A Randomized Controlled Trial Comparing Traditional Plaster Cast Rehabilitation With Functional Walking Boot Rehabilitation for Acute Achilles Tendon Ruptures.
Study Goal
The researchers aimed to compare patient-reported and functional outcomes between traditional cast immobilization and functional rehabilitation using a walking boot for nonoperative treatment of Achilles tendon rupture.
Results Summary
Patients treated with a walking boot reported better functional outcomes (SMFA dysfunction index) at 6 months compared to those in a cast, though with a higher incidence of minor skin complications. Functional rehabilitation with early weightbearing was deemed a safe alternative to traditional immobilization.
Population
140 patients with acute Achilles tendon rupture (median age ~41 years).
Effective Dosage
Not applicable (intervention involved use of a walking boot or cast).
Duration
8 weeks for walking boot, 10 weeks for cast.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
functional rehabilitation with a walking boot | decrease | Short Musculoskeletal Function Assessment (SMFA) dysfunction index | patients with acute Achilles tendon rupture | 6.62 [2.21-12.50] vs 10.66 [4.96-13.42] | reported better | #1 |
functional rehabilitation with a walking boot | decrease | SMFA bother index | patients with acute Achilles tendon rupture | 9.38 [3.13-18.75] vs 15.63 [6.25-25.00] | reported better | #2 |
functional rehabilitation with a walking boot | increase | Achilles tendon Total Rupture Score | patients with acute Achilles tendon rupture | 78.0 [68.0-86.0] vs 72.0 [60.0-80.0] | had better | #3 |
functional rehabilitation with a walking boot | increase | heel-rise height | patients with acute Achilles tendon rupture | 8.0 [5.0-10.0] vs 6.0 [4.0-8.0] | had better | #4 |
functional rehabilitation with a walking boot | increase | heel-rise repetitions | patients with acute Achilles tendon rupture | 15.0 [8.0-20.0] vs 10.0 [5.0-15.0] | had better | #5 |
functional rehabilitation with a walking boot | increase | heel-rise work | patients with acute Achilles tendon rupture | 80.0 [40.0-120.0] vs 50.0 [25.0-80.0] | had better | #6 |
functional rehabilitation with a walking boot | increase | transient minor skin complications | patients with acute Achilles tendon rupture | - | had a higher incidence of | #7 |
BACKGROUND: There has been a shift toward functional nonoperative rehabilitation in the treatment of Achilles tendon rupture (ATR) despite a shortage of studies directly comparing nonoperative functional rehabilitation with traditional nonoperative immobilization. PURPOSE: To compare patient-reported outcome measures and functional outcomes for nonoperatively treated ATR with traditional cast immobilization or functional rehabilitation in a walking boot. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 2. METHODS: In a single-center nonblinded study, 140 patients were randomized to compare treatment for acute ATR in (1) an immobilizing cast in reducing degrees of equinus over a 10-week period with 8 weeks of nonweightbearing mobilization or (2) a walking boot for 8 weeks with reducing equinus and immediate full weightbearing. Exclusion criteria were delayed presentation >2 weeks after injury, tendon reruptures, and latex allergy. Analysis was undertaken on an intention-to-treat basis. RESULTS: A total of 69 patients (median age, 41 years [interquartile range, 33-50.5 years]) were randomized to walking boot treatment and 71 patients (41 [32-49]) to cast treatment. At 6 months, patients treated in a walking boot reported better Short Musculoskeletal Function Assessment (SMFA) dysfunction index (6.62 [2.21-12.50] vs 10.66 [4.96-13.42]; CONCLUSION: Functional rehabilitation with early weightbearing is a safe alternative to traditional immobilizing treatment for ATR, giving better early functional outcomes, albeit with a higher incidence of transient minor skin complications. REGISTRATION: NCT02598843 (ClinicalTrials.gov identifier).