I know personally how uncomfortable wearing the CAM boot (moon boot, air cast) can be for some of us, especially while sleeping. The only way I could sleep in boot without discomfort in bed was by releasing most of  air pressure out of my boot's air sleeves (not to be recommended, by the way).

    Could you actually cause harm to your mending fractures by sleeping without protection of boot so early in bone healing process?

    Yes and no. There are so many variables involved, including severity and location of fracture(s), and how rapidly bones are knitting, plus how 'active' your body is when you sleep. Did you ever see any videos of people sleeping at night (for clinical studies of insomina, apnea, etc., with night vision cameras?) Some sleepers act like contortionists moving every which way possible, all the while they are unconscious.

    So if you are feeling really, really lucky you might risk it. Or else just put up with it until the duly appointed time the doctor has laid out for you to take off boot for sleep.

    It's a shame that these boots have to be worn when they act like torture devices in bed for so many patients. When we are under stress of healing a traumatic fracture etc. we need all the restorative sleep we can get.

    I wish there was a fail safe answer for your particular situation but I certainly don't have it.

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    • Posted

      Thanks for your response kpower - I've read lots of people's comments about their air pockets but mine doesn't come with them.  I felt lucky until the day of my fall, and I guess the idea that I can't hurt myself is still ingrained.  I'm getting more medical advice, fingers crossed I haven't done any harm.

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  • Posted

    Hi there, I too found it awkward and uncomfortable to sleep in the boot so I mentioned this to my physio who immediately gave me a night boot. This is more like a slipper version of the boot, nice and soft and light whilst also giving the ankle support.

    I an also a fidgeted when in bed so I was concerned I may do something in my sleep.

    Hope this helps, Kenny

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  • Posted

    Hi Jessica,

    The answer to that is so tricky because we are not doctors and not familiar with your situation.  I was put in my boot at the  two week mark, after a cast.  It was such a relief to be out of the cast for showers and resting!  But, I had your problem.  It hurt!  It rubbed my incision! It was really, really uncomfortable to sleep in! So I asked my surgeon if I could please ditch it at night and resting times.  I had a spiral fracture of the fibula and have a plate and 6 screws.  He gave me the answer I wanted!  He said the hardware was holding my ankle in position for proper knitting of the bone and healing.  The boot was for protection.  What if my dog jumped on the bed and landed on my ankle?  Was I a restless sleeper and could I somehow hurt it while sleeping (I am not sure how- jump out of bed on it??).    Anyway, I decided I was not worried about hurting it in the night- his scenarios did not apply!!  So for me, I stopped wearing it at night and my ankle is fine now. (12 weeks post surgery).  I really only wore it when I went out, and I would loosen it right up wherever I was (restaurant, movie...), as soon as I could.  

    Having said all that, I have read other posts on here where the surgeons say the boot is a necessary part of the healing, so I would ask again and really clarify if he is worried about your ankle being too unprotected, or if the boot is part of the fixation process in your case.  Also, I never heard of this night boot!  That may be your answer!

    Good luck,

    Erin

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    • Posted

      Thanks Erin, that's really helpful and reassuring - I'm going to keep trying to sleep in the boot until advised otherwise but hopefully it means I haven't done any damage in the meantime.

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  • Posted

    Kenny,

    I was thinking too about why they don't make a version of a CAM boot that would be comfortable in bed.

    I checked online and found 'night splints' advertised-- they look super comfortable compared to moon boots (wouldn't anything look more comfortable?). However, they are flimsier than regular boots, so I don't know if they would provide the protection your particular ankle injury at this particular time in recovery would require. Only your doctor could give an educated answer to that question.

    If they ever invent a night splint that provides equivalent ankle sleeping protection (after all, you won't be wearing it out of bed) of a full-size ponderous moon boot I think it will sell like hotcakes.

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    • Posted

      Exactly!! If my GP clears it tomorrow, I'm throwing my money at whichever night-splint-seller will take it fastest!

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  • Posted

    Hi CambootHater

    I had ORIF surgery last January 12 with a plate and 8 screws in my ankle (trimalleolar fracture). I did not have a cast/boot post surgery which made me feel exposed. Doctors said the hardware is there to hold your bones together thats its purpose so really having a cast/ boot is unnecessary and just an extra precaution.

    however i wore the boot  when out and about when i was NWB. i never wore it at home as i felt safe that no one would hit it. Its really uncomfortable and it hurts especially where the incision is. so i was happy that i didnt have to wear it. i dont know about your break as everybodys different like they say, maybe your case is different and that you actually need it.  i spoke to a physical therapist and he told me that these days they dont get people to wear cast anymore.  People get better mobility and faster recovery without. Its good that you got the camwalker as you can actually remove it and do calf pumps. I am 12 weeks post surgery and i am still 50 percent weight bearing but without the boot . i only use crutches.  hope this helps.

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