Cam Walkers – pros and cons
Cam walkers. I’m sure you’ve seen them. Cam walkers are the removable
casts that are used as a step down cast following foot and ankle surgery. The real beauty of a cam walker is two fold. First, the rocker sole on the cam walker really does a great job in off-loading the forefoot. And I particularly like the air pump cam walkers that allow patients to pump air into the bladder of the walker. The air bladder does a great job in controlling edema and limited ‘bobble’ of the leg, ankle and foot inside the walker.
So what are the down sides to cam walkers? First, the heel in most cam walkers is very low. The lower the heel, the stronger the calf. By making the calf stronger, you have to then consider some of the ramifications of using a cam walkers. One common problem I see with use of a cam walker for more than 2-3 weeks is plantar fasciitis. Many folks will complain of plantar heel pain. Usually the plantar fasciitis will resolve in a matter of a few weeks upon the return to a regular shoe. The same holds true for Achilles tendonitis. Best to add a heel lift to the walker if you’re suspicious of either plantar fasciitis or Achilles tendonitis.
And using cam walkers for plantar fasciitis? To me, that just doesn’t make sense. One of the simple treatment tricks used for plantar fasciitis is the use of a simple heel lift.  Elevating the heel and doing some heel stretches go a long way in treating plantar fasciitis. So to put a new case of PF in a cam walker? Just doesn’t make sense in the least.
Other foot problems? I recently saw a case of posterior tibial tendon dysfunction (PTTD) as the result of using a cam walker. Again, you lower the heel, you increase the mechanical stress applied to the foot. And PTTD is directly tied to increased calf strenght.
The next worry up the leg with cam walkers is the knee. I’ve had patients who tear their medial meniscus as a result of using a cam walker. The jamming of the medial compartment of the knee likely has to do with the broad, flat surface of the cam walker. This broad , flat surface tends to throw folks into genu valgum, placing increased pressure on the medial compartment of the knee.
And lastly, lumbar pain. Walking with a cam walker is going to create two problems that can affect the lumbar spine. First is the leg length difference created by the walker. And second is the lifting that is necessary with the use of the walker.Â
Lifting of the leg? Let me explain. Walking is human motion that is designed to be efficient. With normal gait, the pelvis barely deviates from the transverse plane. By keeping the pelvis level, the spine is stable. Now let’s add in a cam walker. Lifting the leg with the walker forces gait to become less efficient and the lumbar spine becomes a pivot point. That places significant load on the lumbar discs. This increase in load can be pretty rough on a middle age to elderly patient.
And even after saying all these terrible things about cam walkers, I still use them regularly in practice. In one resect, they slow patients down a bit. In essence, they work a bit like a ball-and-chain. But they also have therapeutic value. But if you’re going to be wearing a cam walker for an extended period of time, just be sure to have a long talk with your doc and know what the warning signs are for knee and low back problems before they get out of hand.
Jeffrey A. Oster, DPM
The Chery Valley Foot and Ankle Center, Newark, Ohio
Ohio Valley Sports Medicine, Chillicothe, Ohio
Dr. Oster cannot answer medical questions or provide medical care through this blog.
Tags: Achilles tendonitis, cam walker, heel pain, plantar fasciitis, PTTD, walking cast
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