Use of Functional B racing for Acute Achilles Rupture Gaining Popularity.
His experience in treating more than 100 patients with this relatively new nonoperative approach-- plus the wider experience reported by physicians in Canada and Europe, where the approach was pioneered--has left him convinced that functional bracing is the preferred therapy in middle-aged recreational athletes, the population in which most acute Achilles tendon ruptures occur.
Functional bracing also is the treatment of choice in nonathietes of any age, said Dr. DeHaven, professor and associate chair of orthopedics and director of athletic medicine at the University of Rochester (N.Y.).
Only in young, high-performance athletes is functional bracing not the dear first-choice therapy, in his view. When he has used highly sensitive tests of function, strength, and endurance in populations treated with functional bracing or surgery, the results--while well within normal range in both groups--have been slightly better in the surgical group. For elite athletes seeking every competitive advantage, this is a valid consideration, he continued at the joint annual meeting of the American Medical Society for Sports Medicine and the American Osteopathic Academy of Sports Medicine.
Functional bracing's effectiveness is based upon the observation that if the two torn ends of a ruptured Achilles tendon are placed in proximity by putting the ankle in the equinus position, the tendon will heal. Functional bracing lets patients maintain this favorable position most of the time, yet the bracing can be removed temporarily while patients start a graduated and controlled rehabilitation program. This, in turn, avoids the atrophy joint stiffness, and other adverse effects of casting, Dr. DeHaven explained.
Functional bracing offers compelling socioeconomic advantages. Patients avoid the risks and complications of surgery Moreover, in a study by Dr. DeHaven, a complete treatment course using functional bracing cost an average of $1,570, compared with S5,800 for surgical repair.
When Achilles tendon rupture was managed nonoperatively patients missed a mean of just 4 days of work, versus 11-13 weeks in the group who received surgical repair. But these figures overstate the case for Functional bracing, since the patients who received the bracing were office workers who could do their jobs while on crutches for 8 weeks.
In another, nonrandomized study Dr. DeHaven followed for a mean of 41 months 19 patients treated via Functional bracing and an equal number of his surgically managed patients. Both groups returned to normal levels of function, endurance, and strength upon extensive testing.
Session chair Dr. F. James Swenson Jr. said that he has recently worked with Dr. DeHaven on 10 serious recreational basketball players whose acute ruptures were managed nonoperatively using functional bracing. "I've been very favorably impressed. The results have really been kind of amazing. As a result, I've liberalized my indications for functional bracing to include high-performance athletes," said Dr. Swenson, a family physician at the University of Rochester.
Functional bracing begins 7-10 days after the injury, when a custom splint maker fashions a dorsiflexion limiting orthosis out of a fairly rigid, layered foam material. The initial angle is 45 degrees. A matching heel lift wedge is created on the same side using an old sneaker; this way the patient doesn't have to stand on tiptoes. The 45-degree angle is reduced by 10 degrees per week, ending at an angle of 5 degrees.
The patient begins early active plantar flexion exercises with brace off. By week 8 crutches are discarded; stretching and progressive-resistance heel raises begin. The orthosis is discontinued at week 12, and the heel lift at week 16. At week 26 the patient undergoes isokinetic plantar flexion testing; in the absence of any major deficits, a graduated running program begins.
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|Comment:||Use of Functional B racing for Acute Achilles Rupture Gaining Popularity.|
|Publication:||Family Practice News|
|Article Type:||Brief Article|
|Date:||Jul 1, 2001|
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