An orthopedic walking boot includes a housing configured to encompass at least a user's foot, a mechanically adjustable ramp insert including a ramp surface and disposed in the housing, and an adjusting mechanism configured to adjust an elevation angle of the ramp surface. The mechanically adjustable ramp insert includes a base, a threaded shaft secured to the adjusting mechanism at a first end and configured to rotate with the adjusting mechanism, a first slider nut including internal threads, a bracket in physical contact with the ramp surface, a first support coupled to the first slider nut at a first end and to the bracket at a second end, and a second support coupled to the base at a first end and to the bracket at a second end.