An audit of the combined non-operative and orthotic management of ruptured tendo Achillis

At this institution we have introduced combined non-operative and orthotic treatment for ruptured tendo Achillis. An outcome audit was performed to assess this treatment. Patients were treated in a short-leg cast in the equinus position. After a cast period of 4 weeks, the patient was placed in orthoses for a further 4 weeks, after which they returned to normal activities as was appropriate. We performed a retrospective review including visual analogue scores of patient satisfaction and physical examination. Thirty-two patients were reviewed. The average time from injury to review was 2 years (range 6 months to 5.5 years). There were no significant complications following treatment with no re-ruptures to date. Average visual analogue scores (0–10) were for casts 5.9, orthoses 8.5 and overall outcome 8.3. Of those wishing to return to sporting activities 62 per cent did so within 6.6 months (average). Clinical examination showed no significant difference (P, 0.05) between normal and injured leg in terms of ankle range of movement, tone and subtalar movement. The maximum calf circumference was significantly reduced on the affected side (36.84 cm versus 38.2 cm) as was ankle plantar flexion power. This treatment was liked by patients and is at least as effective as other established methods. Calf power and muscle bulk were reduced in the affected leg and may be improved by including a physiotherapy protocol in the treatment.