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Early Ankle Motion after Achilles Tendon Tear

Achilles was a Greek mythological hero. When he was young, his mother held him by the heel and dipped him in the river Styx. Everything the sacred waters touched became strong and unbeatable. The heel remained dry and was unprotected, leaving Achilles' heel weak and at risk for injury.

In human anatomy, the Achilles is the tendon from the calf muscles to the heel. It's the thickest and strongest tendon in the body. When it's injured or torn, a person has trouble putting weight on the foot or walking on it. Like the mythologic hero, Achilles, the tendon is a mystery. How to treat it to get the fastest and best results is unknown. This study attempts to sort out some treatment options after surgery for an Achilles rupture. Two groups of patients were studied.

In the first group, the Achilles tendon was repaired surgically. The ankle was put in a cast with the toes pointed down. This position is called equinus or plantigrade. Group one was told to put weight on the foot and leg as soon as possible. The cast was changed after two weeks.

Group two also had surgery to repair the tendon, and the lower leg was put in a cast. The cast was changed at two weeks and at four weeks. Each time the position of the ankle and foot was changed slightly. Group two didn't put weight on the foot until after week four.

Researchers found that by putting tension on the tendon during healing, the tendon healed faster. Early ankle motion and putting weight on the foot in group one resulted in faster return to work and play. Overstretching the tendon is avoided. The cast prevented too much motion in the wrong direction.

Patients in group one stopped using their crutches sooner than group two. Group one had fewer visits to a physical therapist and reported greater satisfaction with the results of early treatment. Both groups went back to regular physical activity, sports, and work in about the same amount of time.

The authors conclude that early tension on the repaired Achilles tendon is a good idea. The best results come when the Achilles tendon is put under tension early in the healing and recovery phase. This breaks with the traditional treatment of no weight bearing for six weeks.

Nicola Maffulli, MD, MS, PhD, FRCS (Orth), et al. Early Weightbearing and Ankle Mobilization after Open Repair of Acute Midsubstance Tears of the Achilles Tendon. In The American Journal of Sports Medicine. September/October 2003. Vol. 31. No. 5. Pp. 692-700.

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