Recently, I was asked to give a lecture to answer the question, “Is it ok to drive with a cam boot?” My initial reaction to writing a lecture of this topic was a strong “heck no!” Of course, patients shouldn’t drive with cam boot on. It’s a terrible idea. But then I started thinking about the details. So, for anyone who didn’t see the lecture, (Likely almost everyone!), I’ll give the CliffsNotes version.

Let’s look at this topic from three perspectives:

1. Is it really unsafe to drive a car with a cam boot?
2. Is it legal to drive a car with a cam boot? 
3. Is a physician liable if their patient gets into an accident while driving with a cam boot?

For a little perspective, let’s start with a few pieces of information about normal unrestricted drivers. It takes about one second for the average driver to recognize the need to stop,¹ about 0.5 – 1 second to react¹ (ie, move from accelerator to brake) and about 15 ft/sec² to decelerate on dry road.² At 60 miles per hour, then, it takes 304 feet to stop (ie, a football field).² Obviously, anything that elongates the time it takes to come to an actual stop could be detrimental to the drivers’ and others’ health.

Is it Safe to Drive with a Cam Boot?

The research literature has taken two primary forms, experimental studies with simulators, and clinical research with surveys of practice patterns. These studies demonstrate that mean braking response time and mean total reaction time significantly increase with the use of above knee casts, below knee casts, and cam walker boots.^3,4,5

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It is NOT safe to drive with a cam boot or cast.

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The bottom line, here, is that braking response time – the time it takes to brake in response to a perceived need – is significantly increased whenever the ankle is restricted. Thus, it is NOT safe to drive with a cam boot or cast.

It is important to note that in one of these studies⁵ elastic ankle bandages and stirrup braces did not change the braking time. The trend for all of these studies was that boots and casts, which restrict ankle motion, increase the time it takes for us to respond.

Is it Legal to Drive with a Cam Boot?

Since I’m not a lawyer, keep in mind the discussion below should not be considered legal advice, and you should contact your legal counsel for more information. In 2017 Sansosti and colleagues reviewed the United States legal regulations regarding various aspects of driving with an immobilization device, driving with lower extremity pathology, and physician requirements for reporting impaired drivers.⁶ The figures below regarding the United States summarize the data from this study.

Figure 1. State Laws Regarding Driving with an Immobilization Device, Pathology, or Surgery

Figure 2. States in Which Diabetic Drivers are Asked About Complications

The figures above demonstrate clearly that very few states have laws restricting drivers, whether they have an immobilization device, extremity pathology, or diabetic complications. It is a little disturbing to think how lightly regulated this aspect of driving actually is.

Are Physicians Liable?

If a patient were to get into an accident while wearing a prescribed immobilization device this could potentially involve said doctor in a legal manner. So the first question, then is, Are physicians required to report physical limitations such as the use of a cam boot? Figure 3 shows the results of this aspect of Sansosti’s survey. Again, few rules seem to apply in these circumstances.

Figure 3. States Where Physicians Must Report Patients with Disabilities

Interestingly, physicians do not have to report their patients in all but two states, and, according to Figure 4, physicians have stated immunity to liability in the instance their patients are in an accident in all but 11 states, and those 11 states simply have no stated immunity in their statutes rather than a clear statement of liability.

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My best suggestion to caregivers treating patients in these situations is to discourage them from driving with cam walker boots and to clearly document that counseling.

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Luckily for physicians, the legal liability in working with these patients is about as poorly regulated as those of the patients themselves. My best suggestion to caregivers treating patients in these situations is to discourage them from driving with cam walker boots and to clearly document that counseling. For those of you in states that might require reporting or have unstated immunity, I strongly suggest speaking with your legal counsel to be certain of your rights and responsibilities.