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Immediate weight-bearing, walking boot may be helpful for Achilles tendon rupture
Patients were highly satisfied when they followed an 8-week functional mobilization program after a rupture and did not undergo surgery.
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LIVERPOOL, United Kingdom — Functional, nonsurgical management of an Achilles tendon rupture offered patients minimal disruption of day-to-day activities and good functional outcomes following the injury, according to a presentation here by a specialist orthopaedic registrar.
Randeep Aujla, MBChB, and a colleague found that for patients with an Achilles tendon rupture, nonsurgical management with immediate weight-bearing and 8 weeks in a walking boot can provide a minimal risk of re-rupture and functional outcomes that are as beneficial as those achieved with surgical treatment.
“The functional, nonsurgical management has a low re-rupture rate and good functional outcomes. However, I would say these outcomes are slightly lower than the results in the literature compared to surgical techniques,” Aujla said at the British Orthopaedic Association Annual Meeting.
Walking boots and weight-bearing
Aujla presented a study of 290 patients with 291 Achilles tendon (AT) ruptures. One patient had a bilateral rupture. Post-injury, the patients underwent an 8-week program of wearing a walking boot without undergoing surgery. Most of the patients were men who incurred the AT injury playing a recreational sport. The median age of the patients was 47 years.
The 8-week regimen included immediate, full weight-bearing, with patients wearing a walking boot in a static position of 30° flexion for the first 4 weeks. In weeks four to six, 15° dynamic movement was allowed and in week six 30° dynamic movement was allowed. The boots had adjustable joints the physicians could move, but patients were not allowed to adjust the boots themselves, according Aujla.
Acceptable re-rupture rates
At about 2 years follow-up, functional outcomes were available for 52% of the cohort. The re-rupture rate was 3.4%, but venous thromboembolism (VTE) rates were an issue at 6.9%. Macerations or skin blisters occurred under the boot at a rate of 10%, Aujla said.
“The mean AT Total Rupture Score (ATRS) was 72.5 out of 100 with a median of 79, and the average follow-up for patients was 2 years. Age did not have a significant correlation to the functional outcome, but gender did have a difference with superior functional outcomes noted in males with an ATRS of 75 compared to 64 in females. In terms of complications, there were three re-ruptures in these patients, and they obviously had significantly lower functional outcomes,” he said.
The presence of VTE did not affect functional outcomes in terms of ATRS scores. The patients in this study had a slightly lower average ATRS than what is reported in the literature, which is between 78 and 80. According to Aujla, this difference can be attributed to the nature and response rate of the patients. – by Robert Linnehan
- Reference:
- Aujla R, et al. Paper #636. Presented at: British Orthopaedic Association Annual Congress; Sept. 15-18, 2015; Liverpool, United Kingdom.
- For more information:
- Randeep Aujla, MBChB, can be reached at University Hospitals Leicester, Infirmary Square, Leicester, LE1 5WW, United Kingdom; email: randeep.aujla@hotmail.co.uk.
Disclosure: Aujla reports no relevant financial disclosures.