Weight Bearing the Same Day Versus NonWeight Bearing for Four Weeks in Achilles Tendon Rupture

SLR - April 2015 - Timothy Karthas

Podiatric Relevance: Achilles tendon ruptures are frequently seen in both orthopaedic and podiatric practices, and make up 35 percent of all tendon tears. There has been debate as to the correct treatment method, as both surgical and conservative options have been shown to be effective and with similar outcomes overall. As such, there is no gold standard. There is also some debate about early ROM and weight bearing following surgical and conservative therapy. These authors wished to compare outcomes of early weight bearing on the day of initial conservative management with standard non-weight bearing.

Methods: Forty-seven patients with confirmed acute Achilles tendon ruptures per MRI were randomized with computer generated sealed envelopes into two groups. All groups were placed in a BK cast at 20-40 degrees of lantarflexion, but group 1 (23 patients) were permitted to walk PWB with crutches on day one. Group 2 (24 patients) was treated completely NWB for 4 weeks. All patients got physical therapy training for their respective treatment types and physical therapy after the cast was removed. All patients were also given a special walker boot with a supported heel after the four weeks were up. At six months and 12 months the patients were reassessed for Achilles tendon total rupture score (ATRS), physical activity scale (PAS), and AOFAS ankle-hindfoot score. These were then statistically compared.

Results: The two groups were statistically comparable. Mean follow-up was 12 months. Re-rupture rate was 17.4 percent in Group 1 and 12.5 percent in group 2. There were no other complications reported. Both groups had similar gains in AOFAS, ATRS, and PAS scores between six month and 12 month follow-up. There was no statistically significant difference between group 1 or 2 in any of these scores. 

Conclusions: The authors concluded that early weight bearing regimens are at least as good as non-weight bearing treatment for Achilles tendon ruptures. As such, the authors recommend this option, as it may help with physiologic healing and may allow earlier return to work. This does have several limitations, however, as the randomization process was not explained in depth, observer bias may have played a role, there was a very small sample size, and the length of physical therapy was not discussed. Larger studies in the future will be required to confirm these results.