Hi, I am now 9 days post ATR - conservative treatment. I am due to go in a boot next week. I spoke to the OS and the plan is to go into a boot with wedges. I mentioned the vacocast / vacoped boot. He is happy for me to buy this and use a hinged type boot. Does anyone know of any research comparing hinged boots to static boots with wedges? Does the hinging give you any benefits / increase risk? Functionally is it easier to manoeuvre in when FWB and when progressing to 2 shoes?


7 Comments so far

  1. donna on April 24, 2015 2:26 pm

    I had wedges and they worked out fine, but I’ve heard people rave about the convenience of the hinge and that you can get needed plantarflexion without the unwanted dorsiflexion much easier. Hopefully someone with one will pipe in here and set us straight.

  2. kristian on April 25, 2015 12:52 am

    I like the idea of the vacocast / vacoped and the option to have some limited active range of movement. I hope this weight bearing through range of movement will help to promote increased tendon strength and earlier gains in range of movement. I do have a slight worry that the early movement may do the opposite of what I’d hope and increase the chance of rupture. It would be interesting to know if any of the conservative management studies used a hinged boot.

    If non-surgery is the way the research seems to be advising it would great if future research starting comparing conservative treatment options to see if there is any difference in the boots, exercises, time of stretches etc.

  3. Stuart on April 25, 2015 3:06 am

    Although I was a surgical patient there may be some comparisons made. My boot was hinged and I used wedges in it as well. While I was NWB I left it in the locked position. From memory I kept it locked until FWB which was somewhere just after 4 weeks. Unlocking it to allow full plantarflexion while restricting the dorsiflexion made life so much easier. I was able to take the boot off and do active ROM exercises but the mere fact my foot could move down all the time helped with flexibility as well. I am not aware of any studies concerning this. I don’t think I would do this before 3 weeks though.

  4. herewegoagain on April 25, 2015 5:30 am

    I started hinging in a vacoped at 4 weeks, increasing the range of movement at 2 week intervals. I have to confess that I am a huge fan of this boot and felt that the movement helped out as far as maintaining mobility. Long term advantages I am not so sure about, maybe you would end up at the same place in 6 months regardless of the hinging feature. I wore the boot until 10 weeks and then continued to use it for challenging environments for another couple of weeks, having it fully hinging meant that I could walk normally but still have the added protection from re rupturing if it was needed. The vacuum fit and removable soles were other features that worked well, for me it was worth the $ as far as comfort goes.

    Prepare to be amazed by what the body can do on its own after only 4 weeks. It doesn’t seem like nearly long enough for the tendon to reconnect but all the latest evidence supports that the initial reattachment will be underway by then.

    Have you found suddsy’s blog? There is a good conversation in the comments of his last post on non-op protocols from Hilllie that I found very informative.

    As far as your question on swelling goes- elevation and icing helped me out so much. I didn’t get into using compression socks until about 12 weeks and think that I should have been wearing them earlier- maybe around the transition to 2 shoes…..

  5. kristian on April 25, 2015 10:18 am

    Thanks for the info. I’ve found the info on suddys blog and had a good read. Tried to find a full link for the Exeter research but couldn’t find one. If anyone has come across it let me know as I can probably get someone to login and get the full article. I have now ordered the vacoped / vacocast and the even-up. Should be here early next week in time for Wednesday’s appointment with the OS.

  6. donna on April 25, 2015 3:29 pm

    Sounds great Kristian! Have a look at:
    normofthenorth The case for skipping ATR surgery

    …this page of his blog is a great read for non-ops, lots of research info spanning a 4 year period of posting.

  7. Kristian on April 25, 2015 4:19 pm

    Hi. Thanks for the info. I read that a couple of days ago. Starts out quite heated with some very keen that normofthenorth stopped promoting conservative management and research. It was that type of info that got me on here in the first place. Well worth a read.

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