Vaco boot mechanics/6.5 weeks

I’m at true zero degrees in the Vaco now, (reads -5 degrees) because a pad behind my AT pushes my foot forward in the boot.  The top plate fits funky because of my high instep - but the light weight and features are still worth it.   As I posted before, I’m unable to walk comfortably with the flat sole.  The company recommends you use this sole at angles less than 10 degrees.  After trying numerous times yesterday, I decided to try the large "rocker" sole again and I was able to walk normally!!!! I’m not sure why I need this at zero degrees - but the advice to push my shin against the front now works, etc.  Pics of the different soles are below:

img_1290 img_1292

I have to wear the funky clog because it’s the highest, stable shoe I own.  Unfortunately, it still doesn’t come up to the height of the big sole.  Aside from that, I was walking like a champ without crutches or pain by the end of the night.  I had very little swelling (could be my new icing setup) and felt a nice "finally used them" soreness in my injured leg muscles - hooray!!!!  Ditto for this morning - I felt so good I cranked the boot down to the -5 degrees, which is actually zero. (checked it on two other boots)

I’m not sure why Vaco says not to use this sole at this point, and feel good that I’m actually strengthening my leg with actual painless WB!  So I’m going to use the big sole for a week to see if that will help build leg strength to the point that I can cope with the flat sole.  It may be the pushed forward placement of my foot messing me up  - not sure.

Life is starting to improve.  I can carry my food to my seat, keep my foot on the ground without terrible pain, and hold things in my hands with one or no crutches.  If my kids bump the boot, I don’t freak out anymore since my leg feels much stronger and safer.  I’m still wary of slips and falls, especially when taking the boot off for PT.  I rode 6 min. bootless on my bike, and can do longer in the boot.  Not a huge accomplishment compared to others, but moving forward for me! I’ve gained 10 degrees of flexion this week - and will hang there for at least another week.  The flatter the foot gets, the easier it gets to walk. For those behind me, work on ROM as soon as cleared, as this has been my biggest hurdle to moving forward.  It’s more important than strength!  Blessings, Kim

16 Responses to “Vaco boot mechanics/6.5 weeks”

  1. The fact that all the other ortho boots only have the one sole — a rounded rocker sole — makes me think that what you’re doing is probably fine. If you’re using the Vaco “unhinged” — i.e., with its ankle joint fixed at -5 degrees = 0 degrees “true” — then I don’t think I’d go any farther.

    But around this time (7 weeks post-non-op), I started walking around in a hinged boot, as part of my transition to 2 shoes (at 8 weeks, following the UWO schedule). I set it so it was free to hinge from neutral (true 90 degrees) to hugely plantar-flexed.I haven’t seen any strongly persuasive studies, but I certainly felt as if the hinged boot helped build my strength, my confidence, and my balance, while keeping me safe. After 8 weeks, I still dragged it out for scary outings, etc.

    BTW, I briefly tried setting my boot (not a Vaco) to hinge past zero, into a few degrees of dorsiflexion, and I didn’t like the feeling at all, and immediately changed it back. I was nowhere near strong enough to stop my ankle from flexing past neutral while striding, and the combination of DF-stretching and FWB while walking (and FAST!!) didn’t feel safe or comfortable to me.

  2. Thanks for the recap of your boot experience. I read ryanb’s as well and it’s very helpful. I backed off on the DF before PT yesterday, but still had a lot of pain from the stretching when I went in. Of course, this was the day the PT decided to use the torture massage device right over the scar - it was excruciating! I sure hope it’s worth it…

    I think word got around that I was a wimp with stretching and they sent “The Enforcer” in. He really didn’t give a hoot for my whining and protests. :) Told me there “was no way my AT would rupture from the stretching at this point.” I WANT to believe him….:-O

  3. hey Kim ~ Congrats on the Zero degrees ! I got my cast off yest and wore a splint to work today … but, tomorrow I’m going to wear the Vaco Cast ~ 20 degrees … I’m still NWB (4 weeks from surgery this Fri) .. but, I had an issue w the liner of the Vaco cast being too small? I have big calved ~ muscular, so assumed this was the issue ? Wanted to see how urs fit? My incision was pretty nasty too .. about 8 inches … my OS had to go a lot higher bc of my calves so he could reach the tendon on top & pull it back down … but, the incision higher up has healed nicely & the incision on my heel not so much … question ~ should I be wearing my Vaco to bed ? if so, what’s the reason? just to keep the leg/ankle immobile & protected ? Wore the splint / Ace bandage combo last night & going to tonight .. seemed fine & my Vaco seems bigger than the plaster cast they just sawed off yest … btw ~ thanks for the reco on the Vaco .. pretty cool & def a diff ballgame than the clunky one my Dr. gave me yest (going to keep 2 like u did ) … keep up the good work @ PT … I’m starting next week … ~ Mark

  4. Hey Mark, my Vaco liner is actually kind of big - but I was on the lower end of the size range for the small. I would call them and ask them to exchange it. I remember the calf feeling too tight initially, but it was the boot itself I needed to adjust at the top. Did you do this? They have a video to show you how. I don’t close the liner all the way in the footbed either because I like to have room to move my toes a lot.

    I’m not sure why we have to sleep in it, but I know I need it on to keep my foot flexed. If I had a good splint that adjusted angles, I’d wear it! Where’d you get it?

    Like you, I had a lot of tendon removed and was at high angles initially. I take the boot off to work on ROM a lot - as advised by my PT and some here last week. Getting the foot flatter has really helped me walk more easily. I have to use the large sole to have a normal gait. I just ordered some really ugly platform sneakers to balance out the height on the other foot. Vanity is gone, I’ll look like Lady Gaga.

    You’ll love PT and start to really feel more confident - 4/5 weeks was a big change in ROM, strength, and comfort while the leg was down. Have fun making gains!

  5. Norm - just saw that you did not go past neutral while striding? That makes me feel better since I’m stuck at neutral even with pulling it in my crutch handle. The PT said he forced it to +10, but I can’t actively do that yet. Foot feels good at zero today. I’m loving my Cryo cuff for pain! (thanks again for the recommendation, Brian)

  6. Great news on the flexibility. Keep up the good work. BTW, I ditched the boot to sleep in as quickly as I could. I did find that it was a little stiff in the morning but I started my day with streching and had no problem getting back into the boot. Might be worth trying on night to see how you feel in the morning. The better sleep might help more than the boot. :)

  7. Not sure what you mean or what you were reading, kimjax, re your 1st sentence. My recent posts about healing short and my recent podiatrist appointments? I don’t have a full 15 degrees of DF in my right ankle (ATR #1, op, repaired short, seemed great to me these last ~10 years), at least not without opening another joint in my foot that should stay closed — but I do have some DF, maybe 10 degrees I’m guessing. But this is after years and years for me — your ankle is a newborn infant in comparison! ;-)

  8. Norm - the part in your comment above about not hinging the boot into positive DF. I haven’t been ok’d for ROM while walking yet. My doc is at the big foot and ankle conference next week so I won’t see him till July.

    I’d really like to take the boot off during sleep, Constamj, but doc says no. I hope Mark posts a pic of his splint. Has anyone tried the night splints for plantar fasciitis? They look more comfortable.

  9. This is good. I’m glad that your condition is improving everyday. Just few more weeks and you’ll be better.

  10. Hi again, a thought on sleeping in Oped Vacoboot (I believe they have different names US - UK). I did find the boot awkward to sleep in, so tried taking off the front shell and strapping tight (ish); found it a lot more comfortable. Spoke with Oped this morning; their tech man seemed to think this was fine.

  11. Hello,
    I am new to this blog. I am female and 4 weeks post op from rupturing my achiles in 2 places. The dr. took my toe tendon to reinforce one rupture at the base of the gastroc muscle. My other rupture is at the heel base where I had a bone spur removed as well. I feel overwhelmed and tired of not being able to walk with 3 kids through the holidays. I bought a Vaco Achiles boot and am anxiously awaiting its arrival. I see my dr next week. I hope he approves the boot and I get out of my cast. Any advise or encouragement is greatly appreciated! Doubletroublerupture

  12. Hi doubletrouble,
    I don’t check in much anymore as life has pretty much returned to normal - that is: BUSY with lots of kiddos and orphan advocacy. I feel great sympathy for you - dealing with immobility over the holidays must be difficult! I’ve never heard of a double rupture, but I’m sure some of the veteran posters on this group have seen it. :) I LOVED my Vaco - and TOLD the doc that I was going to use it. I had terrible aches and pains in my hips and knees with the Frankenstein boots as I’m a small boned person and they were just too heavy. My advice is to remain purposefully positive (use movies, comedies, treat yourself - whatever it takes) and be diligent with your PT. I didn’t realize how much harder some folks worked until about 6 weeks in. The leg lifts and stretches, etc, don’t seem very helpful - but they are! Hip exercises really helped with stability on the injured leg (your muscles atrophy quickly) and balancing exercises are so important for all the small supporting tendons. It seems so long and dreary, but around 8-12 weeks you will see dramatic improvement and things start to move along quickly. So don’t get discouraged - you’re really at the hardest point, IMO, so hang in there a few more weeks and do all those things with your kids that you’re too busy to do when on the run: read aloud (big kids too), listen to them talk more, teach them to bake/cook, watch some good old movies. (Tale of Two Cities and Gone With the Wind were conversation provoking :)) I had encouraging friends visit for adult conversation as well! I downloaded a LOT of uplifting music to use with PT - and religiously did an hour a day. (love Nicole Britt’s “Walk on Water”) Buy whatever you need and can afford to make life more comfortable while dealing with rehab. (see cryo cuff) So sorry you’re going through this - but it does end. Starting PT is the beginning of the end. Hopefully that’s in your near future? Blessings, Kim

  13. Thank you! I feel encouraged already! Looking forward to next week’s appt. My little goal is to make Chili this weekend for the Redskins Game. I will keep little goals and then they can get bigger as I get stronger!

  14. Good for you - little goals each day give you a feeling of accomplishment. I remember being so excited when I could empty the dishwasher! Now I’m badgering the kiddos to “keep up” again - it all comes back quickly once you’re able to begin walking fast without fear of re-rupture.

  15. CAST OFF! Umm….now what, lol? Dr. said everything looked great and put me in a boot for 4 weeks, said to start PT soon and could do whatever weight bearing I could tolerate. Yeah-no. My foot is frozen into a lovely pointed position. Impossible to stand even at the highest degree even in the Vacocast. What a cruel joke my dr. played on me by saying that, lol! I will be patient and just do free stretching for now I guess. Any little suggestions till PT starts in a week? My surgery sites are scary and I am afraid they are going to split open along with a re rupture which I know are all normal worries. What a disgusting injury is all I can say! I secretly have enjoyed grossing out my “cool” kids unexpectedly sending a text of my sutures and such. Its the little things to keep this fun right?

  16. Oh, I remember those days! I’m so glad it’s over and am feeling great sympathy for you right now! Don’t worry about the WB - I was too afraid to try until 5 weeks. I put the biggest sole in the Vaco, and tried to walk - I even put a pic on the blog with my crutches on the floor. Then I picked them right back up for another 2 weeks as my leg hurt so badly that night. In case the doc hasn’t told you, use one crutch at first, and just practice standing as soon as you can get out of that ballerina point. He gave me goals for ratcheting down my angles, and told me that I had to be at 10 degrees or zero by 6 weeks, I believe. It was very painful in the first day or so of reducing my ankle angle - but necessary. I did it about once a week or more often if possible.

    I also was constantly worried about re-rupture - and they still joke about it at the PT clinic, haha. I’ll never hear the end of it! You’ll start to make big improvements soon - hang in there. Be sure to do the ankle flexibility exercises at least twice a day - I moved mine constantly. There’s a rehab section on the blog somewhere and it was very helpful to follow their protocol as well as what my PT guys gave me. You should take pics of your leg once a week - it’s good for morale to see the improvement. Even now I feel better after seeing how far I’ve come and the small improvements that continue to happen with use. :)

    Enjoy the break from laundry and dishes for a while - it’s good for kids to learn and mine gained great confidence in “life skills” while I was down. Trust me - they “forget” how to do it all quickly when you’re back on your feet, haha! Blessings, Kim

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