What's the best way to treat a ruptured Achilles tendon? I've been given two options: rehab without surgery or surgery and then rehab. What works best? Is there any advantage of one over the other?
There are many variables in the treatment of Achilles tendon rupture. Because of this, there is no clear agreement on the best practice for this condition. Some experts suggest early rehab after injury.
Animal and limited human studies seem to support this idea. Tension placed on the healing tendon and calf muscle seems to help build blood supply and strength in the injured area. Putting weight on the leg and foot help provide the tension needed.
And studies comparing the use of a cast to immobilize the foot with free range-of-motion and weight-bearing showed better function with motion and weight-bearing. The patients went back to work and sports sooner when early weight-bearing was started.
One potential problem with early weight-bearing is the risk of increased pain and discomfort when standing or walking on the injured side. Patients can use a crutch or cane to help offload that foot until enough time has passed to ensure comfort with weight-bearing.
Whether to start rehab first and then consider surgery if treatment fails or to have surgery right away followed by rehab remains an individual decision. The surgeon gives the patient all the factors to consider and his or her best judgment. The patient must choose accordingly.
It may be helpful to know the results of a recent study from Canada. Patients with Achilles tendon rupture all had surgery. Then one group had early weight-bearing while the other group waited longer to resume weight-bearing activities. Early mobilization brought about faster return to function. Patients also reported better quality of life in the first six weeks. There was no difference in results measured six months later.
Amar A. Suchak, MD, et al. The Influence of Early Weight-Bearing Compared with Non-Weight-Bearing After Surgical Repair of the Achilles Tendon. In The Journal of Bone and Joint Surgery. September 2008. Vol. 90. No. 9. Pp. 1876-1883.
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