The last few years have seen a wide variation in the treatment of achilles tendon ruptures and less certainty about the methods of treatment employed. There was a time when all of the patients with these injuries, whether treated conservatively or with surgery, could expect to be in a cast for a 12 week period.
They would have a full equinus below knee cast for 4 weeks and then it would progress to a mid-equinus cast for a further 4 weeks and finally a neutral cast for another 4 weeks. All of the casts would be non-weight bearing. Some surgeons even requested that the first two weeks of a full equinus cast were to be spent in an above knee cast with the knee joint at 30 degrees of flexion.
The most recent developments have centred around rapid mobilisation and fixed walker boots with the addition of heel wedges, which are gradually removed each week until the foot is plantigrade.
As cast technicians, we have to be familiar with the various types of cast and also the available types of fixed walking boots. If we are going to work in the best interests of the patient, we should also be aware of the current evidence-based best clinical practice for an achilles tendon rupture.
What is the best clinical evidence? There are research papers which will assist the cast technician to update their own knowledge and treatment techniques. A very complete thesis entitled Acute Achilles Tendon Rupture - Outcomes, Prediction and Optimized Treatment was published in 2013 by Nicklas Olsson and it will repay the reader with a clear knowledge of how the treatment of an acute achilles tendon rupture is evolving. The full Olsson doctoral thesis document is linked below.
It was noted that there were not any significant differences in outcome between operative and conservative treatments. The immediate weight-bearing after operative repair was a revealing departure from what used to be a 12 week excursion in a range of casts.
Three month functionality in respect of a single heel raise was a marker of later function. It was demonstrated that there was a reduction in function at two years, when compared with the pre-injury functionality.