The Benefit of Early Weight-Bearing After Surgery for Achilles Tendon Rupture
How soon after a Achilles tendon repair procedure is it safe to put weight on that foot? Does walking on the leg during the healing then delay recovery? These are questions researchers at the University of Alberta in Canada addressed in this study.
They looked at a group of 110 adults ages 17 to 65 with an acute complete Achilles tendon rupture. Everyone had surgery to repair the damage. The operation was done within the first two weeks after the injury. At first, all patients wore a posterior splint to support and protect the healing tendon.
They were all non-weight-bearing for the first two weeks. Then the patients were divided into two groups. The first group was allowed to put weight on the leg. The second group remained non-weight-bearing for another four weeks.
Patients were given a special ankle-foot support called a fixed-angle, hinged ankle-foot orthosis. This brace can be set to allow a certain amount of motion. In this study, the orthosis was set in a position of rest with the ankle and toes pointed down slightly (20-degrees of plantarflexion). The angle was slowly changed to zero-degrees over a period of two to three weeks.
Everyone did daily ankle motion exercises without the brace on. The weight-bearing group started putting weight on the leg right away. They were allowed to stop using the crutches. The other group kept weight off the foot and used crutches for another four weeks. A special sensor was placed on the orthosis to monitor patient cooperation with the non-weightbearing status.
Everyone was followed at regular intervals for up to six months. By the end of six weeks, the orthosis was discontinued and active rehab started. Exercises included foot and ankle motion and a strengthening program with resistance (rubber tubing, bicycling, heel raises).
The main measure of results was health-related quality of life. This was measured using the RAND 36-Item Health Survey (RAND-36). The RAND survey looks at physical and social function, mental health, pain, general health and vitality. The investigators also assessed activity level, calf strength, and motion. Any cases of re-rupture in either group was to be reported right away (there were none).
They found that after six weeks, the weight-bearing group had a better result. They had better scores on the RAND-36. They reported fewer physical limitations. And they returned to daily activities, work, and sports participation sooner. Putting weight on the injured leg and getting around easier brought an improved sense of well-being and improved quality of life.
But this difference was not apparent at the end of six months. By that time, both groups had the same results. Muscle weakness and poor endurance was obvious in all patients. The authors had expected faster recovery of strength in the weight-bearing group. But this did not happen.
Since there were no disadvantages in early weight-bearing, the authors have adopted this as their new standard of care. They will be carefully monitoring their patients for postoperative deep venous thrombosis (DVT; blood clots). But it is expected that muscular contraction that comes with weight-bearing will prevent blood clot formation.
The authors suggest continuing rehab beyond the standard six weeks' time period. This will help patients recover strength, endurance, and proprioception (joint sense of position) and possibly prevent future problems.
Amar A. Suchak, MD, et al. The Influence of Early Weight-Bearing Compared with Non-Weight-Bearing After Surgical Repair of the Achilles Tendon. In The Journal of Bone and Joint Surgery. September 2008. Vol. 90. No. 9. Pp. 1876-1883.