Introduction

Charcot foot is a condition that affects individuals with advanced diabetes. Loss of sensation and weakening of structural components in the lower legs can lead to fractures in the feet and ankles. These fractures can cause deformities in the feet, putting one at risk for ulcerations, infections, and amputation. Specially designed orthopedic boots known as Charcot restraint orthotic walkers (CROW) are prescribed by podiatrists to help heal Charcot foot and reduce the risk of complications associated with this condition.

What is a CROW Boot?

A Charcot restraint orthotic walker—or CROW boot—is an orthotic device designed to stabilize and reduce pressure on the foot and ankle. A podiatrist prescribes and custom-fits these boots to accommodate each individual’s unique anatomy. The boot is made of two rigid plastic pieces that encompass the entire foot, ankle, and shin. A soft foam lining is inserted for comfort and to reduce friction between the foot and boot. The boot will hold the individual’s foot in a locked position to prevent further injury and promote healing.

Most patients are expected to wear their CROW boot during waking hours for all weight-bearing activities. The length of time a patient is expected to wear their boot depends on the severity of the injury and the doctor’s recommendation. An individual could wear a boot for eight weeks, several months, or several years. The earlier Charcot foot is treated, the less time the CROW boot needs to be worn.

Should You Drive with a CROW Boot?

The National Highway Traffic Safety Administration does not recommend individuals drive with a leg immobilizing device. One experiment conducted in 2011 using healthy volunteers demonstrated a significant reduction in the subjects’ ability to apply brakes quickly while wearing a leg immobilization device. Additional factors not considered in this study, such as muscle weakness and loss of sensation due to neuropathy, can also impact a driver’s ability to safely stop a car while wearing an orthopedic device.

A CROW boot, which is bulky and designed to limit movement of the foot, may impair one’s ability to differentiate between the gas and brake pedal and may significantly reduce reaction time to obstacles in the road. The driver might not be able to stop the car fast enough to avoid an accident or mistake the gas pedal for the brakes. Both situations could lead to serious injury to the driver, other drivers, and pedestrians.

With the exception of Maine, Vermont, and Connecticut, most U.S. states do not have laws preventing citizens from driving with an orthotic device. However, you and your doctor should have a conversation about the safety of driving with a CROW boot before getting behind the wheel.

What To Do if You Must Drive With a CROW Boot

Before you attempt to drive, it is important to remember why you are wearing the CROW boot. A doctor prescribed the boot to heal Charcot foot and reduce the risk of future injury or amputation. Although driving restrictions can significantly impact day-to-day living, the long-term benefits of treating Charcot foot will offset these short-term limitations. It is essential to follow all of your doctor’s instructions regarding the use of the CROW boot, which usually requires the boot to be worn during all weight-bearing activities. Keep in mind that noncompliance with treatment will increase the risk of complications and additional medical therapy.

If you have exhausted all alternatives and absolutely must drive, please be mindful of your safety and the safety of others. Do not drive with a CROW boot on your foot, and never attempt to drive a car using the opposite foot. You may remove the boot and replace it with a comfortably fitting shoe once seated in the car. Do not put weight on your foot without the protection of the CROW boot. Doing so could lead to further injury. Once you have arrived at your destination, remove the shoe and replace the boot before bearing weight on the affected foot.

Consider Everyone’s Safety

Please remember that driving a car in unsafe conditions puts more people at risk than just yourself. Other drivers, their passengers, and pedestrians could all be severely injured in the event of an accident caused by mobility limitations and reduced reaction time. Although not illegal in most states, driving with a leg immobilizing device has been shown to increase the risk of accidents. You are responsible for keeping yourself and others in your community safe—consider the risks before getting behind the wheel.

Sources

“Crow Boots: Diabetic Support.” Orthotics Plus Melbourne, 30 May 2021, https://orthoticsplus.com.au/orthotics/crow-boot/.

The National Highway Traffic Safety Administration. Driver Fitness Medical Guidelines, 2009.

Shapiro, Jarrod. “Can I Drive With a Cam Boot?” PRESENT Podiatry Online, https://podiatry.com/ezines/view/610-Can-I-Drive-with-a-Cam-Boot/1788.

Waton, A., et al. “Immobilisation of the Knee and Ankle and Its Impact on Drivers’ Braking Times.” The Journal of Bone and Joint Surgery. British Volume, 93-B, no. 7, 2011, pp. 928–931., https://doi.org/10.1302/0301-620x.93b7.25859.

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