- 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.
Surgical and non-surgical treatment of Achilles tendon rupture. A prospective randomized study.
Review of the operative treatment of Achilles tendon rupture.
Combined Conservative and Orthotic Management of Acute Ruptures of the Achilles Tendon.