FUNCTIONAL BRACING FOR RUPTURE OF THE ACHILLES-TENDON - CLINICAL-RESULTS AND ANALYSIS OF GROUND-REACTION FORCES AND TEMPORAL DATA

Fifteen patients who had sustained a rupture of the Achilles tendon we re managed nonoperatively with use of a functional bracing protocol, a nd clinical and functional performance measures were assessed after a mean duration of follow-up of thirty-one months (range, twenty-four to forty-five months), An age and gender-matched group of fifteen subjec ts was assessed to provide normative data for the comparison of side-t o-side differences, Numerical scores were generated on the basis of su bjective responses to a questionnaire, clinical measurements of the ra nge of motion of the ankle and the circumference of the calf, and the results of the Thompson squeeze test and a single-limb heel-rise test, A 100-point scoring system was used to categorize the outcome as exce llent, good, fair, or poor, In addition, ground-reaction forces and te mporal data were assessed during functional dynamic activities that in cluded walking, a single-limb power hop, and a thirty-second single-li mb heel-rise endurance test. The result was graded as excellent for th ree patients, good for nine, fair for two, and poor for one, An increa se in passive dorsiflexion of the treated ankle was the only clinical measure that was significantly different between the groups (p = 0.02) , This increase in dorsiflexon was positively correlated with vertical force output between the mid-stance and terminal-stance phases of gai t (r = 0.40, p = 0.05), With the numbers available, we could detect no significant differences between the groups with regard to the kinetic or temporal variables that were measured during functional dynamic ac tivities. Patients who generated less peak vertical forte and vertical height during the single-limb power-hop test tended to have poorer cl inical scores. We believe that non-operative functional bracing may pr ove to be a viable alternative to operative intervention or use of a p laster cast for the treatment of acute ruptures of the Achilles tendon , The goals of treatment are to prevent the musculoskeletal changes th at are associated with immobilization, to reduce the time needed for r ehabilitation, and to facilitate an early return to work and to preinj ury activities.