A boot assembly apparatus, system and method for elevating the patient's limb when using a manual distractor unit is mounted upon a support frame attached to an operating table side rail. A foot strap is attached to the boot assembly apparatus and to the patient's ankle with a patient's knee support pad, extending from the distractor unit, is positioned under the patient's knee to provide traction to the patient's ankle, which is secured to the support frame. The boot assembly apparatus may be formed with a plurality of attachment points for the foot strap so as to provide improved access to the ankle area with advantages of allowing additional types of procedures a surgeon could perform on the patient and/or the ability of the surgeon to access the ankle area and lower leg.