cast and boots
Hello Again All,
This second page is going to be all about the problems with casts and boots.
For the first two days I just had a plaster slab in gravity equinus, this was because I had to fly back home from the South Island so couldn’t have a full cast because of the air pressure.
Then I was put in a fibreglass cast but woke up in the middle of the night with it feeling hot and tight so then had it swapped for another plaster of paris one.
At 10 days it was cut off and I was put into a USL boot with wedges. Well where do I start on this one?! Angle or night?
Night - I am a good sleeper and can sleep through anything; so apart from the hiccup with the fibreglass one the casts were no problem but the boot - major sense of humour failure! If I don’t get an undisturbed night’s sleep everyone around me suffers too!! Also how can you heal properly if you can’t sleep?! Partly it was the instability in the boot (see more on that below) but it was also the weight of it - 1kg strapped to the bottom of your foot!
I guess if I had carried on then I would have got tired enough after a few sleepless nights but I wasn’t prepared to wait that long. Jim did think of roughing something up in his wood-working shed but in the end decided that the hospital might be a better bet! So off he went and came back with a kit to make a fibreglass back-slab - except we made it a front slab. I was able to bandage this on every night instead of the boot and it was wonderful - no more sleepless nights, except one where we had to adjust the padding - I think we weren’t that skilled in making the slab so there were a few ridges. Jim’s life was much happier too with me sleeping!
My advice is that if your hospital won’t do a slab ask them when they cut off the cast to do it so you can keep the front part for at night; you may need to re-line it and if it is fibreglass file or tape the sharp cut edges.
Now for The angle - I was supposed to be at 20 degrees, i.e. 4cm of heel lift. In this type of boot there is no accuracy of this because it depends where your heel is in relation to the upright posts and as there is no heel cup and no strap at the ankle the heel can drift around; consequently I felt very unsafe in it and wondered how it would be when I was at the stage of reducing the angle and putting weight on it. I’ve heard from the orthopaaedic nurses that I’m not the only one to feel like this and people often want to be back in the cast!!
So after research on AchillesBlog and searching what other boots were around I decided to get myself a Vacocast which I had to order from Australia, but they were very helpful and it arrived within a week and what a difference! Immediately I felt well supported and was confident that the ankle was being held at the correct angle and with 5degree adjustments then the angles could be changed very gradually.
The large wedge for weightbearing with the foot in plantar flexion took a bit of getting used to but in the end worked well for the type of weightbearing I did at that point i.e. heel only , not rocking forward onto the toe.
I liked the bean bag system in the Vacocast in the early stages, especially being able to mould the foot to give arch support, however the front valve meant I had to make modifications to accommodate it on my knee scooter. Also once I started fully weightbearing I found it a hassle and I ditched it and instead put in my sports insole for my foot and cut up an old closed cell foam camping mat for the rest of the padding.
I still really like the angle adjustment and how easy and accurate it is to graduate it, although with my weak leg I find the front “guard” gives a little too much resistance to dorsiflexion movement - I have thought of cutting it at the ankle hinge - has anyone done that?
The other problem with the vacocast is it is too big to fit in a stirrup - and no I haven’t got back on the horse yet! However, when I do I think I will want to wear a boot for protection - more for when walking around before and afterwards on uneven ground or having to move out the way quickly. So I had another look at the USL boot and realised I could fit a shoe in it, but that then made it very high so Jim used his band saw to cut the sole off an old trainer, and I added some more velcro to the straps so that they grip both uprights and it is working well. He also fiddled with the hinge to make it free moving within the range we have set.
On both the boots the shape of the sole means there is an odd feeling to the weightbearing; in the USL there is a “stop” - a sort of dead spot soon after heel strike and my knee starts complaining if I walk too long in it. The Vacocast tends to make me hyperextend the knee on heel strike (snap it back) so I have taken the sole apart at the back and put in a small wedge and that has made a lot of difference.
Final word - there is no such thing as the perfect boot!