tony’s AchillesBlog

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Vacocast or air cast?? Now in fiberglass surgery was 2.5 wks ago & dr said bring bk air cast next visit in a week

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their so cute i love? the crackling the first time they start laughing lol

Interesting post. My husband had similar problems and every information about the boots used and how useful they are is welcome. Thanks.

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I like this post, enjoyed this one thankyou for putting up.

Actually that business about people believing the earth was flat around the time Columbus got lost crossing the Atlantic is completely false and was fabricated by Washington Irving in his biography of Columbus. People had know the earth was round for at least several centuries by then. The ancient Egyptians and Greeks, among others, weren’t “flat earthers.”

Despite all the sensible-sounding advice to “take it easy”, “make sure”, “better safe than sorry”, suggesting that slower rehabs decrease re-rupture rates, the actual **evidence** generally shows the exact opposite! I don’t think the VacoCast protocol has ever been tested in a good-sized study, and I’m not sure about Dr. Berkson’s or the one from Berlin. (Please correct me if I’m wrong.)
But the similar fast one at bit.ly/UWOProtocol HAS been subjected to a good-sized study, published in 2010,and it produced excellent results with and without surgery! That study (with results) is linked in “ATR Rehab Protocols, Publications, Studies” on the Main Page.
For a LONG time, humans thought the Earth was flat, because it seemed logical. Then it was obviously logical that the plates of the Earth did NOT move around. . . Thinking that slow rehab is “conservative” and “safe” belongs in that same discard pile!
That doesn’t mean anybody should go nuts or be careless, but following a good fast modern protocol that produced excellent results is apparently very good for the leg — and it’s great for the lifestyle and the psyche!

i am in a fibreglass cast that i was told was weightbaring, never told how much weight tho. i was FWB by week 4 post-op

quoted Bone fusion??? Damn that sounds scary!! Right now I’m 1 month in on now my other leg. Hearing the term bone fusion makes me shake!! I wish u well with your progress!!

-i’ve never heard of bone fusion really sounds scary, like saw movies ? >_<

As I look forward to spending three months on one leg and crutches after pelvic bone graft it is interesting to come across someone else’s non weight-bearing experiences. It does take an awful lot of patience. And when it’s all over I have to start all over again with a hip revision on the other leg.

I do hope you are fully recovered now. Your own problem sounds very much like my daughter had recently after an accident.

Tom, don’t rush it. Things like this take time to heal. It’s better to be safe than sorry. Avoiding further complications you can cause by rushing, will make the wait worth it.

Hi Tony,

It’s been about 9 months since you made this post. How’ve you been?

I’d give you some advice that I think would help you, but I don’t know about the exact state you’re in right now.

Having said that, you did say that you “should adjust the boot 5 degrees every 5 to 7 days.”

If you kept that pace, then you should be at neutral right now.

Vernon said: “The boot was the best decision I made, with out it I would be crazy and probably weeks or months behind in my recovery,”
I agree, a good friend of mine had the same injury and to quote him: This boot is the best f… thing out there.

Thanks for the thanks, Vernon! It sounds like you’ve been doing a great job.

Good luck and (continued) Good Healing!

I know it’s a bit late after you all asked the question but I thought I would respond for the benefit of those who will be reading this blog in the future. A little background, I’m 43, male fit & no history of ankle injury, did this playing sport and limped around at work for 2 days before I got a doctors certificate to say no work, had surgery.

I went out and bought the Vaco boot as well, mine has the notches on the back that go from 3 to -1 which I assume are from 30 degree’s to -10 degree’s. ( It relates back to the paperwork that came with the boot).

My surgeon was reluctant to put me in a boot initially, until I showed him a picture of the Vaco boot and the way it could be locked in at any set angle, he said as long as your foot can be locked at 30 degree’s (toes pointing to the ground in other words) I could use it.

So at 2 weeks post surgery I set the boot to 30 degrees and put it on. The surgeon said I’ll see you in 6 weeks and walked out. So I figured I’ll follow the recommended recovery process put out by Oped Vaco and Charite’ Hospital in Berlin.
At 3 weeks I was weight bearing and 25 deg, 4 weeks ful

Norm, Odd as it is, I did not even know I had the problem. I am on the FEMA Urban Search and Rescue team which requires an annual physical. When it was all over the dac asked if there was anything else that may be bothering me. I told him my tendon bothered me some when I walk. That led to an xray, which led to an MRI, which led to surgery. I think I was in mild shock through the ordeal.

Tom, I don’t think I’ve heard of another case of an ATR that was so gradual the patient wasn’t sure when it happened. Many people don’t realize it’s an ATR for some time, of course, but they usually know exactly when whatever-it-was happened. Anyway, good to hear you seem to be coming through the ordeal!

Norm, Thanks for the comments. I try to figure out when I could have originaly tore my AT. All I had was the onset of pain. It was mild at first then it continually got worse. I hunt, and golf (a lot). I dont see how either of those activities did anything however I have been at a loss for how it happened. I was allowed FWB at 7 week after the first surgery and re-tore it all after the first step. Then my doc deployed to Iraq. (I am retired military). I was farmed oput to a civilian doctor and whew, am I happy with him. He did a complete rebuild including cadaver parts and rerouting a foot tendon which was also tore. The entire ordeal was a nightmare but I am now FWB in the boot and in a running shoe around the house. I am seeing the light at the end of the tunnel.

Tom, there are a few of us here who tore our ATs playing aggressive and competitive sports, even though we don’t even REMEMBER being 57 years old! Of course, memory is the first thing to go. . . and then there’s also loss of memory!

Bone fusion??? Damn that sounds scary!! Right now I’m 1 month in on now my other leg. Hearing the term bone fusion makes me shake!! I wish u well with your progress!!

Wow. I just joined this site and although I don’t know what the heck I am doing yet, I fell into your blog on being a second timer. I am as well. 1st surgery November 30, reinjured in January, Complete rebuild on May 5th. It has been a long road, and as “sick” as it sounds, it’s good to see I am not alone in this. I am almost 12 weeks post surgery, still in the boot and in PT. I seem to be making tremendous progress since pain and swelling lasted 8 weeks. On my retear I took two other tendons down as well so slow going is the name of my game. I was already informed another tear and it is bone-fusion for me. I am 57 years old (tomorrow) and although I am in good shape, things dont heal so quick at my age. I will be monitoring your progress and hope to learn and share as soon as I figure this place out. Thanks for your posting and “one foot at a time” with thought before each step.

Tony, out of the frying pan into the fire so to speak. I’m a second timer, re-tore when I did too much to fast, mainly due to lack of direction and info, like your OS, mine too was busy and brief on visits. I too had to get the vacocast on my own. My doc wasn’t into the hinged boot but allowed me to work with it. Right now I would start out in as much plantar flex as you need to feel comfortable. Don’t get locked into time, go by how it feels. If it doesn’t feel right it probably isn’t My post surgical time, I went into a fixed boot 2 wks out from surgery. When they took me out of the cast and said to put the boot on I thought I was going to passout from the pain. I had asked the doc how much does it hurt, “its uncomfortable” nurse said the same. Well I was wheeled out to my car in a wheel chair. It took about 12 hrs to calm down and I could walk on it. I would imagine you will be similar. Ice a elevate today. Start with both feet on the ground sitting and see how it goes, don’t try to go past neutral anytime soon. While sitting you can unlock the plantar flex and do gentle ROM, pushing foot down it will help loosen

First, if it hurts when you do “X”, then don’t do “X”!

Second, most of the modern protocols introduce WB before they stretch you to neutral. E.g., “my” UWO Protocol gets to FWB about 2 weeks before the heel wedges come out. I like that approach better than your Doc’s.

Resting your foot on the floor is not even PWB, in my books. When you sit, you’ve been resting your foot on the floor all along (unless you’re elevating), haven’t you? PWB can start at close to 0% of FWB, but it usually gets to 25% and even 50% fairly soon. The UWO Protocol starts that progression at TWO weeks, so I don’t think it’s premature for you. But combining it with the ankle stretch (moving toward neutral) may be too much at once.

If/when you change angle toward neutral, maybe especially after you’re PWB, it seems best to do it before bed. Your leg has an easy time in bed, and the sleep time gives your ankle a chance to get used to the extra stretch, before you add any weight or even drop it down and make it more inflamed.

Sounds like you switched from an angry Doc to one who’s unengaged, maybe bored. That’s lots not to be impressed by! I guess bein

Thanks for the kind words AND the LOL, Tony! Your philosophical musings are not wrong, IMHO.

(I thought lef meant left, but it turned out the same.)

Norm as always your replies are excellent and informative.
I mistyped lef for leg. i have been in the position where my bad side (left) leg is always bent. Either in an elevated positionn slightly bent or on crutches slightly bent. When i straighten out my left leg i feel a burning, pulling sensation that runs from my smallest toe across the top outside of my foot and around to the back of my heel. I will say once i keep it straight for a short time the pain subsides. it is not acute but it does hurt a bit.

I have grown a little concerned about the actual surgery. After the expereince I had with my OS I began to lose confidence that he actually did decent work.

I am probably overly paranoid and this is just normal healinng. As I am sure we are all focused on how this part of our body feels.

thanks for the rest of the informationn on PWB and FWB as tolerated. What a lot to look forward to I have!

It is helpful to know all of us are in the same process. Misery does love company and a sad face cheers the heart. This really demonstrates what relatonal communal beings we are doesnt it?

Congrats on the accomplishemts, Tony!

I don’t think I’ve found a VacoPed/VacoCast user who ISN’T an advertisement for the boot, and the company! I’ve never used it myself, but it sounds very good to me from the reports. (Not good enough for me to try to grow a third AT, but very good!) And I’ve been sold on HINGED BOOTS all along, since I first used one.

Using it for a year is silly, but it’s a useful tool for protecting yourself in high-risk situations and still getting good calf exercise, long after you’re padding around your home in shoes or barefoot.

You say you “feel uneasy as this pain is not something that you just work through. I dont trust myself in this arena and am very concerned to rerupture.” EXACTLY!! Keep that attitude, and you’ll probably apply the right kinds of judgments. “Cautious, sensible impatience” sounds about right to me.

Nobody really knows what PWB means. Some pros have their patients push down on a scale to calibrate the pressure in pounds — but the target pressure (in pounds) is a number they kind of picked out of a hat, so it’s kind of misleadingly precise.

And it’s a sliding scale, too

Issat,
Thanks for taking the time to give helpful insight. Tomorrow I am going to see if there is another OS in the practice who is more progressive without mentioning i already had surgery.
Also, I am going to call a couple in the KC area that I have come across that utilize boots.
I think worst case for me is at the four week post surgery I simply refuse another cast.

Tony, things are slightly different here in the UK. In fact treatment varies from one primary care trust to another and between hospitals in the same trust.

While patients are treated under a particular consultant, it happens that you may see 5 different consultants but not the one you’re registered under! Each belonging to a different school of thought with regards to treatment options (op, non-op, boot, cast…)

Your consultant is an asshole; he obviously doesn’t like being told what to do, esp from patients! Any chance you can see another consultant at the same hospital, try booking a different day slot.

As norm suggested, the old school conform to immobilsation for min 6 weeks - which simply isnt evidence based.

I’m careful not to encourage you to wear the boot, in the event he removes you from his care, which happens in the UK. You will forfeit any physio

I got into a boot at 4 weeks and havent looked back since.

Let us know how you get on.

Tony, I’m in no position to complain about long-winded blogs and posts, as you already know! And I appreciated the details, too.

I think you already know where to find the “UWO” protocol that a few of us here (and 145 patients in the UWO study) have followed, at bit.ly/UWOProtocol .

Your OS sounds pretty awful, or at least like a human being going through a tough patch and taking it out on the people around him. His approach and his protocol both seem archaic.

Many surgeons, including yours (and mine 8 yrs ago) follow instincts that are basically backwards — they think that longer immobilization is safer, more “conservative”, and more likely to produce superior results, while the evidence generally points exactly the other way. In addition, they place no value on the lifestyle and psychological benefits of early weight-bearing and mobility, except to view them as a threat or a challenge to be overcome. And they give little weight to the non-trivial risks of injury from being on crutches for weeks and weeks.

The only good thing I can say about that kind of ultra-conservative protocol is that I survived it myself (post-o

JSKI
Thanks for the helpful insight. It appears that I am going to have to structure my own rehab program. I may wait out this new two week period and when i next see my OS demand that the cast be removed and I make my own transition to the boot and get set up with a PT specialist. They may not even agree to treat outside of the surgeons approval.

Tony,

I was in a similar position concerning rehab and simply followed my own protocol after getting into a boot at 3 weeks. I was happy with the surgery but not the rehab. Luckily I did not have to deal with your cast situation.

Here is a protocol from the US Army:
wbamc.amedd.army.mil/Documents/PatientCare/PostOpRehabProtocols/Achilles Repair WB08.pdf

Another from a university PT program:
/xnet.kp.org/socal_rehabspecialists/ptr_library/09FootRegion/26Ankle-AchillesTendonRepair.pdf

If you go doc’s way and re-rupture you get more of the same style treatment assuming you keep the doc.

If you go your own way and re-rupture doc may refuse to see you again but you’d probably want a different doc anyway.

Good Luck