How long should I wear a boot for an ankle sprain?

Duration of Boot Wear for Ankle Sprains

For an ankle sprain, functional support with an ankle brace should be used for 4-6 weeks rather than prolonged immobilization in a boot. 1

Evidence-Based Recommendations

Optimal Duration and Type of Support

• First 10 days: If immobilization is needed for severe pain or swelling, limit boot use to a maximum of 10 days 1
• Weeks 2-6: Transition to functional support (preferably an ankle brace) for a total of 4-6 weeks 1

Functional support with an ankle brace is superior to immobilization in a boot or cast for most ankle sprains. Multiple high-quality studies (22 RCTs, n=2304) have demonstrated that prolonged immobilization (4+ weeks) results in worse outcomes compared to functional treatment 1.

Treatment Algorithm Based on Severity

Grade 1 (Mild) Sprains:

• Minimal ligament stretching
• Functional support with brace for 2-4 weeks
• Return to light work: 2 weeks
• Full return to former work: 3-4 weeks 1

Grade 2-3 (Moderate to Severe) Sprains:

• Partial or complete ligament tear
• Short-term immobilization (<10 days) may help reduce pain and swelling 1
• Transition to functional brace for remainder of 4-6 weeks
• Return to light work: 3-6 weeks
• Full return to former work: 6-8 weeks 1

Rationale and Supporting Evidence

Why Functional Support is Preferred

1. Better Outcomes: Functional treatment leads to faster recovery than immobilization 1
2. Faster Return to Work: Workers using semi-rigid ankle braces resume work faster than those using elastic bandages (4.2 days sooner) 1
3. Prevention of Complications: Prolonged immobilization can lead to joint stiffness, muscle atrophy, and delayed rehabilitation 1

Exercise Therapy

Exercise therapy should be initiated early alongside functional support:

• Begin proprioceptive and neuromuscular exercises as soon as tolerated 1, 2
• Supervised exercises lead to faster return to sport and better outcomes 1
• Exercise therapy reduces the risk of recurrent sprains (10 RCTs, n=1284) 1

Common Pitfalls to Avoid

1. Prolonged Immobilization: Keeping the ankle in a boot for more than 10 days can lead to muscle atrophy, joint stiffness, and delayed recovery 1

2. Inadequate Follow-up: Research shows 72.6% of patients report residual symptoms 6-18 months after ankle sprain, suggesting standard treatment may be inadequate without proper follow-up 3

3. Ignoring Exercise Therapy: Failing to incorporate early exercise therapy can increase the risk of chronic ankle instability and recurrent sprains 1, 2

4. Overlooking Severity Assessment: Delaying proper assessment (4-5 days post-injury) can lead to misclassification of sprain severity and inappropriate management 2

Monitoring Progress

• Reassess at 2-3 weeks; if no improvement, consider additional interventions 2
• Monitor for signs of chronic ankle instability (recurrent sprains, persistent instability) 2
• Consider referral if no improvement after 6-8 weeks of conservative treatment 2

In conclusion, the evidence strongly supports limiting boot immobilization to a maximum of 10 days (if needed at all), followed by functional support with an ankle brace for a total treatment duration of 4-6 weeks, combined with early exercise therapy.