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Hey list serv,

Thanks for all the replies about the Brostrom protocol for posterior tibial tendon repair.

I did not post all replies because they were mostly uniform.

I did indeed quickly discover that the "High Tide Boot" was a discontinued version of a pneumatic walking boot/cam walker.

The double lateral heel wedge is still a bit mysterious (double thick inside heel wedge, outside heel wedge?).

I am going to add a small outside lateral heel wedge with very small lateral outflare, just enough to reduce chances of accidental ankle inversion in walkign boot. I am also going to provide an inside insert with some lateral wedge/lateral longitudinal arch foot support (credit to Thoman Cutler, CPO for that idea).

I would imagine that simply adding a heel wedge externally would not prevent someone from inverting their heel or ankle INSIDE the boot, so this is what I surmise the "double" part would mean.

I can't imagine a "double thick" lateral heel wedge (internal or external) would have a positive effect on biomechanics or healing (or ambulating), although, many pointed out it may be a gradual removal of wedges, similar to an Achilles tendon repair with heel lifts. I did receive some thoughtful insight on the biomechanics of the wedges. Our orthopaedic surgeon here does not want anything "drastic."

Overall, I think I was trying to make something simple into something complicated.

Regardless, your quick input is always appreciated.

Oh yes, and the second "ankle brace" is unanimously an ASO (lace up ankle).

Thanks,




Stephanie Romero, CO, MSPO

Certified Orthotist/Prosthetic Resident

Carrie Tingley Hospital/University of New Mexico Hospital

Phone: 505-272-5335

Fax: 505-272-4232