Foot Splints: Posterior Ankle, Hard-Soled Shoe & High-Top Walking Boot

Instructor: Anna Monroe

Anna is an emergency medicine and sports medicine physician.

This lesson will describe three common types of foot splints: posterior ankle, hard-soled shoe, and high-top walking boot. These splints are useful for treating a wide variety of conditions of the lower leg, ankle, and foot. They can be useful for both bony and soft tissue injuries, and they can help acute and chronic injuries too.

Introduction

Erin is a ballet dancer, and she has the lead part in an upcoming performance. Last weekend she stubbed her big toe on a large piece of furniture in her bedroom. Her x-ray showed the toe was broken. Let's discuss how to treat her fracture with a foot splint. We will first explain the choices: posterior ankle, hard-soled shoe, and high-top walking boot. We will match each treatment with a problem, and we will follow Erin as she gets back on her toes!

Descriptions of the Types of Foot Splints

A posterior ankle splint prevents pointing and flexing at the ankle (processes called plantarflexion and dorsiflexion respectively). It wraps the back of the lower leg, ankle, and foot in a rigid material to accomplish its purpose. It comes in prefabricated versions, and can also be created by using plaster, fiberglass, or other splinting materials.

One of many kinds of prefabricated posterior splints

A hard-soled shoe is sometimes referred to as a post-op shoe. It is a flat, firm shoe that is secured to the foot with velcro. Its stiffness limits bending at the foot and toes.

Hard-soled Shoe

Finally, a high-top walking boot is a structured splint enclosing the lower leg, ankle, and foot. It holds the ankle in approximately a ninety-degree angle of flexion, and it limits all motion at the ankle and foot.

Walking Boot

Conditions and the Corresponding Splints

Each type of splint can treat many different problems, and sometimes the same problem can be treated with more than just one of the types of splint. The following list describes the most common splinting choices matched with the diagnosis. It might help to think about what sort of immobilization each splint provides to understand the logic of its use. For instance, a fracture of a little toe would respond well to a hard-soled shoe because the shoe would prevent excessive movement at the toes. On the other hand, while a high-top boot would also immobilize the foot, it would additionally limit ankle motion. This treatment would likely be too aggressive, and it might cause unnecessary stiffness in the ankle as a result of the immobilization.

  • Posterior Splint: Achilles tendon injuries, plantar fasciitis (irritation of the connective tissue that supports the sole of the foot, night use only), tendinitis of the extensor tendons at the front of the ankle
  • Hard-soled Shoe: Fractures of the lesser toes (toes 2-5), some metatarsal fractures (breaks in the long bones of the foot beneath the toes), arthritis of the foot, and after surgery on the foot
  • High-top Walking Boot: Fractures of the big toe, sprains of the big toe joint (turf toe), some metatarsal fractures, fractures of other foot bones, fractures of the lower leg and ankle, and severe ankle sprains

Erin received a walking boot to treat her fracture. Most toe fractures can be treated with a hard-soled shoe, but the big toe is a little different. When we push off at the end of our stride, a large amount of force goes through the big toe. Tendons running through the ankle also help the big toe move. For both reasons the ankle and foot are immobilized for most problems of the big toe.

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