Adjustable external equinus boots vs fixed angle functional orthoses: Are they worth the cost? A single centre analysis of change of practice.

James Chapman, Emma Fenlon, Edward Wood

Introduction: Accelerated functional rehab in weightbearing orthoses has become the mainstay of treatment for achilles tendon rupture. Fixed angle boots have been shown to achieve equinus from the midfoot, with the OPED VACOped boot demonstrating an enhanced ankle equinus. We sought to investigate whether the extra cost of the VACOped represented an improvement in PROMS, with a null hypothesis that there is no significant difference. Method: We conducted a retrospective review of 84 patients (42 in each cohort). Achilles Tendon Repair Score (AS) and Rupture Score (ATRS) was prospectively collected to 9-12 months follow up. We set an MCID of 10; score distributions were compared using Mann-Whitney U-test and Incremental Cost-Effectiveness Ratio (ICER) was also calculated. All data was analysed using SPSS v.29. Results: Median ATRS at 4-6 and 9-12 months in Airstep vs VACOped were significantly different; 48 vs 67.5 (p<.001) and 74 vs 81.5 (p=.013) respectively. The difference in score at 9-12 months did not meet the MCID. Median AS was significantly different at 4-6 (55 vs 65, p<.001) but not at 9-12 months (70 vs 80; p=.113); however, both cohorts met the MCID. ICER per median addition point increase per patient for the ATRS was £3.07 at 4-6 and £7.98 at 9-12 months. For the AS, ICER was £5.99 at both time points. There was no significant difference in patients who required surgery (4 vs 6; Chi-square p=.5). Re-rupture was more common in the Airstep group (3 vs 1; p=.281). Conclusion: VACOped represents significantly improved PROMS at an earlier time point and may allow earlier return to function when compared to a fixed angle system. The cost of this appears acceptable when considering the impact of poor function on quality of life and ultimately return to work"