Foot & ankle international
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Surgical and nonsurgical treatments of Achilles tendon ruptures are available. Nonsurgical treatment using immobilization does not have the varying degrees of infection as seen with surgical procedures, but it frequently is linked to muscle atrophy, weakness, and higher rates of rerupture than surgical treatment. This study reports the results of 64 patients with Achilles tendon ruptures treated surgically and with early mobilization. ⋯ Surgery combined with early mobilization reduces range of motion loss, increases blood supply, and reduces the degree of muscle atrophy that typically occurs after Achilles tendon rupture, thereby decreasing the time to resumption of normal activities. Applying tension to the tendon also improved strength of the calf muscles and improved ankle movement. The main concern with early mobilization is rerupture, but this was lessened by patients carefully following the weightbearing and early mobilization protocols. The results of this study strengthen the argument to employ early mobilization rehabilitation after surgical repair.
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Tendon lengthening is an important cause of morbidity after Achilles tendon rupture. However, direct measurement of the tendon length is difficult. Ankle dorsiflexion has, therefore, been used as a surrogate measure on the assumption that it is the Achilles tendon that limits this movement. The aim of this investigation was to assess the relationship between Achilles tendon length and ankle dorsiflexion. The primary question was whether or not the Achilles tendon is the structure that limits ankle dorsiflexion. The secondary purpose was to quantify the relationship between Achilles tendon lengthening and dorsiflexion at the ankle joint. ⋯ The Achilles tendon is the anatomical structure that limits ankle dorsiflexion, even when the tendon is lengthened. There was a linear relationship between the length of the Achilles tendon and the range of ankle dorsiflexion in this cadaver model. Ankle dorsiflexion would appear to be a clinically useful indicator of tendon length.
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Percutaneous Achilles tendon lengthening is frequently done to treat gastrocsoleus equinus contracture. To our knowledge, no study has documented the proximity of tendinous or neurovascular structures to the nearest edges of each hemisection in a percutaneous Achilles tendon lengthening, the complication rates related to injury of such structures, or the Achilles tendon rupture rates from inaccurate cuts. Thus, our goal was to document these distances and determine the accuracy of this procedure. ⋯ In cadavers, reasonably accurate cuts can be made, with some vital structures less than 1 cm from the cut tendon.