Day 3 : I get my Vacoped Boot
At the Fracture Clinic, after the consultation the nurse fitting the boot came to take my foot measurements. He wasn’t sure whether they had the new style ski boot in stock as they were significantly more expensive, but he would check his stock. Came back shortly and confirmed that they had one. I was surprised and pleased to see he was carrying a Vacoped box (UK branding, also known as the Vacocast in North America). I had seen good reviews online from achilles tendon rupture users of this hinged boot.
The nurse ran me through how the Vacoped works as he put the boot on me. He had to pursuade the foot a little to sit down at 30 degree plantarflexion. I was advised that I could remove the boot to wash, but the need to be very careful outside the boot was stressed. The nurse suggested I made an appointment to be seen at 4 weeks in addition to 8 weeks. I did this and went home.
As the boot is such an important piece of equipment in the early stages of treatment I will do a separate post giving details of how I set up and used the Vacoped.
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7 Responses to “Day 3 : I get my Vacoped Boot”
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Hi, sorry but I’m obviously missing something here. You’re describing day 3 but you are 7 weeks since start of treatment according to your timeline. Are you serialising your early days or is the boot happening now? Perhaps its just brain fatigue on my part.
Was the plan to be at 30º PF for 4 weeks (a long time) or did your protocol include directions for fortnightly adjustments and increasing range of movement?
I’m in UK too and also had the Vaco boot, for 6-7 weeks from week 2.
Hi hillie, I was slow off the blocks in setting up my blog but have kept notes, so I am serialising from the date of injury (14th Nov 2012) upto today. I will be posting further over this weekend to get upto date. In this post Day 3 refers to 16th November 2012.
To answer your other question, I have no written protocol from my Fracture Clinic. They gave me the Vacoped boot and told me I would stay at 30º PF for 4 weeks, move to 20º at the week 4 consultation, and then in steps move to 0º by week 8. There was no mention of exercises for ROM, calf etc.
I decided that my hospital was being too cautious. So I have actually moved the boot through quicker and done active ROM to neutral starting at week 3, which the hospital Physio was very happy with when I disclosed this a the Week 4 consultation.
I have mainly used the boot with fixed PF. I used the hinging for a couple of days set at 10-30º, but I didn’t like the sensation when I increased the range to 5-30 and 0-30 so I reverted back to fixed settings to get used to being at neutral. I moved to 0º fixed at 6.5 weeks and have found this ok whilst continuing to walk FWB, no crutches using the rocker sole.
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If it works for you that’s great but I feel that you may be storing up trouble. I was fortunate enough to have a written protocol - similar to the frequently mentioned in this blog “UWO…” but more recent and enhanced to include the hinged Vaco boot like yours. “Other boots also exist”. I was non-op, met the consultant once, then worked with the brilliant physios fortnightly until ‘2 shoes’. I had been assessed as possibly needing surgery but because it was borderline, my specialist (an orthopaedic surgeon) wanted to try the non-op way for a while rather than operate immediately.
After week 4 I finished with the big rocker sole and replaced it with with the flatter version with some ROM in the boot (30º PF - 15º PF), then adjusted it further, until at about the stage you’re at, I had a ROM of 30º PF - 10 or 15º DF. Very easy to walk with this set-up and less of an imbalance to affect the hips and your other leg - very important if you are not to cause potential strain on your good side.
I can understand what you say about the odd sensation and wonder if it was because you weren’t using the flatter sole. That wedge/rocker sole is very thick. With a gradually (fortnightly) increasing ROM and this sole, I was able to follow a fast protocol in safety while keeping the calf muscles working and probably with less atrophy.
After all of this I had extensive PT work, first of all on the NHS, and then privately with a sports physio.
hillie, sounds like your getting great support. If you don’t mind, in what part of the UK are you getting your treatment with the Vaco boot and the integrated accelerated protocol ?
I agree with your observations on needing to be careful about impact on gait. I have been conscious of this in deciding to remain on the rocker sole. For me the flat sole at 0-30 PF is giving me a worse outcome despite trying to switch over a couple of times. I expect if I open up the boot to 30 PF to 10 DF it will solve my issue with the flat sole, but I have decided not to move beyond neutral until I have been for my 8 week NHS consultation next week. I am not rushing to DF as it does not appear that shotfalls in dorsiflexion come up as a complication, whereas healing long does.
I did raise the issues with the boot at my 4 week consultation, but was given no advice/solution as FWB is clearly not part of my orthos plan prior to 8 weeks. It has been difficult making decisions to follow elements of other people’s rehab protocols, without the clinical backup that would normally support the patient. I’ve tried to find a middle ground that works for my circumstances.
I have also arranged to see a private sports physio at the end of next week after the 8 week NHS orthopaedic consultation. Hopefully, their “Mr/Ms Motivators” will help push me and the recovery timescales along now!
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I’m in the South West and my hospital treatment finished some months ago. I had the Vacoped boot from the beginning of week 3, moving into 2 shoes at beginning of week 9, although before that time I was walking barefoot in the house, albeit just a few steps at first.
I had the wedge sole, your favoured option, for just weeks 3 and 4, and was able to start weight bearing (up to fwb) and some exercises, during that time, and weaning off the crutches which became easier the week after, when I had the flatter sole. Does your doctor still have you wearing the boot in bed too? Minus the sole of course.
Ironically, my written protocol, identical for surgical cases, was called ‘conservative’ for its non-op patients. However, conservative here doesn’t mean slow - it is simply avoiding the potentially more arduous route of surgery for cases where it is not necessary (most?). In conversation they do describe it as accelerated or even aggressive, and it is as quick as most protocols and certainly less slow than very many it seems. I would add here though that it is quality of care, and good discipline on your part, that is more important than sheer speed through the protocol steps. I had great NHS physiotherapy for as long as I wanted it (and able to pick it up again now if I have any issues) and then supplemented it with the help of a sports physio who treats rugby players and athletes, In many cases they had used the Vaco boot too - some cases were shown on Facebook if you want to take a look. If you want reference points, talk to Jason at Oped in Devizes (not far from you of course).
Yet again, yours is a case where you have one of the best boots out there but haven’t been given the adequate direction in how to best use it. Chances are, if you’d been fwb at 3-5 weeks (usually pretty straightforward with a good boot), you’d have become used to the ROM and the flatter sole together.
My visits were fortnightly until week 8 when I was ‘allowed’ to adjust the boot to a ROM of 30ºPF, 10ºDF and I had this arrangement for a few days before going into 2 shoes.
Hendrenville - MUST have wedges, Must NOT weight bear… Is this because of some element of your specific injury? Some of us have had damage which does need something a little different to suit their needs - you don’t indicate this in your posts though.
I am getting fed up at the moment. I am now 5 weeks into the rupture. I had a back slab for 10 days followed by nex step walker boot. I have taken 1 insert out of the boot (week 4)and another comes out at week 7. I see the specialist again in early July (between week 7 & 8.). I seem to have been left to my own designs. I am weight bearing and not using crutches around the house. No physiotherapy yet and not meant to take the boot off, though I do loosen it some nights as I get pain in my big toe! There doesn’t seem to be a right and wrong way to deal with it but I am frightened it wont have healed. Any thoughts?
John, I expect the healing is progressing ok, although it does get nervous before you try to use it again. The lack of physio is not ideal though. If you read some of the accelerated protocols you will see that physio starts as early as weeks 2-4, normally with very gentle active ROM exercises. I got no physio advice from my NHS clinic, so I just started AROM at home. You can read my timings in my early posts. I have also posted videos showing how my ROM improved.
AROM is something you could also consider starting at week 5 given you have a boot. Be gentle, don’t force anything, and do not go past neutral until you have seen the specialist at week 8.