1. The Achilles Tendon Problem; Does it need fixing?
Philippa Dolphin
ESP Physiotherapist
June 2016

2. Definitions:
Achilles tendon; the large tendon that connects the calf muscles to the back of the heel
Problem; 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

3. Problem; Achilles Tendon Rupture
7 per 100,000 1
Cost?
DVT 6-34% 2
Physiotherapy Average 14 sessions / 4 months3
Inconclusive evidence, inconsistent management
1. Ham, Maughan 2015, 2. Patel et al 2012, 3. JCUH Physiotherapy data

4. 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);

6. 2012 n = 113, 2015 n = 264

7. Achilles Tendon Rupture Patients presenting to JCUH
Average age 48
71% Male
BMI 28
72% sports related

8. Diagnosis History Observation Palpation Simmonds / Thompson
Ultrasound scan
MRI
Select which tests are relevant

9. JCUH Process Diagnosis A&E Equinus cast (BK NWB) Assessment of defect
TA rupture
Diagnosis A&E
Equinus cast (BK NWB)
FAST Clinic
Assessment of defect
USS if necessary
Conservative
VACOPED Physio led

10. Guideline VACOped (Conservative)
WEEK
BOOT
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

11. TA rupture in Soft Tissue clinic April 2013-2015
130 patients
Conservative 110
Good Outcome 106
Delayed Surgery 4
Immediate surgery 18
Repair 2
Reconstruction 16
Not managed 2

12. Outcome Conservative
Rerupture 3/ (2 within 1st 2 months) Elongated 1/76 VTE 0/76 ATRS outcome 77/100 (At 6 months)

13. Principles of Rehabilitation End stage
End stage dependent on patient need. Stide length and prevention of recurrance

14. Cost effective? 2012 Average 14 sessions over 4 months
2015 Average 8 session over 4 months 1
Cost analysis of SMART programme; annual saving of £91,813 per annum (57 patients)2
1. JCUH Physiotherapy Data, 2. Hutchison et al (2015)

15. Dolphin P, Bainbridge K, Mackenney P, Dixon J
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,

16. Summary
The Achilles Tendon Problem; Does it need fixing?