Achilles tendon rupture : epidemiology, outcomes after treatment and an analysis of plantar foot pressures

Abstract

The influence of socioeconomic deprivation status (SEDS) on the epidemiology of primary Achilles tendon rupture (ATR) has not been explored, while the general epidemiology of Achilles tendon re-ruptures (ATRR) is poorly understood. The optimal management of ATR remains controversial and recent trends towards functional rehabilitation are not supported by robust evidence. The studies comprising this thesis sought to define the epidemiology of primary ATR, with particular focus on the influence of SEDS; to describe the epidemiology and risk factors for ATRR; to report on comparative outcomes from randomised controlled trials comparing long-term outcomes after traditional operative and non-operative management and short-term outcomes after traditional and functional non-operative rehabilitation; and to report on changes in static plantar loading patterns, physical and patient reported parameters after functional nonoperative treatment of ATR. ATR and ATRR were commoner in males and individuals with lower levels of socioeconomic deprivation. The nature of ATR varied with variations in SEDS. Risk factors for ATRR were identified, including younger age and immobilising treatment of ATR. Patients treated surgically did not report superior long-term outcomes to those treated non-operatively. Functional rehabilitation was found to be a safe alternative to immobilising treatment, giving better early outcomes, albeit with a higher incidence of minor skin complications. There was no difference in outcomes beyond one year after injury. Functional, non-operative rehabilitation was associated with reduced forefoot loading and increased rearfoot loading. These changes reduced with time but persisted nine months after injury and were accompanied by progressive changes in uninjured foot loading.