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Ankle FAQ

Question:

I've been told that the best way to get back to full function with an Achilles tendon rupture is to baby it along by wearing a special brace and keeping the foot in a pointed down position. No weight-bearing and no movement. This just doesn't make sense to me. Won't I get stiff and even stuck in that position?

Answer:

You ask a good question and one that others have dealt with quite a bit. The debate continues among surgeons about the best way to treat Achilles tendon ruptures early on after they have happened. The first question is whether to operate and repair the torn tendon or treat it conservatively (without surgery). It would seem that whichever way gives the best results is the way to go. But the problem is that different studies come up with different outcomes. There just don't seem to be consistent results to support one approach over the other. In a recent study by this author (Dr. Kevin R. Willits), a high-quality study was designed to put this argument to rest. Dr. Willits recognized that one reason study results vary so much is because different post-operative rehab programs are used. He started to wonder if the patients who had the best results were doing so well because of a more aggressive rehab protocol. He based this hypothesis on the fact that so many studies that had poor outcomes used a very conservative, slow rehab program. So he put his idea to the test. He compared two groups of patients. They all had an acute Achilles tendon rupture. They all followed the same fast-paced (called accelerated) rehab program. The only difference was that one group had surgery right away and the other group didn't. There are two key features to the accelerated functional rehab program. One is getting up and putting weight on that foot and leg. The second is early ankle motion. Scientists have already shown that load and pressure on healing collagen tissue speeds up the healing process. But the worry with Achilles tendon rupture has always been that the tendon would re-rupture with too much too soon. So, in the past, these injuries were always treated with cast immobilization with no weight on the foot (just as you have been instructed). That protocol was used for all patients whether they had conservative care or surgery. Now this study showed that, in fact, the early mobilization group had the best results. There were less (not more) re-ruptures. They did have a period of non-weight-bearing and immobilization-- but only for two weeks. During that two-week period of time, they were put in a special splint and kept weight off the foot. The conclusion of the study was that early motion and early weight-bearing were keys to a successful outcome. With equal results between conservative (nonoperative) care and surgery, the natural conclusion is that surgery isn't needed after all. An aggressive functional rehab program is what people really need. You may want to go back to your care giver and ask your question directly. There could be specific reasons why you have been prescribed the specific treatment you mentioned. But it's possible that based on the results of this new study, you might be someone who could benefit from this change (more aggressive) in approach. Kevin R. Willits, MA, MD, FRSCC. Treating the Acute Disruption of the Achilles Tendon: The Nonoperative Option. In Orthopedics Today. January 2011. Vol. 31. No. 1. Pp. 62.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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