Early walking in a brace for Achilles tendon rupture
A new study from the University of Warwick and the University of Oxford found that early walking in a brace provides similar outcomes to plaster casting with no increase in the risk of complications, paving the way for a big change in the way that patients are treated.
The results from the UKSTAR trial are reported in The Lancet. The study was funded by the National Institute for Health Research (NIHR) and was a multi-centre collaboration between universities and hospitals across the UK.
Rupture of the Achilles tendon is a serious and increasingly common injury with over 11,000 people from both the sporting and non-sporting populations experiencing the injury each year in the UK. Some patients are treated with surgery, but non-operative treatment is increasingly preferred, with patients either being treated in a plaster cast to immobilise the foot and ankle or by the use of functional bracing that allows weight-bearing. However, before the UKSTAR study there was little evidence towards which was more effective.
Although traditional plaster cast treatment protected the tendon as it healed, there were problems with casts including the immediate impact on mobility, additional risks associated with prolonged immobilisation, and possible long-term issues arising from gait abnormalities and muscle weakness.
With the bracing method, there were questions around the safety profile, specifically whether the risk of re-rupture was higher, leading to the American Academy of Orthopaedic Surgeons being unable to recommend for or against functional bracing in their 2009 guidelines. However, the study found that the risk of re-rupture of the tendon in bracing was lower that reported in existing literature.