Functional outcome and correlation with ultrasound gap size of Achilles tendon rupture treated non-operatively with boot and wedges

Background: The need for surgical management of Achilles tendon ruptures has been decreasing due to a better understanding of their non-operative management. The primary aim of our study was to assess the functional outcome of Achilles tendon ruptures treated with fixed angle walking boots with wedges (FAWW) and its relationship with gap size, functional scores, single leg heel raise height difference (HHD) and calf circumference difference (CCD). The secondary aim was to look at the complication rates. Methods: 34 patients (29 males and 5 females), who presented with acute Achilles tendon ruptures to Blackpool Teaching Hospitals NHS Foundation Trust from October 2020 to April 2022, were treated with an equinus slab for 2 weeks followed by a fixed angle boot, with wedges being sequentially removed every 2 weeks. They were reviewed at 3, 6 and 12 months. At each visit, Achilles Tendon Rupture score (ATRS), HHD and CCD were measured. Any complication, such as deep vein thrombosis (DVT) or re-rupture, was recorded. Results: The mean age group of patients was 50 years (28-87 years). The average ATRS at 3, 6 and 12 months were 29.84, 61.68 and 76, respectively. The mean HHD was 8.9 centimetres (cm) at 3 months, 3.79 cm at 6 months and 2.4 cm at 12 months. The mean CCD was 1.31 cm at 3 months, 0.88 cm at 6 months and 1.07 cm at 12 months. We did not find a significant correlation between Achilles tendon gap size measured by ultrasound and ATRS, HHD and CCD in our study. Conclusions: Non-operative management of Achilles tendon ruptures with boot and wedges gives a good functional outcome, which has no relationship with tendon gap size at the time of initial rupture.