Residual functional problems after non-operative treatment of Achilles tendon rupture

Summary Acute Achilles tendon rupture can be treated both surgically and by immobilization in plaster alone. We have used the latter approach, since it has been shown that results are almost equivalent, but with fewer complications. In both cases, patients are often immobilized for many weeks, although treatment which encourages movement has been used in operated cases. The physiology of tendon healing would suggest that a certain amount of movement and stress during healing is beneficial. This study investigates the subjective outcome and functional results in 37 patients who were immobilized in plaster casts, after an average of 21 months. They were interviewed and examined by an independent observer. The range of movement of the ankle was investigated with the MacReflex system and the functional strength with Cybex-II measurements. Strength and balance were evaluated by the one-legged broad jump and single-leg toe rises. The calf girth and the tendon width were measured. It was demonstrated that while we could not show an objective difference in strength between the injured and uninjured leg, most patients perceived the injured leg as weaker and less reliable, and had reduced their sporting activities due to fear of rerupture. Thus, while the outcome was good on an objective basis, there is room for improvement in subjective outcome. Perhaps a more active early mobilization can achieve this goal.