What is the appropriate treatment and management plan for a patient requiring an Aircast boot?

Prescribing an Aircast Boot: Treatment Protocol and Management

For patients requiring an Aircast boot, prescribe a removable walker boot that extends to knee-height with appropriate padding and an adjustable insole to provide optimal offloading and protection while maintaining patient mobility. 1

Indications for Aircast Boot Prescription

An Aircast boot (removable walker) is indicated for:

• Neuropathic plantar forefoot ulcers in patients with diabetes 1
• Avulsion fractures of the fifth metatarsal 2
• Ankle sprains (providing better functional outcomes than elastic bandages) 3
• Protection following foot and ankle surgery
• Offloading pre-ulcerative lesions in high-risk patients

Prescription Details

When writing a prescription for an Aircast boot, include:

1. Type of device: "Removable knee-high walker boot with rocker sole"
2. Specific features needed:
   • Padded interior
   • Adjustable/insertable insole
   • Total contact design if for diabetic foot ulcer
3. Duration of use: Typically 4-12 weeks depending on condition
4. Weight-bearing status: Specify full, partial, or non-weight bearing
5. Wearing schedule: Full-time vs. removal for bathing/sleeping

Patient Education Points

When dispensing the Aircast boot, provide these instructions:

• Proper application technique to ensure correct fit
• Daily inspection of skin under the boot for pressure points or irritation
• Importance of adherence to wearing schedule
• Use of appropriate footwear on the contralateral limb to prevent gait imbalance
• Instructions to keep the boot dry and clean

Clinical Considerations

For Diabetic Foot Conditions

For patients with diabetes and neuropathy, consider:

• Converting the removable walker to an "instant total contact cast" by wrapping it with cohesive bandage to improve adherence 1
• Ensuring the boot provides at least 30% pressure relief compared to standard footwear 1
• Monitoring for signs of new pressure points, especially at the margins of the boot

For Acute Injuries

For traumatic conditions:

• Patients treated with Aircast boots for fifth metatarsal avulsion fractures return to pre-injury function approximately 3 weeks earlier than those treated with short-leg casts 2
• Aircast braces provide significantly better ankle function at both 10 days and one month compared to elastic bandages for ankle sprains 3

Follow-up Protocol

1. Initial follow-up: 48-72 hours after dispensing to check fit and skin condition
2. Regular follow-up: Every 1-2 weeks for diabetic foot ulcers; every 2-4 weeks for fractures
3. Assessment at each visit:
   • Skin integrity under the boot
   • Proper fit (should not be too tight or too loose)
   • Progress of healing of the underlying condition
   • Need for adjustments to the boot or padding

Common Pitfalls to Avoid

• Improper sizing: Ensure the boot is 1-2 cm longer than the foot and wide enough at the metatarsal phalangeal joints 1
• Poor patient adherence: Consider converting to a non-removable device if adherence is an issue with diabetic foot ulcers 1
• Inadequate offloading: Check pressure distribution with weight-bearing
• Contralateral limb issues: Provide a shoe lift for the opposite foot if needed to prevent gait abnormalities
• Skin complications: Ensure adequate padding at bony prominences

Alternative Options When Aircast Boot is Contraindicated

If a knee-high walker is contraindicated:

• Forefoot offloading shoe
• Cast shoe
• Custom-made temporary shoe 1
• Felted foam in combination with appropriate footwear 1

Remember that for diabetic foot ulcers, conventional or standard therapeutic shoes should not be used for healing plantar foot ulcers 1.