Category: Sports, Hindfoot
Keywords: Achilles Tendinosis, Functional Rehabilitation, Sports
Introduction/Purpose: The study’s purpose is to evaluate the efficacy of AFO bracing for Achilles tendinopathy after failed conservative management. Conservative management included physical therapy, eccentric stretching, night splinting, heel gel cushions, topical and/or oral anti-inflammatories for at least six months. Though operative management is noted to have success in treating chronic Achilles tendinosis, it is not without morbidity, risks, and an arduous period of recovery. Our hypothesis was that patients with chronic Achilles tendinosis can achieve satisfactory functional outcomes if the patient is compliant with a solid AFO brace for six months.
Methods: We collected data prospectively on a cohort of 113 patients at a single institution who were prescribed a custom AFO brace after failing conservative therapy. VISA-A scores were recorded at time of AFO prescription and then after at least six months of bracing. If patients did not complete a follow-up questionnaire in clinic, they were contacted via telephone for VISA-A scoring. The primary outcome was change in VISA-A score after treatment in the custom AFO brace. 33 patients were excluded due to noncompliance with bracing. 17 patients were excluded due to lack of follow up. Seven patients are still not six months from time 0.
Results: 56 patients aged 62 ± 10 years and BMI 33 ±5 completed the second timepoint at a median 373 days. The mean VISA-A score at time 0 was 32±19, median 33, and the mean VISA-A score at follow-up was 59±25, median 61. The mean paired change in scores was 27±21 (median of 28 points better). Nine (16%) of patients progressed to surgery after failing to improve with six months of AFO bracing. An additional four patients (7%) were considering surgery at time of final follow up. Of the 43 patients who were improved and were no longer surgical candidates after six months of bracing, the mean VISA-A score at follow up was 68±20, an improvement of 35±17 points from time 0.
Conclusion: Of those patients who were compliant with six months of custom AFO bracing, 77% were able to avoid undergoing further consideration for surgery. Many of these patients reported being symptom free.
Long-term solid AFO bracing may be considered as an alternative to procedural treatment for chronic Achilles tendinosis. This may be especially useful for patients with comorbidity precluding surgical candidacy. Future research would consist of a larger patient cohort and a comparison group comprising those undergoing surgery.
