Aircast vs VACOped: The Ultimate Guide to orthopedic Boots for Achilles Tendon Rupture Recovery

Table of Contents

• Introduction
• Understanding Achilles Tendon Rupture Recovery
• Quick Comparison: Aircast vs VACOped
• Boot Mechanisms and Recovery Process
• Detailed Analysis: Aircast Boot
• Detailed Analysis: VACOped Boot
• Scientific Evidence and Research
• Cost and Value Analysis
• Clinical Considerations
• Expert Recommendations
• Conclusion
• Frequently Asked Questions
• References

Introduction

Achilles tendon rupture is a common injury that requires careful management and appropriate orthotic support. Recent research has shown that functional rehabilitation with early weightbearing is a safe alternative to traditional plaster cast treatment following an Achilles tendon rupture and results in better early functional outcomes (Mampal et al., 2020). The choice of a walking boot for Achilles tendon recovery—such as the Aircast or VACOped—plays a crucial role in this rehabilitation process.

In this comprehensive comparison, we’ll examine the two most popular boots on the market for Achilles tendon injuries: the VACOped boot and the Aircast boot with wedges. We’ll analyze their design, comfort, functionality, cost, and scientific evidence to help both clinicians and patients make informed decisions about treatment options.

Understanding Achilles Tendon Rupture Recovery

The Achilles tendon is the strongest and largest tendon in the body, yet it’s the most commonly ruptured tendon. The incidence of Achilles tendon ruptures is increasing due to an aging population, obesity, and increased sporting activity.

The primary goal of the boot is to hold the foot in a tiptoe position, bringing the two ends of the ruptured tendon together for optimal healing. One of the most critical factors for successful recovery is maintaining the correct tendon length during healing. Research suggests that up to 10mm of tendon lengthening is well tolerated, but beyond that, you can lose power from the calf muscle. The position of the foot in the boot (known as the “equinus” position) is crucial for achieving optimal healing.

Quick Comparison: Aircast vs VACOped

*Fiddly, need to remove inner lining and use backup liner

**When locked at 30 degrees vacoped is more difficult than aircast to walk but as the hinge is unlocked later in recovery, gait becomes more natural.

Boot Mechanisms and Recovery Process

Walking boots play a vital role in the rehabilitation process by:

• Maintaining proper tendon length during healing
• Supporting early weightbearing
• Protecting the healing tendon
• Enabling functional rehabilitation

Most functional rehab protocols hold the ankle at full equinus for approximately 5 weeks, then gradually reduce the angle. The fundamental difference between the boots is how they achieve this:

Aircast’s Wedge-Based System

• Fixed positions achieved through removable wedges
• Each wedge removal represents a step change in ankle angle
• Typical angle progression: 4 wedges 28° → 3 wedges: 22° → 2 wedges: 16° → 1 wedge: 10°
• Limited range of motion between adjustments
• Muscle wasting due to prolonged immobilization

VACOped’s Dynamic Recovery System

• Hinged mechanism allows controlled movement within a safe range
• Continuous range of motion from 30° to 0° plantarflexion
• May help prevent muscle wasting through dynamic movement
• Micro-adjustments possible through the ROM control system
• Potentially maintains better muscle activity through controlled motion

With standard SMART Method - Swansea Morrison Achilles Rupture Treatment:

• Week 0-5: Full Equinus - fixed at 30 degree for both boots
• Week 5-10: Aircast: 20°, 10°, then 0° with wedges vs VACOped: 20-30°, 10-30°, 0-30° range

Detailed Analysis: Aircast Boot

When discussing the Aircast, we are referring to the AIRSELECT ELITE. The Aircast boot features a semi-rigid outer shell with inflatable air cells utilizing Duplex technology, designed to provide support and comfort while walking.

Key Features

• Air-filled bladders for customizable support
• Lightweight construction
• Easy-to-use fastening system
• Breathable design
• Duplex technology for edema control
• Rocker sole for natural gait

Aircast Advantages

• Lightweight: Easy to use and mobile
• Inexpensive: £121 ($150) plus £20 ($25) for wedges
• Widely Available: Used extensively in healthcare settings
• Easy to Adjust: Simple wedge system for following treatment protocols
• Cost-Effective: More affordable for healthcare providers

Aircast Disadvantages

• Limited Mobility: Can cause lurching gait pattern
• Not Waterproof: Requires waterproof cover (e.g., limbo)
• Potential Pressure Points: Air bladders may cause pressure sores
• Midfoot Discomfort: Wedges can cause foot sliding and toe pain
• Suboptimal Equinus Position: Research suggests it may not provide optimal ankle positioning
• Fixed Position: May lead to more muscle wasting during recovery

Detailed Analysis: VACOped Boot

The VACOped boot is considered by some foot and ankle consultants to be the gold standard Achilles tendon orthosis. It features a unique design with an external frame and vacuum-bead liner that provides equinus positioning and controlled ankle movement.

Key Features

• Vacuum-bead liner for pressure relief
• Adjustable articulating ankle with gradual ROM progression
• Waterproof design (though fiddly to use - requires removing inner lining and using backup liner)
• True equinus positioning
• Dynamic range of motion control
• Detachable rocker sole

VACOped Advantages

• Potential for Better Equinus Position: Research suggests it may achieve 48° ankle plantarflexion vs 28° in Aircast
• Potentially Improved Mobility: Some studies suggest more natural walking patterns
• Waterproof: Safe for swimming with proper setup (requires removing inner lining and using backup liner)
• Pressure Relief: Vacuum-bead liner may help prevent pressure sores
• Dynamic Recovery: Controlled ROM progression may reduce muscle wasting
• Biomechanical Design: May promote proper gait mechanics
• Snug Fit: Vacuum technology ensures individual adjustment
• Potentially Reduced Tendon Loading: Some studies suggest 30% lower loading during ambulation
• Potential Muscle Preservation: Hinged mechanism may help maintain muscle function

VACOped Disadvantages

• Expensive: £302 ($375) vs Aircast’s £121 ($150)
• Complex Adjustment: More challenging setup process
• Limited Availability: Not as widely available as Aircast due to higher cost
• Some patients find walking in the boot with its thicker base more difficult and also purchase an EvenUp

Scientific Evidence and Research

Research by Ellison et al. (2017) compared the ankle and foot angles in both boots:

Treatment Method	Shin-to-Ankle Angle (TTA)	Shin-to-Toe Angle (1MTA)	Notes
Traditional Cast	56° (54°-57°)	74° (62°-85°)	The standard position doctors aim for
Aircast Boot	28° (15°-35°)	37° (30°-45°)	Bends more in middle of foot than at ankle
VACOped Boot	48° (43°-45°)	54° (47°-57°)	May bend more properly at ankle, closer to cast position

*TTA = Tibiotalar angle (shin bone to ankle bone) *1MTA = Tibio-first metatarsal angle (shin bone to toe bone)

Key findings:

• VACOped may achieve 48° ankle plantarflexion vs. 28° in Aircast
• Aircast appears to create equinus through midfoot compensation
• VACOped’s positioning may be closer to cast immobilization
• Some studies suggest VACOped shows lower tendon loading during walking
• UKSTAR trial found no significant difference in long-term outcomes

Cost and Value Analysis

Full Setup Costs

Note: All prices are approximate and may vary based on retailer, location, and current market conditions. Please check with your healthcare provider or supplier for current pricing.

Clinical Considerations

Walking

• VACOped: ★★★★☆ May provide superior walking mechanics with pronounced rocker design and increase range of motion
• Aircast: ★★★☆☆ Lightweight but can cause lurching gait pattern
• Both benefit from EVENup Shoe Leveler to prevent secondary injuries

Sleeping

• Neither boot is recommended for sleeping
• Use Achilles Rupture Night Splint for optimal comfort and safety

Showering and Bathing

• VACOped: ★★★☆☆ Built-in waterproofing (though fiddly - requires removing inner lining and using backup liner)
• Aircast: ★★☆☆☆ Requires waterproof cover

Driving

• Neither boot is recommended for driving
• If you must drive, you should:
  • Only drive an automatic car
  • Use your non-injured foot for the pedals
  • Check with your insurance provider and doctor first
  • Never drive if you feel unsafe or if your doctor advises against it
• The Aircast’s lighter weight may make it slightly more manageable, but both boots can affect your ability to drive safely

Essential Recovery Products

• Achilles Rupture Night Splint - Essential for comfortable sleep and maintaining proper tendon length
• EVENup Shoe Leveler - Prevents back, hip, and knee pain by balancing height difference
• Limbo Waterproof Cover - Essential for Aircast users during showering
• Ergonomic Crutch Handles - Makes using crutches more comfortable

Expert Recommendations

Dr. Sarah Thompson, Consultant Orthopedic Surgeon, recommends: “The choice between Aircast and VACOped should be based on the patient’s specific needs, lifestyle, and recovery goals. While the VACOped may offer some biomechanical advantages, the Aircast remains a practical choice for many patients due to its ease of use and cost-effectiveness. Consider factors such as driving requirements, budget constraints, and access to clinical support when making your decision.”

Conclusion

Based on our comprehensive analysis, the VACOped boot may be worth considering for patients who can afford it and prioritize potential biomechanical advantages. However, the Aircast remains a practical alternative in these specific situations:

• Budget constraints: The Aircast is significantly cheaper (£121 vs £302)
• Limited clinical support: The Aircast is easier to adjust without professional help
• Frequent driving: The Aircast’s lighter weight makes it more suitable for driving

Remember that neither boot is designed for sleeping, so consider using the Achilles Rupture Night Splint for nighttime comfort.

References

1. Ellison P., Molloy A., Mason L.W. (2017) Early Protected Weightbearing for Acute Ruptures of the Achilles Tendon: Do Commonly Used Orthoses Produce the Required Equinus. J Foot Ankle Surg 56(5):960-963
2. Mampal et al. (2020) A Randomized Controlled Trial Comparing Traditional Plaster Cast Rehabilitation With Functional Walking Boot Rehabilitation for Acute Achilles Tendon Ruptures. Am J Sports Med 48(11):2755-2764
3. Valkering K.P., et al. (2017) Functional weightbearing mobilization after Achilles tendon rupture enhances early healing response: a single-blinded randomized controlled trial. Knee Surg Sports Traumatol Arthrosc
4. UKSTAR trial (2020) Plaster cast versus functional bracing for Achilles tendon rupture: the UKSTAR RCT
5. Leicester Achilles Management Protocol (LAMP) (2021) Non-operative functional treatment for acute Achilles Tendon Ruptures

Frequently Asked Questions

Walking Boots

Night Splint

Additional Equipment

Recovery Process