- See:
Achilles Tendonitis
- Discussion:
-
indications:
- may be indicated in older patients w/ minimally displaced ruptures;
- note that younger patients w/ expectations of participating in sports such as basketball may not be good candidates for non operative rx;
- atheletes should not expect to resume full activities for one year;
-
managment:
- short leg cast strategy:
- SLC is applied w/ ankle in plantar flexion;
- some surgeons place the cast in gravity equinus where as other surgeons place the ankle in maximal equinus;
- w/ time the cast is brought out of equinus over 8-10 weeks;
- walking is allowed (in the cast) at 4-6 weeks;
- as an alternative, consider using functional brace starting in 45 deg of flexion;
- the functional brace prevents ankle dorsiflexion but allows ankle plantar flexion;
- following casting, a 2 cm heel lift is worn for an additional 2-4 months;
- long leg cast:
- some orthopaedists have recommended an initial long leg cast in gravity equinus for 6 weeks, followed by a SLC for 4 weeks;
-
expected outcome: non operative vs operative outcomes:
- expect a re-rupture rate from 4% to 33% (avg 18%);
- decrease in strength and endurance of 30%;
- 83% of surgical patients vs 69 % immobilization patients returned to the preinjury level of activity;
- 93 % of surgical patients were satisfied with the results of treatment vs 66% of immobilized patients;
- poor results w/ non operative treatment occur when the ankle is casted in neutral position (leads to relative lengthening of the tendon);
- even w/ initial positioning of the ankle in equinus, non operative treatment cannot be expect to restore the correct length of tendon;
Effects of immobilization
on Achilles tendon healing in a rat model.
Functional bracing for rupture of the Achilles tendon. Clincial results and analysis of ground reaction forces and temporal data. GP McComis et al.
JBJS Vol 79-A. No 12. Dec 1997.
Surgical and non-surgical treatment of Achilles tendon rupture. A prospective randomized study. Nistor, L. J. Bone and Joint Surg.. 63-A:394-399, March, 1981.
Abstract
Review of the operative treatment of Achilles tendon rupture.
Kellam, J. F., Hunter, G. A., and McElwain, J. P.: Clin. Orthop.. 201:80-83, April, 1985.
Abstract
Combined Conservative and Orthotic Management of Acute Ruptures of the Achilles Tendon.
