Does early weight bearing improve outcomes for non surgical treatment of Achilles tendon rupture?
Non surgical treatment of Achilles tendon rupture has been shown to be equally effective to surgery. However, the best treatment protocol is still unclear, especially the role that early weight bearing bears on recovery. It has been hypothesized that early weight bearing can improve the tendon healing and increase the the quality of treatment because it improves the patients ability to function independently.
The purpose of this study was to compare immediate weight bearing with non weight bearing for non surgical treatment of the Achilles tendon. This protocol also included controlled early range of motion exercises for both groups. The results were measured with the Achilles tendon Total Rupture Score (ATRS), strength of heel-rise compared to the uninjured side, duration of sick leave, re-rupture and quality of life during treatment.
Both groups had the exact same eight week treatment protocol except that the experimental group was allowed to begin full weight bearing from day one. The control group was instructed to prevent any weight bearing for the first six weeks, and full weight bearing allowed for the last two weeks of treatment in the walking boot.
The results show that there was no significant difference in the scores between groups for the ATRS at both six and 12 month follow ups. The heel-rise work outcome also did not differ between the groups at the six or 12 month followup. The questionnaire about quality of life during the eight week treatment period showed that immediate weight bearing did significantly increase quality of life.
This report concludes that is it reasonable to recommend immediate weight bearing for patients being treated with non surgical protocol following Achilles tendon rupture. This is based on the fact that this research showed no detrimental effect on the long term outcome and did improve the quality of life during the initial eight weeks.
Weisskirchner Barfod, K., PhD, MD, et al. Nonoperative Dynamic Treatment of Acute Achilles Tendon Rupture. In Journal of Bone & Joint Surgery. September 2014. Vol. 96-A. No. 18. Pp. 1497-1503.