Tag: Aircast

Walker Boots vs Plaster Casts: Cost-Effectiveness and Clinical Outcomes

Posted on | by Matthew Blackwell

For decades, plaster casts have been the default choice for immobilizing lower-limb injuries such as Achilles tendon ruptures and ankle fractures. However, growing clinical evidence suggests that functional walker boots offer a cost-effective alternative without compromising patient outcomes or safety.

So what does the latest research actually tell us? And how should this influence treatment decisions in modern orthopedic care?

Rethinking Immobilization: Why Cost-Effectiveness Matters

Healthcare systems are under increasing pressure to deliver high-quality outcomes while controlling costs. Immobilization strategies play a significant role in this equation, not just in terms of device cost, but also:

  • Time and resources required for application and removal
  • Follow-up appointments and unplanned hospital visits
  • Need for informal care and support
  • Speed of functional recovery and return to work

Multiple studies now indicate that walker boots consistently perform well across these areas, particularly when early weight-bearing protocols are used.

Achilles Tendon Rupture: Comparable Outcomes, Lower Overall Costs

One of the most robust datasets comes from the UKSTAR trial by Costa et al.1, a large multicenter randomized controlled study involving 527 patients across 39 NHS hospitals. The trial compared:

  • Traditional plaster casting (8 weeks, delayed weight bearing)
  • Functional walker boot (8 weeks, immediate weight bearing)

Key findings:

  • Total health and social care costs were slightly lower in the walker group (by approximately £103 per patient), although the difference was not statistically significant
  • No difference in functional outcome at 9 months, measured using the Achilles Tendon Total Rupture Score (ATRS)
  • No difference in re-rupture rates, confirming comparable safety profiles

In other words, functional bracing delivered equivalent clinical results at a lower or comparable cost, while enabling earlier mobilization.

Importantly, clinicians concluded that early weight-bearing in a walker boot can be considered a safe and cost-effective alternative to plaster casting.

Why Walker Boots May Support Better Recovery

The cost-utility advantage of walker boots is not purely financial, it is closely linked to how patients recover.

Evidence suggests improved functional recovery may be related to:

  • Greater comfort and convenience for patients2
  • Compatibility with early weight-bearing protocols1,3,4
  • Ability to remove the boot for controlled mobilization exercises1,5,6
  • Reduced reliance on informal carers7

These factors can translate into faster return to normal activity and work1,4,7, which has major societal and economic implications beyond direct healthcare costs.

Ankle Fractures: Strong Evidence Across Operative and Non-Operative Care

The evidence is equally compelling for ankle fractures. A UK multicenter randomized trial evaluated cast immobilization versus walker boots in 669 patients across 20 NHS trauma units.

Clinical outcomes:

  • No significant difference in functional outcomes at 4 months or 2 years8,9
  • Functional outcomes measured using the Olerud-Molander Ankle Score (OMAS) were equivalent8,9
  • Complication rates were similar between cast and walker groups8,9

Economic outcomes:

  • Cost-utility analysis showed that, from an NHS perspective, removable braces were cost-effective under commonly accepted willingness-to-pay thresholds10

The authors concluded that a removable walker boot is as effective and safe as a plaster cast, for both operative and non-operative ankle fracture management, and remains so in the long term.

Post-Operative Ankle Fractures: The Case for Early Weight Bearing

Recent studies have added another important dimension: timing of weight bearing.

Two major UK trials provide valuable insights:

1. Ankle Recovery Trial (ART)

  • Compared walker boots versus casts after ankle fracture surgery
  • Found the total treatment cost per patient was £676 lower in the walker group
  • Analysis included not only device cost, but also informal care and productivity losses

2. Weight-bearing in Ankle Fracture (WAX) Trial

  • Compared early vs delayed weight bearing post-operatively
  • Early weight bearing was associated with £722 lower mean societal costs, largely due to reduced work absence

Taken together, these findings suggest that early weight bearing in a walker boot may offer substantial cost savings compared to delayed weight bearing in a cast, without compromising safety or outcomes4,7.

What This Means for Clinical Practice

Across Achilles tendon rupture and ankle fracture management – both conservative and post-operative – the evidence consistently shows that walker boots:

  • Are at least as effective as plaster casts
  • Offer comparable safety profiles
  • Support earlier mobilization and weight bearing
  • Can deliver meaningful cost savings, especially when societal costs are considered

For clinicians and healthcare systems alike, this supports a shift toward functional immobilization strategies where clinically appropriate.

Conclusion: Walker Boots are Evidence-Based, Patient-Centered, Cost-Effective

Modern functional walkers allow clinicians to align clinical outcomes, patient experience, and economic efficiency. As the evidence base continues to grow, walker boots are increasingly positioned not as an alternative, but as a first-line option for many lower-limb injuries.

As always, individual patient factors and clinical judgement remain paramount, but the data clearly supports giving functional bracing serious consideration in contemporary orthopedic care.

DonJoy® Nextep Xcel™: a New Cost-Effective Walker Range from Enovis™

DonJoy Nextep Xcel walker boot range

Healthcare professionals need dependable orthopedic solutions that are designed to deliver consistent patient outcomes while remaining practical. The new DonJoy® Nextep Xcel™ range meets these needs through a family of full-shell walker boots for post-operative and post-trauma foot and ankle care.

By integrating established technology with streamlined design, Nextep Xcel offers a comprehensive approach to patient mobility management. The range provides the clinical performance clinicians expect while supporting efficiency within practices.

The Nextep Xcel range represents a balanced approach to orthopedic care, delivering the functionality patients need and the reliability clinicians value.

For more information on Enovis’s portfolio of orthopedic walker boots, visit our website or contact your local Enovis representative.

References

  1. Costa ML et al. UKSTAR trial collaborators. Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet. 2020 Feb 8;395(10222):441-448.
  2. Hampton MJ et al. Functional Walker Boots are Preferred to Synthetic Casts by Patients and Carers in the Management of Pediatric Stable Ankle Injuries. J Pediatr Orthop. 2024 Feb 1;44(2):99-105.
  3. Ghaddaf AA et al. Early versus late weightbearing in conservative management of acute achilles tendon rupture: A systematic review and meta-analysis of randomized controlled trials. Injury. 2022 Apr;53(4):1543-1551.
  4. Bretherton CP et al. WAX Investigators. Early versus delayed weight-bearing following operatively treated ankle fracture (WAX): a non-inferiority, multicentre, randomised controlled trial. Lancet. 2024 Jun 29;403(10446):2787-2797.
  5. Egol KA et al. Functional outcome of surgery for fractures of the ankle. A prospective, randomised comparison of management in a cast or a functional brace. J Bone Joint Surg Br. 2000 Mar;82(2):246-9.
  6. Barile F et al. To cast or not to cast? Postoperative care of ankle fractures: a meta-analysis of randomized controlled trials. Musculoskelet Surg. 2024 Dec;108(4):383-393.
  7. Baji P et al. Use of removable support boot versus cast for early mobilisation after ankle fracture surgery: cost-effectiveness analysis and qualitative findings of the Ankle Recovery Trial (ART). BMJ Open. 2024 Jan 11;14(1):e073542.
  8. Kearney R et al. AIR trial collaborators. Use of cast immobilisation versus removable brace in adults with an ankle fracture: multicentre randomised controlled trial. BMJ. 2021 Jul 5;374:n1506.
  9. Nwankwo H et al. Cost-utility analysis of cast compared to removable brace in the management of adult patients with ankle fractures. Bone Jt Open. 2022 Jun;3(6):455-462.
  10. Haque A et al. the AIR Trial collaborators. Use of cast immobilization versus removable brace in adults with an ankle fracture: two-year follow-up of a multicentre randomized controlled trial. Bone Joint J. 2023 Mar 15;105-B(4):382-388.

Enovis™ Unveils Unified Brand Identity

Posted on | by Matthew Blackwell

For decades, healthcare professionals have trusted products from DonJoy®, Chattanooga®, and Aircast® to deliver exceptional patient outcomes. These iconic brands, part of the Enovis™ family, have shaped orthopedic care and rehabilitation across the globe. Today, Enovis—a worldwide leader in medical technology solutions—announces a strategic visual transformation that unites these trusted names under a cohesive brand identity while preserving their individual legacies of innovation.

The Enovis Family: A Legacy of Innovative Brands

Enovis encompasses approximately a dozen specialized product brands within its comprehensive portfolio. Each brand brings distinctive expertise to the continuum of care, from prevention and rehabilitation to surgical intervention. Let’s explore the remarkable journeys of three cornerstone brands:

DonJoy® – Protecting Knees (and More) Since the 1970s

DonJoy has become virtually synonymous with knee bracing excellence. This cornerstone Enovis brand has manufactured and supplied braces for knee ligament protection since the late 1970s, utilizing patented technology specifically designed to reduce anterior cruciate ligament (ACL) strain1,2.

The Garage That Changed Orthopedics

In 1978, Philadelphia Eagles’ offensive line captain Mark Nordquist and lawyer Ken Reed founded a small company in a Carlsbad, California garage. They named their venture DonJoy after their wives, Donna and Joy—a personal touch that reflected their commitment to improving patients’ lives.

DonJoy initially focused on developing knee braces, and by the late 1990s, it was generating approximately $100 million in annual revenues through an expanding range of orthopedic products. Following a series of strategic acquisitions and mergers, the company evolved into DJO and later, Enovis. Throughout these transformations, the DonJoy name has endured for almost half a century, proudly displayed on products worn by millions worldwide.

Flagship Product: Defiance® PRO

The Defiance® PRO represents the culmination of decades of research in knee stability engineering. This custom-fit functional knee brace features aircraft-grade aluminum and proprietary hinge technology that mirrors natural knee movement while providing crucial support for ACL, PCL, MCL, and LCL injuries. Professional athletes and weekend warriors alike rely on its lightweight yet robust design for confidence during activity.

Aircast® – Over Half a Century in Service of Medical Professionals

For more than 50 years, medical professionals worldwide have depended on Aircast for technological breakthroughs in patient care.

Rooted in sound scientific methods, each Aircast product is developed using the concept of “functional management,” setting progressive standards of care for lower limb fractures, ankle sprains, and other injuries with patented technology and graduated pneumatic compression.

Aircast was founded in 1972 by U.S. inventor Glenn Johnson Jr. after he created the eponymous pneumatic ankle brace system. The innovative air cell technology provides targeted compression and stabilization while allowing appropriate movement—a revolutionary approach to ankle injury management. Among Johnson’s other inventions was the VenaFlow™ system, a DVT-prevention device used in hospitals worldwide.

Flagship Product: AirSelect™ Walker

The AirSelect™ Walker exemplifies Aircast’s commitment to functional recovery. Its SoftStrike technology absorbs shock and reduces heel loading, while integrated air cells deliver customized compression. The intuitive pump system allows patients to adjust pressure levels independently, promoting compliance and improving outcomes. Clinical studies have demonstrated faster recovery times compared to traditional immobilization methods for appropriate indications.3,4

Chattanooga® – Supporting Physiotherapists Since 1947

Founded in Chattanooga, Tennessee, by local athletic trainer Lee Jensen and his business partner Jack Walker, the Chattanooga Group began as Chattanooga Pharmacal Company in 1947.

From Local Startup to Global Leader

The company initially created hot and cold therapy products for the physiotherapy market before expanding its innovation focus. A significant breakthrough came with the development of the Intelect line, which brought portable ultrasound and electrotherapy devices into private clinics and transformed treatment accessibility.

By the early 2000s, Chattanooga had established itself as the world’s largest manufacturer of rehabilitation equipment, contributing to improved treatment outcomes in hospitals, clinics, and home settings worldwide. After nearly 80 years, the Chattanooga brand continues to be associated with technological advancements in treating musculoskeletal, neurological, and soft tissue disorders.

Flagship Product: LightForce® Laser

The LightForce® laser therapy system represents a significant advancement in non-invasive pain management. Using specific wavelengths of light to penetrate tissue and stimulate cellular metabolism, this photobiomodulation therapy helps reduce inflammation and relieve pain.5 Clinicians appreciate its intuitive interface and customizable treatment protocols that address a wide range of conditions from tendinopathies to post-surgical recovery.

Introducing the Updated Enovis Product Brands

As a family of brands under the banner of Enovis, DonJoy, Aircast, Chattanooga, and their sister brands now share a cohesive visual identity that clearly communicates their relationship while honoring their individual histories.

Enovis product brand logo update

The refreshed type treatment applied to the product brand logos achieves a unified aesthetic while creating a clear hierarchy between the corporate brand and its product brands. The updated design maintains recognizable elements from each brand’s heritage while bringing them into alignment with Enovis’s forward-looking vision.

For healthcare professionals who have relied on these trusted brands throughout their careers, this unified identity signals not an ending but a strengthening—a commitment to continued excellence and innovation under the Enovis banner for decades to come.

Healthcare professionals interested in learning more about Enovis products can contact their local Enovis representative.

References

  1. Fleming BC et al. The influence of functional knee bracing on the anterior cruciate ligament strain biomechanics in weightbearing and nonweightbearing knees. Am J Sports Med 2000;28(6):815-24.
  2. Lin CF, Liu H, Garrett WE, Yu B. Effects of a knee extension constraint brace on selected lower extremity motion patterns during a stop-jump task. J Appl Biomech. 2008 May;24(2):158-65.
  3. Shahid MK, Punwar S, Boulind C, Bannister G. Aircast walking boot and below-knee walking cast for avulsion fractures of the base of the fifth metatarsal: a comparative cohort study. Foot Ankle Int. 2013 Jan;34(1):75-9.
  4. Haworth L, Booth N, Chohan A, Chapman G, Richards J. How does orthotic walker boot design influence lower limb and trunk function during gait? Prosthet Orthot Int. 2024 Mar. E-Pub ahead of publication.
  5. Chatterjee P, Srivastava AK, Kumar DA, Chakrawarty A, Khan MA, Ambashtha AK, Kumar V, De Taboada L, Dey AB. Effect of deep tissue laser therapy treatment on peripheral neuropathic pain in older adults with type 2 diabetes: a pilot randomized clinical trial. BMC Geriatr. 2019 Aug 12;19(1):218.

The link between COVID-19 and heel pain

Posted on | by Matthew Blackwell

Since the COVID-19 pandemic began in 2020, the number of patients reporting heel pain has risen. The condition is now so common it has come to be known as “pandemic foot”. Is there really a link between COVID-19 and heel pain, and if so, what treatment options are available?

What is plantar fasciitis?

While “pandemic foot” might be a catchy name, the correct medical term is plantar heel pain, or plantar fasciitis. This condition presents as pain felt on the bottom of the foot around the heel and arch. It is an overuse condition often associated with runners, especially those over the age of 40.

Excessive pressure on the foot, along with a tight calf or Achilles tendon, can cause inflammation of the plantar fascia, the thick band of tissue on the bottom of the foot connecting the heel to the toes.

The pain is commonly felt during the first step, as well as during weight-bearing tasks, particularly after periods of rest.1 Patients often report the pain at its worst as they take their first steps of the day after getting out of bed. It typically decreases as the calf and Achilles tendon become looser during activity, only to return the following day after things have tightened up again during the night.

Does COVID-19 cause plantar fasciitis?

There is no current evidence to suggest there is a direct link between COVID-19 and heel pain. Instead, the rise in plantar fasciitis is more likely to be due to the changes in our daily lives the pandemic has brought about.

Gym attendances have declined since the beginning of the pandemic, with outdoor running and walking becoming more popular instead. More running and walking mean more stress on the plantar fascia, which, due to an increase in flexible working, can be exacerbated by more time spent walking around at home in bare feet, slippers, or flip-flops.

Without the additional support that a heeled shoe can provide, like those typically worn in office environments, the foot spends more time in a flat position, which, for extended periods, can put additional strain on the fascia. Add to this stiff muscles and tendons from running, and you have a recipe for plantar fasciitis. This is the indirect link between COVID-19 and heel pain.

How can heel pain be treated?

There are a number of conservative treatment options for plantar fasciitis. They range from relatively simple orthotics to more advanced rehabilitation devices.

Taping for heel pain

Physio tape (also known as kinesiology tape) like Chatt-Tape is elastic adhesive tape that can be applied to parts of the body to aid healing and recuperation of the soft tissue.2

Tape can be applied to the heel, ankle, and underside of the foot to release tension in the plantar fascia as well as stabilize it. A study by Tezel et al. (2020) showed that kinesiology tape provided pain relief and improved quality of life for patients with plantar fasciitis, as well as improved functionality.3

Chatt-Tape plantar fasciitis
Aircast AirHeel and Dorsal Night Splint

Bracing for heel pain

Plantar fasciitis can be relieved by wearing an orthotic during the night to help reduce the tightening of the calf muscles and Achilles tendon.4 One such device is Aircast’s Dorsal Night Splint; this product is worn while the patient sleeps, to maintain the position of the foot at 90°, thereby helping to stretch the calf and Achilles tendon.

Another type of foot orthosis for plantar fasciitis is a pneumatic ankle brace. Also from Aircast, the AirHeel is designed to treat plantar fasciitis, Achilles tendonitis, and heel pain. Using two interconnected aircells located under the foot arch and in the back of the heel, the brace applies pulsating compression with every step to help reduce swelling and discomfort and enhance circulation.

Kavros’s 2005 study showed that patients with higher plantar fasciitis pain experience faster relief with the Airheel than with a shoe insert.5

Shock wave therapy for heel pain

Shock wave therapy is an electronic modality that uses acoustic waves to stimulate the body on a cellular level for healing purposes. Generally divided into focused shock wave (F-SW) and radial pressure wave (RPW) therapy, shock wave therapy has been shown to be a clinically proven treatment option for plantar fasciitis, especially when treatments like taping have not been successful.1

In a 2022 study by Wheeler et al., RPW treatment provided significant improvement of pain and function in patients with chronic plantar fasciopathy.6

Intelect 2 RPW
LightForce laser therapy

High power laser therapy for heel pain

High power laser therapy, like that offered by LightForce, uses the energy of focused light to trigger the body’s natural healing processes, thereby speeding recovery.

Ordahan et al.’s 2018 study demonstrated that high power laser therapy provided improvement of pain and function in patients with plantar fasciitis.7

Combining laser therapy with shock wave therapy has shown to be even more effective.8

To learn more about products for heel pain, visit enovis-medtech.eu

References

  1. Morrissey, D., Cotchett, M., Said J’Bari, A., Prior, T., Griffiths, I. B., Rathleff, M. S., Gulle, H., Vicenzino, B., & Barton, C. J. (2021). Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British journal of sports medicine, 55(19), 1106–1118.
  2. Homayouni, K., et al. (2013). Comparison between kinesio taping and physiotherapy in the treatment of de Quervain’s disease. J. Musculoskelet. Res. 16(4).
  3. Tezel, N., Umay, E., Bulut, M., Cakci, A (2020). Short-Term Efficacy of Kinesiotaping versus Extracorporeal Shockwave Therapy for Plantar Fasciitis: A Randomized Study. Saudi J Med Med Sci. Sep-Dec;8(3):181-187.
  4. Powell, M., Post, W. R., Keener, J., & Wearden, S. (1998). Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Foot & ankle international, 19(1), 10–18.
  5. Kavros, S. J. (2005). The efficacy of a pneumatic compression device in the treatment of plantar fasciitis. Journal of applied biomechanics, 21(4), 404–413.
  6. Wheeler, P. C., Dudson, C., & Calver, R. (2022). Radial Extracorporeal Shockwave Therapy (rESWT) is not superior to “minimal-dose” rESWT for patients with chronic plantar fasciopathy; a double-blinded randomised controlled trial. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons, 28(8), 1356–1365.
  7. Ordahan, B., Karahan, A. Y., & Kaydok, E. (2018). The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial. Lasers in medical science, 33(6), 1363–1369.
  8. Takla, M. K. N., & Rezk, S. S. R. (2019). Clinical effectiveness of multi-wavelength photobiomodulation therapy as an adjunct to extracorporeal shock wave therapy in the management of plantar fasciitis: a randomized controlled trial. Lasers in medical science, 34(3), 583–593.