Oct 30 2013

Wedge to Rocker

Published by hopalong at 8:06 am under Uncategorized

Hi all

Wondered if anyone has advice on the transition from the Vacocast wedge to the Rocker ( which is not a rocker in any sence of the word-  German humour perhaps)!

Background: I am on the very conservative road. 9 weeks cast at 30 degrees and have been in boot for 3 weeks, slowly coming down from 30 degrees equinous with the wedge sole to 5 degrees. As per the Vacocast instructions tried out the slimmer sole at 5-30 degrees (called the rocker), but now understand all those posts that talk about 2 steps forward and 1 back! Had got quite proficient on the wedge, FWB and no crutches. Tried the thin Rocker sole and ……..when trying to walk with weight, Tendon/calf stiff as hell and need 2 crutches to move at a snails pace! Have to walk on the heel. In fact reminiscent of the hobble back to the house immediately following the ATR.

Couple of people posting here  seem to have had similar issues and opted to go back to the wedge, but thought that this transition may be a necessary evil before the hallowed ground 2 shoes!

Thoughts on a postcard!

Hoppy

10 Responses to “Wedge to Rocker”

  1. normofthenorthon 30 Oct 2013 at 3:00 pm

    I wish I knew, but I’ve never seen a Vaco in person, so I’ll leave the techie suggestions to the folks that have. Some thoughts, though:
    1) DON’T walk with your toes out to the side. Way better to go back to the other sole, or even back to crutches.
    2) DO make your feet equal height, or risk lingering problems.
    3) Most orthotic boots — hinged and fixed — have one sole only, and it’s a rounded thing that facilitates rocking your weight from heel to toe. Standard rehab keeps that sole shape constant while decreasing the plantar-flexion angle from ~20-30-degrees down to 0 degrees PF aka neutral aka 90 degrees.
    If the “wedge” adds some plantar-flexion (as its name suggests), then it may or may not be possible to get to neutral ANKLE angle with it. And getting there at the proper time is important. Last thing in the world you want to do is jump from boot-protected at a non-neutral PF angle, straight to 2 shoes unprotected with none.

  2. hopalongon 30 Oct 2013 at 10:44 pm

    Norm
    As usual, indebted to you. Many thanks for taking the time to reply not only to my post, but all the others. Your point 3 is the clincher for me. You are right, the wedge is the more rounded sole, and as I am not yet at 0 degrees yet, will try the flatter sole for one more day and then go back to the Wedge. For the first time, really feeling the tightness around the tendon today. Not sure if its the new setting at 5 degrees or the flat sole, or a combination of both.
    Cheers Hoppy

  3. Ronon 31 Oct 2013 at 5:04 pm

    Hi Hoppy,

    I agree with Norm as usual. I had a difficult time for 2 days going from the wedge to the rocker and spent about 30 minutes on the phone with Ken and Jeremy at Oped.

    However, I did not go to the rocker until I was at 0, which Ken said should have happened at 5, but sorry, it felt strange. The goal is to NOT go into Dorsiflexion, so they stop your forward progress too much at 5 degrees, but it gives a bit more at 0 (I hope that makes sense).

    Regarding the tightness - yes, that comes from the PF drop and the rocker.

    I am happy saw that a week with the rocker is GREAT! I use the evenups on my left foot and the rocker on my right with no crutches and am flying around again. You will also find that at 0 with the wedge is very uncomfortable because it rocks you forward too much, putting pressure on your ankles, etc.

    In essence, head Norm’s advice in general, but regarding the Vacocast, it takes 1-3 days to get used to with the rocker, but once you do, you will love it.

    Good luck.
    Ron

  4. Ronon 31 Oct 2013 at 5:11 pm

    Hoppy,

    Drop Ken an email at Vacocast if necessary @ ken@opedusa.com

    Ron

  5. Ronon 31 Oct 2013 at 5:26 pm

    Sorry about a few of the typos.
    Ron

  6. DaveGon 31 Oct 2013 at 6:41 pm

    Hi there Ron

    I love my vaco boot but understood that I would be able at about 10 weeks to df to 10 degrees. From what you know, won’t I be able to do that - or do you mean that it is just too early right now? How long will you be boot for?

    DG

  7. hopalongon 31 Oct 2013 at 10:47 pm

    Ron
    Very useful reply, thank you, and suspect that a lot of people with the Vacocast will have similar queries. Reassuring to know that the wedge - rocker transition is another one of those “difficult” milestones, but once achieved, worthwhile.
    I suspect that for those of us in the conservative/slow lane, this transition may be particularly tight, as the tendon has not benefited from the early weight bearing. But we are in it, so just have to deal with it!
    For me the rocker at 5 degrees just feels too tight, so for now, I’ve gone back to the wedge. Will run with that for 5 days, (figuratively of course)! until the tendon is used to 5 degrees and will then attempt the rocker again.

    Would be also interested to know what PT you were doing before you got to 0 PF, and if you have/will go into the DF settings with the boot (ala the comment from DG).
    Also any comment on your transition to 2 shoes would be useful, so that those following in your “footsteps” can be prepd!
    Cheers Hoppy

  8. Ronon 01 Nov 2013 at 1:11 am

    Hi DG,

    Sorry for the confusion. I was at 0 at 6 weeks. Start doing some ROM work and SLOWLY stretching out your Achilles.

    You cannot afford for it to heal short, but you don’t want to over stretch it either (pain should preclude that from happening - hopefully). Short or long healing will lead to walking\other issues later.

    Again, I am no expert at Protocols, but 10 weeks to get to 10 degrees PF is a bit too long, IMHO. From reading this blog alone, most are either looking at, or in 2 shoes by then.

    However, it’s never too late to start. I left a link for Hoppy above for basic ROM, and will put my protocol up this weekend with many more example links. (Should not take the replaced by a real Ortho\Pod., PT or someone who knows what they are talking about). :-)

    Good luck,
    Ron

  9. DaveGon 01 Nov 2013 at 10:17 am

    RonRon! So good they named you twice.

    10 degrees PF? No, I wrote that I would be 10 degrees DF i.e. DORSIFLEXION, at 10 weeks.

    So, your thoughts please on DF in my boot because you had posted previously that the goal is NOT to go to df. According to my schedule it most certainly is my goal, and it is this Monday. For one week then the shoes, putting only about 2 or 3 weeks behind OWU etc.

  10. 8 ball poolon 01 Jun 2020 at 3:46 am

    This is good

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