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Achilles Tendon Rupture: Non Operative Treatment


(see also: 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