Differences between boot types?
July 1st, 2013
Hoping for some good advice from you longer-term veterans out there. What are the pros and cons of different boot styles? I haven’t moved from splint to cast yet, and my ortho’s office has only spoken in general terms about what’s ahead. They probably have a standard boot protocol that they follow, but I want to go in well informed if there are better options. What’s the difference between the Bledsoe and the Vaco? Is there one I should push for? Thanks in advance!
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I am guessing your doctor will say here is your boot. I knew nothing of boots and was not in great shape when they gave me mine. (Sick from pain meds). I got a Bledsoe boot which is basically a bunch of pieces all velcored together. I’m not going to lie I am not a fan of my boot and will be solo happy to see it go. I know other people had boots with hinges and air - these do not. In the end I think they are probably similar. Not the most comfortable things ever. I used to wear a short sock but have switched to a knee high tube sock. It helps with rubbing andI am hoping it helps with the boot stink!
When you go in for the cast you should ask what kind of boot options you have and who knows if you have time you might be able to order something if others say they really liked their boot. Good luck!
I didn’t mind Bledsoe as much as lodinpdx. I felt like he was a fine companion–very secure (with 6 velcro straps) and had a rocker sole that was easy to walk around in. You can’t swim in Bledsoe–not sure if you can with a Vacocast (but I’ve read about people swimming in some kind of boot.) He is rather cumbersome but I managed pretty well nevertheless. Good luck!
People here who’ve used the Vaco have generally loved it. The two main types are “fixed” and “hinged”, and there’s a probably-minor advantage to hinged. But any orthopedic boot that’s well fitted and adjusted can and will do the job pretty well, and I don’t think anybody can tell the difference in your results afterwards.
Some boots are waterproof. (Vaco and AirCast are.) But the liner comes out of the water soaking wet, and has to be wrung out to be mostly dry. Some are easy to buy with an extra liner, which solves this problem and a few others. Some are lighter than others, some are slimmer and easier to fit into pants than others.
Most people and protocols use the boots in “fixed” mode, even if they’re hinged, for the first month or more of rehab. I think the new UK-and-Vaco protocols that we discussed recently on Suddsy’s blog page started to let their hinged boots hinge a bit earlier than I did in my variation on bit.ly/UWOProtocol . (I started hinging, big-time, at 7 weeks post-non-op.)
Walking in a hinged boot is a nice transition from walking in a fixed boot to walking in 2 shoes. You’re still more protected than 2 shoes, but you can get your foot and ankle and calf more accustomed to what’s coming. The results from the new UK/Vaco study seem even better than those from the UWO study (lower rerupture rate anyway), and they went even faster and used a hinged Vaco boot (UWO study used “fixed” AirCast boots>), so that suggests that there’s a clinical advantage.
In addition to having adjustable Velcro straps and foam-type liners, some boots have inflatable air bladders or vaccuum-lockable ceramic beads in bladders, to let the boot be more precisely fitted to your foot/ankle. When I was using an Aircast boot, I decided that the inflatable bladder wasn’t very helpful for me, and it made my foot too hot, so I left it uninflated. Others need or like/love the various bladders.
Most boots come with rounded “walking” soles that are designed to facilitate rolling from heel to toe, simulating a normal walking motion. Vaco provides two (or more?) different snap-on soles, and I’ve never used one or examined it, and I’m not really clear on why you’d want a flatter sole.
Following a good proven fast protocol in a well-fitted and well-adjusted “bad” boot is still probably better than the average ATR patient gets. And it’s also pretty easy to walk badly (and destructively) in a very good boot, so watch out for that, too.
Hi Kiki, I have a Bledsoe hinged boot with the air pump. I never had any other boot, so I can’t give you a comparison. I like the boot and it is easy to walk in. The downside is it is not waterproof. The sole can not be interchange as ” norm” describes. That would be a great option, so I could change the sole when I come inside.
Hope this helps.
Just above the box in which I’m typing, it reads “Speak your mind”. I will do that but I would like to copy normofthenorth’s mind as well. Norm you really should be directing a rehab/ortho department when it comes to common sense.
Now that’s out of the way…. VACOCAST!!
Got it delivered yesterday (day 15 post-op) . Put on the evenup support while still in old aircast on way to hospital. This made a significant difference in moving around on crutches while getting to the hospital. Got the Vacocast on. WHAT A DIFFERENCE!! I can’t say enough. Vacocast on with the wedge rocker boot fixed to 1.0 (10 degrees) which feels similar to the 4 wedges (4cm or 1.6 inches rise at back of heel and sloped down). (I am very concerned about my direction at this point, but that has nothing to do with Vacocast).
Immediate relief on foot area, immediate huge relief along back of heel along scar line. Was snug around the foot. Did not wiggle around calf area like aircast. Great comfortable fit. So much of discomfort was due to aircast, not achilles. With the rocker wedge with the evenup (platform to raise non-injured foot) I went immediately from an awkward forced limp to something resembling a walking gait. The cast/liner fit on the foot like a big soft comfortable shoe compared to the aircast. I got into car on crutches and was about to put right foot on pedals…I had forgotten the cast was on. Hot day and foot did not feel sweaty and clammy as it did in aircast (using cool liner). Amazing how much happier and comfortable that can make someone.
I used the vacocast pro-achilles. It was $299 plus cool-liner plus evenup (total over $400 with taxes). I highly recommend the evenup, or some shoe/manner in which you can evenup. I believe the vacocast also comes without the adjustments (where one would use wedges) and think the price of that is not much more than aircast and would also be worth considering if you don’t want the pro-achilles. In my opinion where surgeons are paid as much as they are for this procedure the vacocast is a necessary bargain.
After reading normofthenorth and bionicI am jealous. I really had no choice, like I said they handed me the boot. I do wonder if I had researched at all if I would have been able to talk him into something else. I too have had some pain that I thing is as much the boot as the achilles. Tough to tell. I would also love to have had different liners as my boot stinks.
God luck Kiki and you are wise to ask for advice!
Wow, thank you SO MUCH, everyone. Bionic’s endorsement of the Vaco boot is pretty persuasive, as is that picture of Kobe. (Where did he get those crutches, I wonder? They look like they’re titanium and designed by a Scandinavian!)
Stitches out and cast goes on tomorrow. I will ask about ordering the Vaco ahead of time (and get their sense of how much insurance will cover vs. the cost of the standard boot), and will report back to you all. (Yes, my ortho is working July 4th because they had such an overflow. Will give him props for that…)
Then we’re going on a 700-mile drive over a couple of days to get to a family event. Fun with crutches!
Bionic,
I second Your opinion of norm, I would have no problem paying the guy for counselling advice etc, if I do my other ATR I think my vacation will be Canada, hey I forgot belated happy Canada day, norm is a legend but not sure about his croc advice, only joking I’m a croc convert , but only in the dark