I went to see the doctor 13 days after the surgery. It started with a heated argument between the doctor and my wife regarding the fact that she’s not a doctor and that the internet doesn’t know everything. I just sit there and take it since I want my sutures gone. I will try to make him see things my way let him have his moment for now. The doctor said everything looked good and proceeded to remove my sutures.
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I really wanted to find out what the next steps where, specially after reading articles about early weight bearing an ROM. After reading about the benefits of the VacoCast I decided that would be the next step. I was hoping to find them in Colombia, but again, third world. I couldn’t find it here so I had to pay through the eyes for overnight shipping game again. I wanted to have it to show my doctor. Unfortunately it arrived 30 minutes too late.
I showed my doctor the documentation for the VacoCast. He had never seen it. He didn’t really see any benefit between that and my plaster cast. He said to keep the cast on for another 4 weeks. He didn’t really explain why, just the fact that I ruptured my tendon and I had to be careful.
At this point I think I’m on my own. This guy seems to be using older rehab protocols. Does anyone have a details rehab protocol that utilized the VacoCast Pro boot? I’ve read several including Hillie’s explaining the Royal Devon & Exeter Hospital (NHS) schedule. But it isn’t detailed enough. I know it sounds crazy to try to rehab without a doctor, but his method just seems antiquated. I’m currently in search of an up-t0-date doc, but in the meantime I’m flying solo.
11 responses so far ↓
1 dcoughlan // Jun 8, 2014 at 1:49 pm
Juan, did you read through the comments linked through on the Hillie post you referenced? There’s a link to a PDF there that appears to be a near copy of the Exeter schedule. Or did you want more detail than that?
There are also some other modern protocols listed on cecilia’s page: achillesblog.com/cecilia/protocols
Most get you where you want to be going (or at least in a better direction than you think your doctor might be taking you!)
Good luck with this,
2 hillie // Jun 8, 2014 at 4:25 pm
There is a more detailed pdf on Suddsy’s blog (where I posted Exeter and other stuff). The other one (a London clinic) blogged by suddsy Says:
“June 24th, 2013 at 1:03 pm
I haven’t received the exact protocol yet, but I know it is very similar (or may even be the same) as this one that I googled while I wait. cfas-uk.com / pdf/ vacoped-rehab. pdf “. Fill in URL gaps.
It is actually more cautious than Exeter’s world-class protocol (see study, also on Suddsy’s blog) with a little longer in the boot and FWB at around 8 weeks +, whereas FWB at Exeter began in week 3.
3 dcoughlan // Jun 8, 2014 at 4:44 pm
Hillie,
Are you sure you’re reading that PDF correctly? I see FWB occurring in weeks 2-4…
4 hillie // Jun 8, 2014 at 5:00 pm
Whoops, getting late over here, or that’s my excuse! I mistakenly only looked at the 8 weeks + when crutches were dispensed with in the London rehab. Exeter didn’t use crutches after 4 weeks, although with any schedule, some users might keep them longer for perceived security.
Not sure why Cecilia has Exeter down as FWB by 8 weeks, when it is by 4 weeks (weaning off crutches after 2 weeks). Sorry Cecilia for not spotting earlier.
5 dcoughlan // Jun 8, 2014 at 5:12 pm
So that’s *not* the Exeter protocol in the linked cfas-uk PDF? Cecelia should probably change the citation on her protocols page if so.
6 hillie // Jun 8, 2014 at 5:37 pm
CFAS, as the pdf reads, is the Clinic for Foot & Ankle Surgery at the Lister Hospital in London. Exeter is 200 mile away, in, well, Exeter - the Royal Devon & Exeter Hospital. It’s no big deal though when these protocols are so close when across the world, most others seem to be way behind.
7 juanr // Jun 8, 2014 at 11:26 pm
Thanks dcoughlan & hillie. I read the PDF from the Clinic for Foot and Angle. Since I’m in weeks 2-4. It says to lock at 30′, but in week 4-6 it says 15′-30′. Does that mean I should be incrementing by 5′ each week during my 2-4 week? Also, it says FWB, does that mean I can walk on it with the VacoCast? I assume at 30′ I have to use that large sole at the bottom.
I tried using the VacoCast today, but it just felt like my toes went numb and it didn’t feel like it fit properly. So I’m back in the cast for a couple of days. The cast was only in the front part of the leg, so I can take it on and off easily with bandages. I’m seeing my doctor again this week. I’ll bring along the boot and the pdf, let’s see what he says. It’s a bit scary flying solo.
Thanks again!
8 dcoughlan // Jun 9, 2014 at 2:03 am
The Vacocast is a hinged boot, which means you can actually set it allow your leg to move within a range of degrees, as opposed to boots which only allow for fixed positions. On the back of the boot, setting the top adjuster at 30 and the bottom at 15 will give you a range of movement between 30 and 15 degrees, which is what is intended by the protocol at that point.
In addition to handing your doctor the PDF, you may want to show him a few of the studies that demonstrate the benefits of early stage functional rehabilitation. Those are also linked to on Cecilia’s page. Since you mentioned your doctor appears more inclined to trust fellow doctors, perhaps peer reviewed medical studies will be of value to him.
As for the comfort of the Vacocast, it can be a little odd at first. I struggled with it initially and took it off. Then I put it on my opposite for a few hours to practice adjusting the fit (there’s a slider on the bottom) and making sure the beads were easily distributed and that got the Vacocast to a point that it was comfortable when I put it back on my injured leg. I do find the toe-box area to be the least comfortable / most challenging to keep a good level of pressure, though, so part of it just may be the boot’s design, or the way our feet happen to swell. I believe the manual recommends using the larger curved sole whenever the boot is > 10º.
Good luck with your doctor — it is a shame to have to go it alone, but in the event that you make that decision there’s plenty of support and experience to read through here, so hopefully it doesn’t feel too much like the wild west. And there’s always the possibility that your doctor will come around once he sees that you’ve made progress.
Good luck!
9 dcoughlan // Jun 9, 2014 at 2:08 am
Hillie,
You can confirm that it’s not the same protocol but with a different sponsoring clinic? (The reason I ask is because there are several different versions of the UWO protocol floating around with different names at the top, so the different location doesn’t necessarily mean they haven’t just borrowed the protocol from their neighbors.
It’s good that it’s close, but if it’s not Exeter it probably shouldn’t be labeled as such in the protocols writeup to avoid confusion.
10 normofthenorth // Jun 10, 2014 at 3:31 pm
If I had a boot that hinged and allowed 5° changes (like the Vaco), I think I’d be more gradual than 15° changes. Of course if it feels fine, then fine. But if it feels like a stretch, I’d spread it out more gradually.
Going solo, without your surgeon’s blessing and support, is scary, and can go wrong. Several people have done it, here and on YouTube. (1 or 2 guys here chopped off their own cast!)
Some “orphans” found strong PTs to adopt them…
Good luck!
My recollection of the post-op studies is that slow rehab is more a waste of time than a bad-outcome risk - unlike non-op, where slow rehab clearly makes outcomes worse.
11 Hillie // Jun 11, 2014 at 2:07 pm
Juan
It probably won’t matter if you move cautiously in increments of 5º but Exeter’s very successful rehab protocol allowed for a change from 30º static to a rom of 30º PF - 15º PF in one go (and, though not stated in the protocol at the time, I changed to the flat sole as well).
And no need to wear the boot in bed (this was confirmed in the protocol). That was from the end of week 4. A key milestone as I was then also without crutches (but available close by). Exercise sessions increased too.
2 weeks later my rom was set at 30º PF - 0º, again in one move.
2 weeks after that I adjusted my rom to a setting of 30º PF - 10º DF.
After each change it certainly felt quite different so I took it steady that day, and the following morning it always felt more comfortable.
As for fitting the boot it is vital to get the beads arranged for comfort, put the front piece on correctly, and it does help if you fasten the straps in the order suggested.
I’m not in a position to give individual advice, I only know what I was advised, and that it worked for me.