pa61’s AchillesBlog

At the start of this week I took delivery of a Vacoped boot. I’d dithered for days about whether to pay personally for the upgrade from the Aircast boot provided by my local NHS hospital, but in the end, based on lots of reading at Achilles Blog, I’d decided it probably made sense for several reasons:

- lighter

- more comfortable

- more hygenic, due to the removable footbed and the washable soft liners

- finer angle adjustment steps than with the simple 4 wedge system in the Aircast

- more adjustable, once I was able to start doing some ROM rehab exercises rather than just using it as a rigid static boot like the Aircast

After using it for a few days, I’m very happy that I made the investment in it.

It’s not actually much lighter than the Aircast, but it is FAR more comfortable. The "rocker" sole dramatically reduces the jarring heel impact that I was experiencing in the Aircast, and the microbead padding is nicely adjustable to relieve pressure points as they arise - something that was pretty much impossible in the Aircast.

Having switched to the Vacoped, I now needed to "map" the Aircast wedge removal schedule across to an equivalent schedule in the Vacoped.

By gentle experimentation & comparison between the two boots, I decided that the current 4 wedge angle in my Aircast was more than 20 degrees but slightly less than 25 degrees. So I decided to set my Vacoped at the 25 degree setting for a couple more days before trying to reduce it to 20 degrees. The subsequent adjustment from 25 degrees to 20 degrees, on 3rd June, went very easily with no pain at all. Let’s hope this pattern continues with future angle reductions ( I still sweat about that ripping sensation when the nurse tried to force my foot onto 3 wedges!).

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So, the big day where I hoped to lose my plaster cast and be given a "boot".

Off to the plaster room where my cast was sawn off to reveal a rather horrible sweaty dirty swollen foot.

The nurse brought in an Aircast boot with three wedges in it and proceeded to press my foot down into it. I yelped with pain as a I felt a sensation of tearing flesh in my right heel. She stopped and then said OK, looks like you need 4 wedges then. I asked to speak to the doctor (since it didn’t seem like I was even going to get a chance to do this without demanding it!).

The doctor came and felt my leg and did another Thompson test. I asked my question about how he knew that the tendon ends were close enough together to start healing, and he assured me he could do this just by feeling my leg.

So, back to the nurse and into the Aircast boot with 4 wedges, this time with only a little pain rather than a ripping sensation.

I was told that I could weight bear on the boot straight away. I should remove a wedge every 2 weeks, and then 2 weeks after removing the final wedge I would have a follow up appointment with the physiotherapy department to explain the "rehabilitation process".

I was given a copy of the short single page "Primary Achilles rupture regime" document produced by Colchester Hospital University. It said barely any more than what I’ve already written above.

Having been assured that I could weight bear straight away, I actually found this impossible to do, and hobbled out of the hospital using my crutches pretty much as before. The boot was heavier than the plaster cast, hot and heavy. I came home feeling very despondent that the boot actually felt like a backwards step, rather than the step forward that I had hoped and anticipated!

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Having checked myself in at a machine terminal (no human receptionist any more!), I only waited a few minutes to be called through to the orthopaedic department. The doctor ran briefly through my case history and gave me the standard spiel about NHS recommending non-surgical treatment because I wasn’t David Beckham and it didn’t make sense to take the (low but potentially serious) risks of undertaking surgery.

I was then sent through to the plaster room to have my cast removed for a brief leg inspection. The high speed circular saw used to cut apart my plaster cast was pretty scary I must say!

Once my leg was out of plaster the doctor did another Thompson test and confirmed the initial A&E assessment of a complete rupture.

I was then re-fitted with a new (slightly lighter weight) cast, with my foot stretched further below the horizontal (probably 30 degrees now, rather than 20 degreees). There was no discussion of whether this was a conscious decision, or just the whim/standard practice of the particular nurse applying the cast…

I was told to expect another appointment in about a week’s time, at which I would be taken out of plaster and fitted with an Aircast boot with heel wedges.

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I’d planned a tennis game on the morning of 9th May, but then scheduled a second game for the evening (something I’d never done before, and probably won’t ever again!).

About 20 minutes into the game, when lunging forward from the service line, my right leg didn’t move forwards with the rest of my body…and I ended up in a heap on the ground with a couple of choice swear words.

The initial stab of pain faded almost immediately, but I had an immediate sense that something pretty catastrophic had happened. Five minutes later, when I gingerly tried to get up and stand on both feet, this was confirmed. I felt dizzy and had very little sense of connection between my right foot and the ground.

A few minutes later I hobbled very slowly back to my car in the car park, and gently drove the half mile back to my house.

I put a bag of frozen peas round my ankle and started googling achilles tendon rupture. I didn’t immediately hit on AchillesBlog, but found some NHS and US medical sites that quickly convinced me of my self-diagnosis.

After dinner my wife Sue drove me straight down to Colchester A&E where we joined the estimated 3 hour queue to wait to be seen.

I finally got home 6 hours later just after 3am…

An initial Thompson test by the A&E doctor confirmed a full rupture. I was sent for an X-ray and told afterwards that the result was "good". No time for any better explanation than that - I now assume that "good" means that there was no evidence of any bone fragments having broken off from the heel? After another long wait I was sent to the plaster room and put in a heavy plaster cast with my foot pointing downwards by about 20 degrees from horizontal. I was given a pair of crutches and told I’d be seen again in about a week. Then off home to bed at last.

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