Immobilisation - Moon boot

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Indications

Fractures of:

Fibula (Weber A or non-displaced Weber B)

Medial malleolus avulsion

Base of fifth metatarsal

Midfoot (non-displaced)

Contraindications (absolute in bold)

Open fractures

Neurovascular compromise

Complex fractures

Alternatives

Short leg backslab

Open reduction with internal fixation

Informed consent

Verbal consent

Less complex non-emergency procedure with low risk of complications

Potential complications

Failure (of immobilisation)

Neurovascular compromise

Dermatitis

Abrasions and pressures sores (with risk of infection)

Joint stiffness

Venous thromboembolism

Procedural hygiene

Standard precautions

PPE: non-sterile gloves

Area

Seated in chair (ideally raised)

Staff

Procedural clinician

Equipment

Moon or controlled ankle motion (CAM) boot of correct size (XS, S, M, L, XL)

Sizing

Place foot in boot with heel as far back as possible

Ensure toes do not reach the endplate

Ensure top of boot is below the fibula head

Positioning

Sitting on chair or raised plinth with knee bent 90 degrees

Feet placed on ground

Sequence

Remove spare padding from boot and put to one side

Pull outside straps (now allowing inner to stick to the Velcro)

Open the straps and padded insert

Place foot in boot with heel as far back as possible

Close the padded insert (without bunching the material)

Apply straps starting above the ankle

Apply addition padding if required for comfort

Post-procedure care

Ensure straps are firm but comfortable

Advise patient to weightbear as tolerated

Consider prescribing crutches (to assist with mobility and gradual increases in weightbearing)

Tips

Moon boot fit both left and right feet interchangeably

Extra padding is often used in front of the ankle, or inside the actual boot around lower calf to improve fit

Peer review

This guideline has been reviewed and approved by the following expert groups:

Emergency Care Institute

Please direct feedback for this procedure to ACI-ECIs@health.nsw.gov.au.

References

NSW Agency for Clinical Innovation. Orthopaedic/musculoskeletal. Sydney: ACI; 2020. Available from https://www.aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/clinical-tools/orthopaedic-and-musculoskeletal

Roberts JR, Custalow CB, Thomsen TW. Roberts and Hedges’ clinical procedures in emergency medicine and acute care. 7th ed. Philadelphia, PA: Elsevier; 2019.

Dunn RJ, Borland M, O’Brien D (eds.). The emergency medicine manual. Online ed. Tennyson, SA: Venom Publishing; 2019.

Eiff MP, Hatch R. Fracture management for primary care. 3rd ed. Philadelphia PA: Saunders; 2011.

Stracciolini A. Basic techniques for splinting of musculoskeletal injuries In: UpToDate. Waltham (MA): UpToDate. 2019 April 18. Available from: https://www.uptodate.com/contents/basic-techniques-for-splinting-of-musculoskeletal-injuries

Liverpool hospital emergency department: Plaster booklet (2019)

© Agency for Clinical Innovation 2021

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