Written by Clay Smith
Spoon Feed
A walking boot vs rigid cast resulted in equal outcomes and adverse events, including tendon re-rupture rate at 9 months for patients with Achilles tendon rupture.
Why does this matter?
Nonoperative treatment of Achilles tendon rupture is a viable option, with equal outcomes. Usually, patients are treated in a cast for 8 weeks. Casts offer maximum protection for the tendon but at the expense of being non-weightbearing, along with muscle atrophy, ankle stiffness, and the potential increased risk of DVT. Would a functional brace work for this?
What are you talking – a boot?
This was an unblinded, multicenter RCT called UKSTAR, with 540 patients who had Achilles tendon rupture and chose a nonoperative approach. They were randomized to a plaster cast with slight plantar flexion (usual care) or functional, weight-bearing brace. The cast was successively altered to allow less and less plantar flexion over 8 weeks; at 6 weeks, weight bearing was allowed. The brace consisted of a removable walking boot with wedges to lift the heel and relax the Achilles tendon. These patients were allowed immediate weight bearing and had wedges removed over 8 weeks until the foot was perpendicular to the floor by 8 weeks. Then the brace was removed. See images. All had usual PT starting at 8 weeks. Most patients were compliant with assigned treatment, with minimal crossover. At 9 months, there was no difference in the primary outcome of Achilles tendon rupture score. Adverse outcomes were statistically equal among groups and included: tendon re-rupture (6% cast/5% brace; p=0.40), DVT/PE, fall with or without injury, heel pain or numbness and pressure sores. Total cost was not statistically different. I know which one I would choose if I opted for non-op treatment. Non-weightbearing is very difficult. And the ability to remove the brace and take a shower is a big deal.
Source
Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet. 2020 Feb 8;395(10222):441-448. doi: 10.1016/S0140-6736(19)32942-3.
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Would a boot allow you to drive, too?
Been in a cast for 5 weeks I am over it surely I can move into a boot
take off the boot to go to bed can you use something else for support while you are sleeping if so what can you use
Yes there are sleeping splint braces avaible – i would wait
Till you have been the air cast
Boot for a period of 5 wks
Before not sleeping with the
Boot on : proceed with caution
Yep proceed with caution
You do not want to Re rupture
The achilles again the 2 nd time
Means certain surgery as apposed to natural healing process /my
Strong advice especially if you
Are in a cast for a period of time
In the start : be sure to move the
Leg a bit each day or you may
Get a dvt or other blood clots
This is an injury that should be
Taken seriously when you begin
Physio try hydrotherapy 1 st
Be very care ful when you begin
Weight bearing take it slow
Build it up gradually over several
Wks a small amount more each day – proceed with caution !!
I have a partial tear (I think) if the Achilles tendon, I was given a soft cast/boot. I take it off to shower and to sleep. The tear happened during a leg press of 1400 pounds. I didn’t know it was torn at the time, I just figured I pulled a muscle, etc. I was finally given a Dr appointment and then given an appointment with a pediatrist. The back of may ankle has a visible bulge/lump, this happened months ago and I kept going to the gym, so I probably kept making it worse until finally stopping and now in the boot for about 2 weeks. Am I wasting my time with the boot since the injury is already months old? Would a cast or surgery be better? Should I ask for an MRI to see how bad the tear actually is? Thanks.
Meant to say Podiatrist, not pediatrist, although at this point I’ll take whatever help I can get. lol
Yes, you definitely need an MRI.