Experience from a dedicated physiotherapist led Achilles rupture service

A. Jones, R. Berber, M. Bhatia

Introduction: Conservative management is preferred for the majority of acute Achilles tendon ruptures. Implementing specific treatment regimes is difficult in traditional fracture clinic settings. We established a dedicated service with the key objective of improving patient care.

Methods: Eligible patients were treated in dedicated clinics led by a specialist physiotherapist. Functional VACOped orthoses (weight-bearing) regimes were initiated from day 1 (all patients). Movements were permitted within the boot from 4 weeks, with a total treatment time of 8 weeks followed by accelerated rehabilitation. Six months after treatment ATRS and FOAS scores, calf muscle girth, heel raise height, heel raise repetitions and satisfaction scores were collected for all patients. Conversion to surgery, re-rupture and DVT rates was recorded.

Results: Between January 2014 and November 2015, 245 patients were treated, 164 having completed 6 months follow-up. There were 134 men (81.2%). Mean age was 51 years (26-86). Mean interval between injury and treatment was 6 days (0-33). Mean ATRS score 6 months following treatment was 69 (SD = 21), which compared to the Swansea Morriston Achilles Rupture Treatment programme (mean=67.8; t= 0.96; p= 0.83). Mean 6 month FOAS score was 81 (48-100). Difference in mean calf girth was 1.18cm (t=7.89; df=40; p< 0.001). Mean heel raise height was 6.8 vs. 10.6cm on the contra-lateral side (t=10.34; df=39; p< 0.001), and mean heel raise repetitions were 13.1 vs. 14.5 (t=2.44; df=40; p=0.02). Three cases were converted to surgery due to failure to heal (3/164; 0.02%). There was 1 case of re-rupture (1/245; 0.004%), and 9 DVTs (9/245; 0.04%) diagnosed during treatment. Overall patient satisfaction scores were 93.5%.

Discussion: A dedicated service for the treatment of acute Achilles tendon ruptures using a functional orthoses regime provides excellent outcomes. Early physiotherapist involvement enhances continuity of care that is not seen in standard fracture clinic management.