A question about adjusting hinged boots

Hi All,

I have a Vaco boot. My doc not familiar, I bought it myself. He asked me not to adjust the boot below neutral, ( to make the foot DF even more). He’s an Aircast man so not used to boots that DF the tendon. I’m at 8 weeks and I have a copy of a protocol from an NHS hospital in the UK that uses Vaco. It says I should crank my boot down to “step Through” walking at 8 weeks. Not sure what to do. Guys, can you explain to me exactly what this step through setting achieves. Norm, I know you had a hinged boot second time around. Can you explain the mechanics and benefits for me please. My healing feels good at 8 weeks post op.


9 Responses to “A question about adjusting hinged boots”

  1. Hi Sheena, you may recall in my blog I adjusted my own boot, but the hospital protocal was 7.5% every two weeks starting at 22.5 degs, I made that change every week.

    The protocal never went beyond neutral, but I adjusted for walkthrough at the point when I was in two shoes but wore the boot for outdoors as a precaution to prevent over stretching in the event of an accident (slip/trip/fall).

    The step through allows you rehab your gait within the protection of the boot itself.

  2. Hi Andrew,
    thanks for this. Can you remind me at how many weeks you went into two shoes?

  3. Hi Sheena,

    I never went past neutral and I think my surgeon said you’re not meant to. I think I was at neutral 5 weeks post op, but that was quick and they slowed me down after that.

    How are things?

  4. Hi Sheena - Was in two shoes at 9wks around the house only but became more confident over time

    I was @ 11weeks when I ditched the boot for all except excessive walking or uneven surfaces.


    But looking back I wish I’d used orthotics to support my arch during this phase I feel very flat footed on my ATR foot now and the physio is not improving that.

  5. Hey Sheena, I was told the same thing as Andrew - the “walk through” setting is meant for the “two shoes” stage. Use the boot as a precaution while in the “danger time”, which my doc says is 18 weeks. Seems longer than I’ve read on the blog. Perhaps non-op is a couple weeks longer. K

  6. BBride, with a good protocol, I don’t think the danger period should be any longer with non-op than with op — see the UWO results, for example. But there’s a long “tail” to the danger period, so saying exactly when it ends is a bit like mapping a shoreline while there’s waves and tides. The vast majority of reruptures happen before 12 weeks, but quite a few happen even later, especially with long slow old-school protocols, which are more common on the non-op side. The worst rerupture rates have always been from “conservative casting”, i.e., non-op treatment that goes ultra-slow, AS IF going slower was safer. Unfortunately, the opposite is true, so many people have suffered (and some still do) needlessly.

    Sheena, I had a hinged boot BOTH times, right and left, op and non-op. First time, it was my surgeon’s first boot ever, it came way late (~12 weeks?) after 3-ish casts, and it was always set to hinge. (I gather the Vaco folks call hinging “walk through”?)

    Second time around, I still had the old hinged boot, so I prescribed it for myself, at about 7 weeks post-non-op — i.e., about 1 week before UWO’s “wean off boot” at 8 weeks.

    In your post, you seem to use “below neutral” to describe DORSIflexion, which I always think of as ABOVE neutral, so I may be confused. I only set my boot to hinge above neutral — past neutral in the DF direction — for a few minutes. I hated the feeling, so I reset the “stop” back to neutral. Whenever I had my boot free to hinge, it could hinge from neutral (where I had set a firm, metal-on-metal stop) to way far down in the PLANTARflex direction. The stop prevented me from overstretching my AT with my body weight (DF), but allowed my ankle to hinge normally during the end of my stride.

    The only time I got into trouble in my hinged boot was when I went straight from walking very fast (with friends on a sidewalk), to walking very fast BACKWARDS. (I was walking faster than my friends, and wanted to keep going fast AND keep talking with them.) Walking BACKWARDS is a VERY different exercise from walking forwards, when you’re in a hinged boot — trust me on this! It’s much more advanced and challenging to the healing AT and the weak calf muscle. Warning! (I was fine, but I stopped walking backwards IMMEDIATELY!)

  7. Hi Norm,
    Vaco guys call it “step through” walking. They also refer to DF angles as -. So when you are in full PF and going into the boot, their instructions say you are at +30 moving down in degrees to neutral and then down past they refer to -. So step through, according to their booklet is set at -10…..rather than +10. Unless I have misunderstood but I have the booklet here.
    Anyway, can I ask you a question, when you say set to hinge, do you mean that your boot actually moves or is set fixed at a DF angle? The vaco doesn’t move as in hinge move. I dodn’t know if I’m making sense here Norm?

  8. Hi Norm
    my last question…..doh I sorted it out! Cheers got my vaco moving as it should!

  9. Oh, good! For others, YES, the Vaco CAN be set to hinge freely, within user-set limits. And so can lots of other (less high-tech space-age, older-designed) hinged boots.

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