The Achilles Tendon Problem Does it need fixing Philippa Dolphin ESP Physiotherapist June 2016 Definitions Achilles tendon the large tendon that connects the calf muscles to the back of the heel ID: 764603
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The Achilles Tendon Problem;Does it need fixing? Philippa DolphinESP PhysiotherapistJune 2016
Definitions: Achilles tendon; the large tendon that connects the calf muscles to the back of the heelProblem; a question or condition that is difficult to understand or to deal with Fixing ; the act done by someone or something that fixes Fix: to repair
Problem; Achilles Tendon Rupture 7 per 100,000 1Cost?DVT 6-34% 2Physiotherapy Average 14 sessions / 4 months 3 Inconclusive evidence, inconsistent management 1. Ham, Maughan 2015, 2. Patel et al 2012, 3. JCUH Physiotherapy data
Does it need fixing? Debate conservative vs surgical (1) Decline in surgical rate (2) Functional rehabilitation; similar rerupture rate to surgical (3) 1. Wilkins, Bisson (2012); 2. Matilla et al (2015); 3. Sorosceanu (2012);
2012 n = 113, 2015 n = 264
Achilles Tendon Rupture Patients presenting to JCUH Average age 48 71% Male BMI 28 72% sports related
Diagnosis HistoryObservationPalpationSimmonds / ThompsonUltrasound scanMRI Select which tests are relevant
JCUH Process
Guideline VACOped (Conservative) WEEKBOOT ADVICE 0-4 30 Locked Do not remove boot. Consult physio gym urgently if boot rubbing 4-6 30-20 6-8 30-10 Remove boot for hygiene. Sitting calf raises 8-10 30-0 Flat sole Boot off overnight. Flat sole Theraband 10-16 Heel raise insert in shoe Rehab as relevant 16+ Impact
TA rupture in Soft Tissue clinic April 2013-2015
Outcome Conservative Rerupture 3/ (2 within 1st 2 months)Elongated 1/76 VTE 0/76 ATRS outcome 77/100 (At 6 months)
Principles of Rehabilitation End stage
Cost effective? 2012 Average 14 sessions over 4 months 2015 Average 8 session over 4 months 1Cost analysis of SMART programme; annual saving of £91,813 per annum (57 patients)2 1. JCUH Physiotherapy Data, 2. Hutchison et al (2015)
Dolphin P, Bainbridge K, Mackenney P, Dixon J. (2016) Functional dynamic bracing and functional rehabilitation for Achilles tendon ruptures: a case-series. Physiotherapy Practice and Research. 37, 119-125
Summary The Achilles Tendon Problem;Does it need fixing?