July 26 Moved To My VACOcast Pro

Hi everyone- I was able to change Orthopedic Surgeons. The new OS was sort of aloof. I dont think he felt comfortable taking me after someone else did the surgery. He looked at the surgery report and said he would not have used the kind of sutures that my previous OS used. He also knew my previous OS and said he was having personal problems. I feel for him but hope that did not impact the work he did on me. I am disapointed with Orthopedic Surgeons in general. But he did allow me to move to my boot and I am 3 days into my fourth week. So no more cast.
He attempted to push my foot to 90 degrees or neutral and I was close to that but it was a real stretch, painful and scary.

I showed him my boot and what it was capable of doing but he was really not interested. In fact he didnt put it on me or adjust it. He simply said work to get to 90 degrees which is the foot parallel to the ground or standing flat footed in the next two weeks. Dont do any weight bearing at all for two more weeks. He gave me a script for physical therapy which i start in two weeks. That will be 6 weeks out from surgery and then he left the room.
One problem with the boot is that it has numbers for inflection and not degrees. So 0 is neutral or 90 degrees. Since i had been immobilized at what I supposed was -30 degrees I put myslef at 1.5 which is -15 degrees. I did this myself in the room after he had left. This was a bit demoralizinng but at least he took me on. I had the feelling that he did not want himslef or his staff to work with or put me in the boot for liability reasons. I just thought it was strange that he would leave the room and not attempt to get me set up in the boot.
The major point is that I am in the boot. I have read that I should adjust the boot 5 degrees every 5 to 7 days. I may adjust more aggressively to get to neutral at 5 weeks since I should be there now.
Does anyone have any thoughts on pushing to get to neutral in that time frame? Should I just force my foot into neutral right now strap the boot on and sleep with it that way?
Also, I have read that some are full weight bearing at 4 weeks. That seems aggressive to me. This surgeion explicitly told me not to put weight at all on it for two more weeks. I should think that I can set my foot on the floor right now in the boot. I have and it feels fine to do that even though that is weight bearing.

Anyway, interested in any thoughts on that.

Also, i feel a hot stinging pain moving from the outside toe, across the outside edge of my foot, under my ankle and into my Achilles. This happens when i straighten out my leg. I have no idea what this is and didnt get a chance to ask the doc.

30 Responses to “July 26 Moved To My VACOcast Pro”

  1. 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 being treated like a God throughout your professional career takes its toll. . .

  2. 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 scar tissue along ankle. Just remember slow is good.

  3. 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.

  4. 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!!

  5. 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! ;-)

  6. 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.

  7. 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!

  8. 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.

  9. 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 full weight bearing and 15 deg, 5 weeks 0 deg 5 and a half weeks took off the wedge sole and went for the flat sole, and now at the end of week 6 I can walk around with a limp in shoes. I use the boot with full movement when I go out of the house. There were gradual steps in between that I have missed out.

    Along with the timetable for recovery provided with the boot I used the recovery stages & exercise in the link provided by Eric Berkson, MD (Orthopaedic Surgery of Quincy, Massachusetts General Hospital). Top link in the ATR Rehab Protocols, Publications, Studies.

    The boot was the best decision I made, with out it I would be crazy and probably weeks or months behind in my recovery, Next week I go back to the surgeon, I’m not sure what he will say when I walk in. I haven’t been to a physio yet either. I must say a big thanks to everyone on this blog, especially normofthenorth I read a lot of your stuff.

    The recovery continues…..

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

    Good luck and (continued) Good Healing!

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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 ? >_<

  16. 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

  17. 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!

  18. 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.”

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

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

  22. I am not sure where you are getting your information, but good topic. I needs to spend some time learning more or understanding more. Thanks for wonderful info I was looking for this info for my mission.

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  25. 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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