Dos and Don'ts: Knee Braces, Slings, and Boots

by Kris Paley

Dos and Don'ts: Knee Braces, Slings, and Boots

There are many types of braces on the market that address specific needs based on the issue you have and various purchase options. It’s important to understand your specific needs before reaching for a drugstore brace. When selecting a brace, I recommend you seek advice from a specialist who can guide you to the type of brace that best suits your needs. 

Once you have an order from your provider, a professional fitter will assist you with the appropriate brace, ensuring size, fitting and adjustments are correct. They are also able to assist with questions during your appointment and long after you take the brace home. The fitter’s  job is to ensure you have exactly what is necessary for your individual need.  

Today, we will be discussing a few of the numerous types of braces used in sports medicine and orthopedic offices, including the simple sling, post-op sling, knee immobilizer, post-op knee brace, hinged knee brace, short boot, and tall (standard) boot.  

Simple sling  

The simple sling is a piece of equipment you’ve probably seen. It’s used for many types of injuries and after surgical procedures on wrists, elbows, shoulders, or collarbones.  

When you wear a sling, your elbow should always fit snuggly into the corner of the sling. With your elbow in the right place, at least half of your hand should be inside the sling. There may be a little loop you can place your thumb in to help secure your elbow and hand in position. 

To ensure the best fit, there are two places you can adjust the sling. If you adjust both you’ll get a better fit than if you just adjust one. Most brands use Velcro to make adjustments.  

Your hand should be a little higher up than your elbow to make sure that swelling moves away from your hand.  

Post-op sling  

This sling is used with a special pillow underneath it to hold your arm away from your body. It’s often used after shoulder surgery to hold your shoulder in the proper position. It’s also called an AB sling for abduction sling; abduction is moving something away from your body. 

Like the simple sling, you want to make sure your elbow is sitting snugly in the corner of the sling. The pillow will go between the sling and your body and will be fastened around your body with an adjustable strap. Your arm may be placed in front of or on the side of your body. 

Simple knee immobilizer  

We regularly see patients come into the office with a simple knee immobilizer that has slid down around their ankle, which is obviously not stabilizing their knee.  

The simple knee immobilizer is defined as a “non-functional” brace. Non-functional braces aren’t designed for the wearer to be active in. If you are trying to do too much in this brace, it will fall around your ankle. 

It’s important that the brace is snug, but not too snug. If the brace is too tightly strapped to your leg, it can cut off circulation. Having the right length for your height and your injury is also important. This brace comes in different lengths ranging from 12 to 24 inches. 

PRO TIP: functional vs. non-functional brace  

Non-functional braces are designed to be worn after surgery or serious injury. They are for rest, recovery, and rehabilitation, and not for exercising or sports. If you try to do too much in these braces, they will fall down your leg, won’t offer the needed support, and you could possibly prolong the recovery period.  

Functional braces are ordered for patients that are past a post op or injury phase and “functioning” in a brace. With a functional brace, you can exercise or play soccer, etc. if approved by your health care provider.  

PRO TIP: strap maintenance  

When you take off your brace, stick the Velcro strap back on itself. By re-strapping, you will keep pet hair and other debris from sticking to your straps.  

Post-op knee brace 

This brace is a little more complicated and is commonly used for ACL reconstructions, tibial plateau fractures, patella fractures, patellar tendon ruptures, or any condition where you need to have true immobilization or range of motion control.  

Like all braces, it is crucial for the post-op knee brace to fit well. When fitting, the pads, called condyle pads, should be centered on the side of the leg with the top of the knee cap. If you draw an imaginary line from the top of the kneecap to the center of the condyle pads you should be in a good place. If you initially set the brace too low on the leg it will not stay in place.  

A good starting point is to also check the back strap that sits directly below the back of the knee crease. It should sit at the top of your calf muscle so when you tighten that strap first, it anchors the brace in the correct place. You will know you have properly placed the brace when you feel the strap in the back is right at the calf muscle.  

When you first get this brace, the fitter will set a range of motion as ordered by your doctor. The brace will allow your knee to bend only the specified amount. You shouldn’t change the range of motion or unlock the brace unless your doctor tells you to. 

The post-op knee immobilizer is a non-functional brace. If you do too much in it, it will start to slide down your leg like the simple knee immobilizer. These braces are for resting, rehabilitation and recovery.  

The straps on this brace are made long. We recommend that you do not cut them until you are certain you will not need surgery. The extra length of the straps will be needed if you have a bulky dressing placed around your knee after surgery.  

PRO TIP: Don’t wear most knee braces over loose pants  

If you wear functional knee braces or post op knee braces over your pants and bend your knee, the pants will pull the brace down. 

If you have a cotton-lycra knee sleeve or tight leggings that are not slippery, you can wear your functional knee brace over your pants. Non-functional knee braces such as the knee immobilizer can be worn over pants if necessary because they do not allow the knee to bend.  

Hinged knee brace  

The hinged knee brace is a functional brace. You will wear it to play soccer or basketball for instance. Measurement is required to make sure you have the proper fit. 

The hinged knee brace stabilizes the knee joint and keeps the bones from moving around too much. It can keep the four main ligaments of the knee from working as hard and may control your range of motion. It’s commonly used for tears in the knee. 

Sit in a chair with your leg slightly bent to put on these functional braces so you can see how to align the brace properly. Many people try to put them on while standing, but the brace won’t be in the best position. The cutout goes in the back so there isn’t extra fabric when you bend your knee.  

These braces come in a wrap-around version and a pull-on version. The brace may have two or four straps depending on your needs. 

PRO TIP: knee brace straps 

Always start with the strap right below the back of the knee. This strap helps stabilize the brace and keeps it in place while you fasten the other straps. 

Short version boot and tall standard boot  

The short version boot is used for foot fractures or toe fractures. The tall standard boot can be used for foot issues, but it is also used for high ankle sprains and fractures.  

The short version boot is light, but it stabilizes the foot. You can be active in these, but don’t push it. You should only walk when necessary. Do not go on any big trips around the mall or on a hike.  

Sizing again is important. Boots typically go by shoe size, and the fit is the same on short and tall boots. Toes should not hang over the edge of the boot, where they might get blisters or be stubbed. If the toes are too far back, you can easily trip on the extended edge of the boot, leading to another injury. 

When you put on a boot, push your heel into the back of the boot as far as possible. Fasten the strap closest to your ankle first to hold the heel in place. Then finish the foot strapping and work your way up your leg.  

The liners of these boots come out, and you can wash them using hand wash or a gentle cycle setting on your washing machine with a small amount of soap. These pads are up against your skin constantly and can cause some irritation if not taken care of. We do recommend that you wear a tall sock when you wear a boot.  

Most patients do not sleep in a boot unless your physician has told you otherwise.  

Most of the boots we use allow you to add extra air to the boot to fill the space around the heel and ankle so the boot fits better. These boots are called pneumatics. Your fitter can show you where the button is to add air to your boot. 

PRO TIP: QR code  

Take advantage of YouTube videos with detailed instructions from the vendor of your brace. Many of our braces have a QR code on them that you can scan with a smart phone for on-the-go fitting instructions. Of course, you can always call or come back to the office if you are feeling uncomfortable or struggling with your brace. 

PRO TIP: heel lift  

When wearing a boot, there will often be a little bit of a height difference between the leg wearing the boot and the leg not wearing the boot. We recommend that you place a heel lift in your other shoe. The difference in height between your legs can hurt your knee, hip, shoulder, and neck.  

Frequently asked questions  

Can I purchase a brace from a drugstore or online?  

Yes, you can. However, you’re not going to get all the benefits that buying a brace from OrthoVirginia will give you. 

When you buy a brace from OrthoVirginia, you’ll receive: 

  • Precise measurement and an accurate, personal fitting from certified fitters 
  • Exactly the brace ordered by your provider, so it correctly addresses your recovery 
  • Products that have been thoroughly evaluated to reflect the high quality of OrthoVirginia 
  • Billing through your insurance, which applies to your deductible 

In many cases, we have found that after insurance billing patients pay less out of pocket than if they bought the brace themselves. Braces may even be covered at 100% depending on your insurance plan and deductible. 

Is there a way to alter a knee brace if it pinches the back of your knee?  

If the brace is pinching the back of your knee, you can wear a knee sleeve with cotton-lycra in it underneath the brace. You can purchase the sleeve or take a pair of leggings and cut the legs off to make inexpensive homemade sleeves.  

Do compression sleeves help?  

Yes, they do.  

If you just want to keep your knee going warm or if you have some swelling, the compression sleeve will offer some relief. However, if you have more severe arthritis or other issues with your knee, we recommend you use a knee brace with hinges for improved stabilization and protection. You may also wear a knee sleeve under the functional off-the-shelf hinged brace for compression.