Assessment of Functional Conservative Treatment of Acute Achilles Tendon Rupture in Rambam Health Care Campus

Background: In recent decades, the traditional conservative non weight bearing cast immobilization for Achilles tendon rupture (ATR), went through a radical change to a functional protocol. This approach allows complete weight bearing after two weeks, while placing the foot in a plastic boot in equinus, using interchangeable wedges under the heel. This change in the conservative approach has dramatically narrowed the gap in the rate of re-rupture.

Purpose: The purpose of this study is to assess our department current approach towards functional treatment in most acute complete ATRs.

Methods: 15 subjects were invited to an evaluation that included a bilateral ultrasonographic evaluation, a comparative measurement of the gross motor force (GMF), the circumference of both calves, ankle joint range of motion (ROM) and the single-leg heel-rise test (SLHRT). In addition, standard scoring methods (ATRS AND PAS) were examined. We also collected data on complications such as re-rupture and DVT.

Results: 14 subjects were successful in SLHRT. The mean score of the subjects in the ATRS functional questionnaire and PAS physical activity questionnaire was 85.6 out of 100, and 4.7 out of 6, relatively. There were statistically significant reduction in the circumference of the calve, the thickness of soleus muscle (by US), and the GMF produced on the injured leg. There were no statistically significant differences in ankle ROM, no cases of re-rupture and one case of DVT.

Conclusions: The conservative functional treatment of ATR demonstrates very good functional outcomes, with the patients returning to close to normal activity, although noted muscle wasting and weakness. This protocol presents a true alternative to surgery and should be considered for most ATRs.