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Removable boots or braces significantly reduce unscheduled healthcare visits and time to return to activitiesRemovable Boots May Help Children Recover Faster From Ankle Fractures

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Key Takeaway
Consider removable boots or braces as a favorable alternative to casts for low-risk pediatric ankle fractures.

This meta-analysis evaluated the management of low-risk, stable, or suspected occult ankle fractures in children (0-18 years). The study compared removable boots or braces against traditional cast immobilization and assessed outcomes including healthcare utilization, functional scores, and time to return to activities.

Key findings indicate that patients using removable boots or braces had a significantly lower risk of unscheduled healthcare visits (RR 0.26; 95% CI 0.13 to 0.52; p = 0.0001) compared to those in casts. Furthermore, the time to return to normal activities was shortened by 6.83 days (MD -6.83; 95% CI -11.20 to -2.96; p = 0.0031). Functional scores were improved (SMD -0.79; 95% CI -1.03 to -0.55; p < 0.00001). For patients using supportive bandaging, missed school days were reduced (MD -0.49; 95% CI -0.81 to -0.18; p = 0.002) and return to baseline activities was accelerated (14.17 vs 20.19 days; p = 0.0002).

No significant differences were found regarding pain, complications, emotional wellbeing, or mobility between the groups. However, the authors noted high heterogeneity in results for supportive bandaging. While removable devices offer a favorable alternative for low-risk pediatric cases, the necessity of rigid over soft immobilization remains uncertain, and a definitive RCT based on a core outcome set is required.

How this fits prior evidence

This meta-analysis extends the understanding of non-operative management for pediatric ankle fractures. While previous evidence noted an increased wound complication risk of 14% with early functional treatment versus cast immobilization, this study suggests that removable boots or braces offer a favorable alternative for low-risk cases by reducing unscheduled visits (RR 0.26) and improving functional scores (SMD -0.79).

A review of several studies looked at how children with low-risk, stable, or suspected hidden ankle fractures recover. The researchers compared using removable boots or braces against traditional casts. The study included data from 503 children to see which method helped them get back to their normal lives faster.

The results showed that children using removable boots or braces had significantly fewer unscheduled visits to healthcare facilities. These children also returned to their normal activities about 7 days sooner than those in casts. Additionally, children using supportive bandaging missed fewer days of school and returned to their baseline activities faster than those in casts.

While the results are promising, the study notes that the choice between rigid casts and softer supports is not yet fully settled. The evidence for bandaging specifically had some variations across different studies. These findings suggest that removable options are a helpful alternative for certain types of fractures, but you should talk to a doctor to determine the best treatment for a specific injury.

What this means for you:
Removable boots or braces may allow children with stable ankle fractures to return to activities faster than casts.

Common questions

How does a removable boot compare to a cast for a child's fracture?

Children using removable boots or braces had significantly fewer unscheduled visits to healthcare facilities and returned to normal activities about 7 days sooner than those in casts. They also showed improved functional scores compared to those in traditional casts.

Can supportive bandaging help children get back to school faster?

Yes, the study found that children using supportive bandaging missed fewer days of school. These children also returned to their baseline activities faster, at an average of 14.17 days compared to 20.19 days for those in casts.

Are there any safety concerns with using boots instead of casts?

The study did not report any significant differences in pain, complications, emotional wellbeing, or mobility between those using removable boots and those in casts. However, the study notes that more research is needed to confirm the best treatment for every specific case.

Study Details

Study typeMeta analysis
EvidenceLevel 1
Follow-up216.0 mo
PublishedNov 2026
View Original Abstract ↓
INTRODUCTION: Low-risk ankle fractures in children are commonly managed with immobilisation, using options such as supportive bandages, removable boots/braces or casted devices. The aim of this study was to review the literature to determine the optimal treatment for these fractures. METHODS: A systematic review of randomised controlled trials (RCTs) was conducted in November 2024. Comprehensive searches of MEDLINE, Embase and Cochrane CENTRAL were performed. Studies recruiting children (0-18 years) with low-risk, stable or suspected occult ankle fractures managed non-operatively were included, comparing different immobilisation devices. Unscheduled returns to healthcare facilities, patient-reported outcomes, functional outcomes, and complication rates were assessed. FINDINGS: Seven RCTs involving 503 children were included. Compared with casts, removable boots/braces significantly reduced unscheduled healthcare visits (risk ratio [RR] 0.26; 95% confidence interval [CI] 0.13 to 0.52; = 0.0001), shortened return to normal activities (mean difference [MD] -6.83 days; 95% CI -11.20 to -2.96; = 0.0031), and improved functional scores (standardised mean difference [SMD] -0.79; 95% CI -1.03 to -0.55; < 0.00001). Patient and parent satisfaction was also higher with removable devices. Supportive bandaging reduced missed school days (MD -0.49; 95% CI -0.81 to -0.18; = 0.002) and accelerated return to baseline activities (14.17 vs 20.19 days; = 0.0002), although results showed high heterogeneity. No significant differences were found in pain, complications, emotional wellbeing or mobility between groups. CONCLUSIONS: Removable boots or braces offer a favourable alternative to cast immobilisation for low-risk paediatric ankle fractures. However, the necessity of rigid over soft immobilisation remains uncertain. A definitive RCT based on a core outcome set and cost-effective analyses is required to inform treatment recommendations.
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