Any advice for getting into two shoes from Vacocast?

I’m really excited to be on post op week seven.  I’ve been FWB for a few days now and its feels great to be off crutches!  My gait still needs a lot of work and I take a lot of small steps but I’m definitely enjoying the freedom.

After surgery, I was in a splint for two weeks and then went into the Vacocast.  I was NWB for six weeks.  Unfortunately, no one here is familiar with the Vacocast so I have been adjusting it on my own.  After starting at fixed 30 degrees PF, I went down by 5 degrees each week until I reached 10 degrees last week.  As I started to wean off the crutches, I opened up the hinge to allow 5-30 degrees PF with the big wedge sole.  I tried the flat sole last night and it was too uncomfortable.  My foot is still not near neutral and is probably around 10 degrees of PF at rest.

Whats the best way to transition to the flat sole and then into two shoes?  Should I keep my foot fixed at 5 degrees or neutral first?  I like keeping it hinged with the ROM because its so much easier to walk but wanted to ask for any helpful guidance.

I’m also wondering when I can try to stand up on two feet barefooted.  It would be really nice to stand up to shower again!

I just got back from an overseas trip so I will be starting more active PT on Monday and I’m hopeful that will help me with the transition.

I hope we all come back stronger…including Kobe Bryant!

5 Responses to “Any advice for getting into two shoes from Vacocast?”

  1. 1 Lisa April 13, 2013 at 12:25 pm

    I found that the easiest way was to put a couple of heel pads in the shoe (started wit 2 but you may need 3) and then remove one at a time when you feel comfortable. With my first leg I waited longer than I should have to shower standing up simply because I assumed I couldn’t and didn’t ask! When I did ask my doctor was surprised I wasn’t already doing so. I’m 6 weeks out from my other leg and walked barefoot at PT last week and was told I could shower standing but the fear was more in slipping/falling, not so much putting the weight on it.

  2. 2 normofthenorth April 14, 2013 at 1:06 am

    If having the boot hinged feels good and not scary, I’d say keep it hinged. The setting that matters is the upper or DF-direction limit. So the step after 5-30 is 0-30 (or 0 to even more, I doubt that it matters). Make sure you do NOT step or walk backwards in the himged boot, because that puts WAY more tension on your healing AT.

    Some Docs, PTs, and Protocols include heel wedges in 2-shoes, others not. I tend toward
    “not”, because (1) neither of my docs had me do it, and (2) I think most of the modern studies that got great results with fast protocols (op and non-op) didn’t. Neither reason actually proves anything…

  3. 3 Stuart April 14, 2013 at 3:49 pm

    Norm and I agree on most things but when it comes to wedges in shoes we have a standing difference of opinion. It doesn’t matter to me that the studies sited never used them. My physio went to a conference where a world renowed physio spoke and she came back with the insistance I use them in my shoes. All I can say is that it worked for me. I was able to walk without a limp and started walking at speed and over distance very quickly. My recovery was great. Standing barefoot with limited dorsi flexion on one foot is a bit hard. You feel awkward. I used to put my injured leg out in front ot the other and bend a knee in the shower. We often comment from our own experience but in the end you have to make the decision yourself. I also set my plantar flexion free on the boot when I was FWB and it made walking in the thing much easier.

  4. 4 Eyechilles April 15, 2013 at 1:51 pm

    Hello Lisa, Norm, and Stuart. Thank you all so much for all the advice. I am still working on improving my gait in the boot right now and ordered some heel lifts from amazon for future use when I can move into two shoes. I am really, really looking forward to that moment and your insight is much appreciated. After that moment, hopefully I can drive again (I have a six speed and currently keep stealing my wife’s automatic) and start to shower normally again.

  5. 5 yakswak April 16, 2013 at 3:39 pm


    Ahh, at least you can drive an automatic! I have a right ATR so I can’t drive my cars (they are all manual, but an auto is not allowed either). Good luck with the flat sole, and then your move to the shoes. Just do what you did moving from NWB to PWB to FWB…I did a lot of balance weight shifting standing on both legs holding onto a desk or counter until I could tolerate more weight before starting to step. I did the same in the flat sole to get me used to the angle (foot had to be out in front or to the side a bit due to the limited DF angle, even at “neutral”). Same thing with starting to walk without the boot, weight shift standing up gradually putting more weight on the injured foot. The mechanics of walking I haven’t gotten to yet but it looks like you have good advice above on how to do that!

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ATR Timeline

  • Name: eyechilles
    Location: New Orleans
    Injured during: Football
    Which Leg: R
    Status: 2-Shoes

    419 wks  2 days Post-ATR
    419 wks
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  • eyechilles has completed the grueling 26.2 ATR miles to full recovery!
    Goal: 365 days from the surgery date.
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