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Clinical outcomes of heel-elevating insole application in the late phase of functional rehabilitation after Achilles tendon rupture
Arthrosc Orthop Sports Med 2020;7:30-34
Published online November 1, 2020;  https://doi.org/10.14517/aosm20012
© 2020 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine.

Jungtae Ahn, Bi O Jeong

Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
Correspondence to: Bi O Jeong, https://orcid.org/0000-0002-9881-2319
Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Korea. Tel: +82-2-958-9488, Fax: +82-2-964-3865, E-mail: biojeong@khmc.or.kr
Received October 5, 2020; Revised October 20, 2020; Accepted October 27, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: The optimal treatment for Achilles tendon rupture has long been debated and is still subject to considerable controversy. Tendon elongation occurs during the first 6 months of recovery; during which, re-rupture or elongation of an Achilles tendon that is not fully healed can occur. The current study reports the clinical results of the application of heel-elevating insoles to both feet to prevent tendon elongation in the late phase of the rehabilitation process.
Methods: This study included 14 patients with acute or chronic Achilles tendon rupture who showed tendon elongation in the rehabilitation phase. The mean follow-up duration was 12.9 months, and the mean age of the patients was 45.7 years. Out of 14 cases, 11 had acute rupture and 3 had chronic rupture. Heel-elevating insoles were applied in the 6th month of rehabilitation. The clinical outcomes, including various patient-reported outcome measures, were evaluated.
Results: All patients could perform a single heel raise at the last follow-up. The side-to-side difference in maximal calf circumference was 1.8 ± 1.2 cm. Of 4 cases in which tendon elongation was present in the initial rehabilitation phase in which a brace was worn, 2 (2/14, 14.3%) had persistent elongation at the last follow-up. No wound complications or infections were observed after the surgery. The mean Achilles tendon Total Rupture Score, Foot Function Index, Foot and Ankle Outcome Score, American Orthopaedic Foot and Ankle Society ankle-hindfoot score, and Visual Analogue Scale for pain were 88.7 ± 6.9, 1.6% ± 1.8%, 94.4 ± 4.0, 96.6 ± 4.9, and 0.5 ± 0.5, respectively.
Conclusion: Good clinical results were demonstrated in patients who showed tendon elongation during the rehabilitation phase after Achilles tendon rupture. Heel-elevating insoles were applied in the late phase of the rehabilitation process, and may aid rehabilitation after Achilles tendon rupture.
Keywords : Ankle; Achilles tendon; Rehabilitation; Heel-elevating insole
References
  1. Thevendran G, Sarraf KM, Patel NK, Sadri A, Rosenfeld P. The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskelet Surg 2013;97:9-20.
    Pubmed CrossRef
  2. Willits K, Amendola A, Bryant D, et al. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am 2010;92:2767-75.
    Pubmed CrossRef
  3. Lantto I, Heikkinen J, Flinkkila T, et al. A prospective randomized trial comparing surgical and nonsurgical treatments of acute Achilles tendon ruptures. Am J Sports Med 2016;44:2406-14.
    Pubmed CrossRef
  4. Olsson N, Silbernagel KG, Eriksson BI, et al. Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study. Am J Sports Med 2013;41:2867-76.
    Pubmed CrossRef
  5. Brumann M, Baumbach SF, Mutschler W, Polzer H. Accelerated rehabilitation following Achilles tendon repair after acute rupture: development of an evidence-based treatment protocol. Injury 2014;45:1782-90.
    Pubmed CrossRef
  6. Huang J, Wang C, Ma X, Wang X, Zhang C, Chen L. Rehabilitation regimen after surgical treatment of acute Achilles tendon ruptures: a systematic review with meta-analysis. Am J Sports Med 2015;43:1008-16.
    Pubmed CrossRef
  7. Park SH, Lee HS, Young KW, Seo SG. Treatment of acute Achilles tendon rupture. Clin Orthop Surg 2020;12:1-8.
    Pubmed KoreaMed CrossRef
  8. Barfod KW, Bencke J, Lauridsen HB, Ban I, Ebskov L, Troelsen A. Nonoperative dynamic treatment of acute Achilles tendon rupture: the influence of early weight-bearing on clinical outcome: a blinded, randomized controlled trial. J Bone Joint Surg Am 2014;96:1497-503.
    Pubmed CrossRef
  9. Eliasson P, Agergaard AS, Couppé C, et al. The ruptured Achilles tendon elongates for 6 months after surgical repair regardless of early or late weightbearing in combination with ankle mobilization: a randomized clinical trial. Am J Sports Med 2018;46:2492-502.
    Pubmed CrossRef
  10. Glazebrook M, Rubinger D. Functional rehabilitation for nonsurgical treatment of acute Achilles tendon rupture. Foot Ankle Clin 2019;24:387-98.
    Pubmed CrossRef
  11. Maffulli N, Loppini M, Longo UG, Maffulli GD, Denaro V. Minimally invasive reconstruction of chronic Achilles tendon ruptures using the ipsilateral free semitendinosus tendon graft and interference screw fixation. Am J Sports Med 2013;41:1100-7.
    Pubmed CrossRef
  12. Matles AL. Rupture of the tendo Achilles: another diagnostic sign. Bull Hosp Joint Dis 1975;36:48-51.
    Pubmed
  13. Nilsson-Helander K, Thomeé R, Silbernagel KG, et al. The Achilles tendon Total Rupture Score (ATRS): development and validation. Am J Sports Med 2007;35:421-6.
    Pubmed CrossRef
  14. Budiman-Mak E, Conrad KJ, Roach KE. The Foot Function Index: a measure of foot pain and disability. J Clin Epidemiol 1991;44:561-70.
    Pubmed CrossRef
  15. Knobloch K, Schreibmueller L, Longo UG, Vogt PM. Eccentric exercises for the management of tendinopathy of the main body of the Achilles tendon with or without an AirHeel Brace. A randomized controlled trial. B: effects of compliance. Disabil Rehabil 2008;30:1692-6.
    Pubmed CrossRef
  16. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, mid-foot, hallux, and lesser toes. Foot Ankle Int 1994;15:349-53.
    Pubmed CrossRef
  17. Scott J, Huskisson EC. Graphic representation of pain. Pain 1976;2:175-84.
    Pubmed CrossRef
  18. Lantto I, Heikkinen J, Flinkkila T, et al. Early functional treatment versus cast immobilization in tension after Achilles rupture re-pair: results of a prospective randomized trial with 10 or more years of follow-up. Am J Sports Med 2015;43:2302-9.
    Pubmed CrossRef
  19. Silbernagel KG, Steele R, Manal K. Deficits in heel-rise height and Achilles tendon elongation occur in patients recovering from an Achilles tendon rupture. Am J Sports Med 2012;40:1564-71.
    Pubmed CrossRef
  20. Young SR, Gardiner B, Mehdizadeh A, Rubenson J, Umberger B, Smith DW. Adaptive remodeling of Achilles tendon: a multi-scale computational model. PLoS Comput Biol 2016;12:e1005106.
    Pubmed KoreaMed CrossRef
  21. Neumayer F, Mouhsine E, Arlettaz Y, Gremion G, Wettstein M, Crevoisier X. A new conservative-dynamic treatment for the acute ruptured Achilles tendon. Arch Orthop Trauma Surg 2010;130:363-8.
    Pubmed CrossRef
  22. Park SY, Park DJ. Changes of gait pattern, muscle activity, and perceived comfort in response to variations of height-elevating insoles in young adults. J Exerc Rehabil 2018;14:100-5.
    Pubmed KoreaMed CrossRef
  23. Diniz P, Pacheco J, Guerra-Pinto F, Pereira H, Ferreira FC, Kerk-hoffs G. Achilles tendon elongation after acute rupture: is it a problem? A systematic review. Knee Surg Sports Traumatol Ar-throsc 2020 May 3 [Epub].
    Pubmed CrossRef
  24. Weon JH, Cha HG. The influence of high heeled shoes on balance ability and walking in healthy women. J Phys Ther Sci 2018;30:910-2.
    Pubmed KoreaMed CrossRef
  25. Song SJ, Lee M, Shin MJ, Suh JS. Correlation between a rupture of the hypovascular zone and early single heel raising after Achilles tendon repair. J Korean Foot Ankle Soc 2018;22:21-5.
    CrossRef
  26. Olsson N, Karlsson J, Eriksson BI, Brorsson A, Lundberg M, Silbernagel KG. Ability to perform a single heel-rise is significantly related to patient-reported outcome after Achilles tendon rupture. Scand J Med Sci Sports 2014;24:152-8.
    Pubmed CrossRef
  27. Maffulli N. The clinical diagnosis of subcutaneous tear of the Achilles tendon. A prospective study in 174 patients. Am J Sports Med 1998;26:266-70.
    Pubmed CrossRef
  28. Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK. Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg 2007;46:65-74.
    Pubmed CrossRef
  29. Sierevelt IN, Zwiers R, Schats W, et al. Measurement properties of the most commonly used Foot- and Ankle-Specific Questionnaires: the FFI, FAOS and FAAM. A systematic review. Knee Surg Sports Traumatol Arthrosc 2018;26:2059-73.
    Pubmed CrossRef

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