Functional Brace Suitable for Ruptured Achilles Tendon

A functional brace offers a safe alternative to plaster casting in the management of non-surgical Achilles tendon rupture, claims a new study.

Researchers at the University of Oxford (United Kingdom), the University of Warwick (Coventry, United Kingdom), and other institutions conducted a pragmatic, randomized, controlled study involving 540 patients being treated non-operatively for a primary Achilles tendon rupture at 39 hospitals across the United Kingdom. Study participants were randomly assigned to receive a plaster cast (266 patients) or functional brace (274 patients) using a centralized web-based system. The main outcome was patient-reported Achilles tendon rupture score (ATRS) at nine months; the main safety outcome was the incidence of tendon re-rupture.

The results showed no difference in ATRS at nine months post injury, and no difference in the rate of re-rupture of the tendon. The mean total health and personal social care cost was £1,181 for the plaster cast group, and £1,078 for the functional bract group. The researchers therefor concluded that for early weight-bearing, traditional plaster casting was not superior to a functional brace, as measured by ATRS, and that a functional brace is as a cost-effective alternative to plaster casting. The study was published on February 8, 2020, in The Lancet.

“Rupture of the Achilles tendon is an increasingly common injury in both the sporting and non-sporting populations, leading to a prolonged period away from work and social activities,” concluded lead author Professor Matthew Costa, MD, PhD, of Oxford, and colleagues. “Functional bracing is an alternative treatment, in which the patient's lower leg is placed into a removable walking boot which contains wedges to lift up the heel. The brace allows the patient to put weight through their leg as they walk, and can be removed to allow movement at the ankle joint.”

The Achilles tendon is the largest tendon in the body, connecting the muscles in the back of the calf to the heel bone. Traditionally, patients with an Achilles tendon rupture have been treated with serial plaster casts over several weeks. The cast provides maximum protection for the tendon as it heals, but immobilization can increase calf muscle atrophy, ankle joint stiffness, gait abnormalities, and the risk of blood clots.

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