Abstract
BackgroundChronic Achilles tendon rupture is associated with persistent weakness at push-off with the affected foot and poor balance, resulting in significant alterations to normal gait. Surgical repair is the most common treatment for improving gait in patients with a Chronic Achilles tendon rupture, but, to date, the outcomes have not been quantified in the literature.MethodsA total of 23 patients with a Chronic Achilles tendon rupture (mean age 61 ± 15 years) underwent three-dimensional gait analysis according to a standardized protocol using an optical tracking system. Data of spatiotemporal, kinematic and kinetic variables were collected preoperatively and one year postoperatively. In addition, the postoperative gait biomechanics were compared with the gait biomechanics of a control group consisting of 70 healthy individuals (mean age 49 ± 20 years). The prospectively collected data were analyzed by an independent t test.ResultsPostoperatively, increments were found in gait speed (mean difference − 0.12 m/s), stride length (− 0.12 m), peak ankle moment (− 0.64 Nm/kg), peak ankle power (− 1.38 W/kg), peak knee power (− 0.36 m) and reduced step width (0.01 m), compared with preoperative gait biomechanics (p < 0.014). Compared with the control group, patients with a Chronic Achilles tendon rupture exhibited slower postoperative gait speed (mean difference 0.24 m/s), wider step width (− 0.02 m), shorter stride length (0.16 m), longer relative stance phase (− 2.15%), lower peak knee flexion (17.03 degrees), greater peak knee extension (2.58 degrees), lower peak ankle moment (0.35 Nm/kg), peak ankle power (1.22 W/kg) and peak knee power (1.62 W/kg), (p < 0.010).ConclusionSurgical intervention and postoperative rehabilitation can be an effective treatment for alterations in gait after a Chronic rupture of the Achilles tendon. However, at one year postoperatively, patients still exhibit impairments in spatiotemporal variables and knee and ankle power compared with healthy controls.
Highlights
The incidence of Achilles tendon ruptures (ATR) peaks in individuals between 30 and 50 years, but a second peak phenomenon has been found after the age of 60 years [1, 2]
The authors found that one patient had been incorrectly included in the study since too short a time had passed since the ATR, after which that patient was excluded from the statistical analysis and a total of 23 patients with a Chronic Achilles tendon rupture (CATR) were included in the study
The patients with a CATR exhibited a significantly reduced step width, increased speed, stride length, ankle moment and ankle and knee power compared with the preoperative status (Fig. 1; Table 2)
Summary
The incidence of Achilles tendon ruptures (ATR) peaks in individuals between 30 and 50 years, but a second peak phenomenon has been found after the age of 60 years [1, 2]. Up to 25% of ATRs are missed, either due to a misdiagnosis by the physician or as a result of the patient misinterpreting the injury and not seeking immediate care [5, 6]. An ATR that is left untreated results in persistent weakness at push-off with the affected foot/ankle and is defined as “chronic” (CATR) when the diagnosis and adequate treatment are delayed for 4 weeks [5, 9, 10]. Chronic Achilles tendon rupture is associated with persistent weakness at push-off with the affected foot and poor balance, resulting in significant alterations to normal gait. Surgical repair is the most common treatment for improving gait in patients with a Chronic Achilles tendon rupture, but, to date, the outcomes have not been quantified in the literature
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