Aims. This prospective cohort study aimed to determine if the size of the tendon gap following acute tendo Achillis rupture influences the functional outcome following non-operative treatment. Patients and methods. All patients presenting with acute unilateral tendo Achillis rupture were considered for the study. Dynamic ultrasound examination was performed to confirm the diagnosis and measure the gap between ruptured tendon ends. Outcome was assessed using dynamometric testing of plantarflexion and the Achilles tendon rupture score (ATRS) six months after the completion of a rehabilitation programme. Results. 38 patients (mean age 52 years, range 29–78 years) completed the study. Patients with a gap ≥10mm with the ankle in the neutral position had significantly greater peak torque deficit than those with gaps < 10mm (mean 23.3% vs 14.3%, P=0.023). However, there was no overall correlation between gap size and torque deficit (τ=0.103), suggesting a non-linear relationship. There was also weak correlation between ATRS and peak torque deficit (τ=−0.305), with no difference in ATRS between the two groups (mean score 87.2 vs 87.4, P=0.467). Conclusion. This is the first study to identify tendon gap size as a predictor of functional outcome in acute tendo Achillis rupture, although the precise relationship between gap size and plantarflexion strength remains unclear. Large, multi-centre studies will be needed to clarify this relationship and identify population subgroups in whom deficits in peak torque are reflected in patient-reported outcome measures

A key factor delaying rehabilitation after a tendo Achillis (TA) rupture is gait abnormality. We quantified changes in planter pressures after a rupture of the TA in four groups of patients:. 15 controls subjects, mean 40 years, with no history of lower limb abnormality. 14 patients, mean 48 years, treated in a non-weight-bearing plaster cast. 12 patients, mean age 45 years, treated with immediate weight-bearing in a ‘rigid’ orthosis. 14 patients, mean age 51 years, treated with immediate weight-bearing in a ‘flexible’ orthosis. Mean and maximum peak planter pressures within the forefoot and heel were measured using in-shoe pressure pads two weeks after removal of the cast/orthosis; five gait cycles were recorded. The terminal stance and pre-swing phases were also measured as a proportion of the total stance phase of the gait cycle. One-way ANOVA was used to compare the difference in means between the groups. The normal control group had less than 2% difference between the limbs on all of the measured parameters. The patients in the plaster cast and ‘rigid’ orthotic groups had significant deficits (p = 0.04 and < 0.001 compared to control) in mean peak forefoot pressures, implying weakness in the triceps surae. However, the patients in the flexible orthosis group had only an 11% deficit (p = 0.25 compared to control). All of the patients treated for a TA rupture had increased heel pressures but only the ‘rigid’ orthotic group had cadence abnormalities (p = < 0.001). This may be the result of abnormal motor patterns secondary to mobilising in the rigid orthosis. This study highlights the gait abnormalities associated with triceps surae weakness following rupture of the TA. Accelerated rehabilitation using weight-bearing orthotics may alleviate some of these problems, but new designs for flexible orthotics may be required for maximum benefit

Background: Acute rupture of Tendo achillis can be treated by open, percutaneous surgery and minimally invasive technique. Open method reported to have high complication.

Objective: We report the outcome and length of hospital stay with minimally invasive technique with achillion

Design: Non randomised prospective observational study form October 2002 to December 2005

Materials and Methods: 9 male non professional athletes of mean age 38 years (range 23-73) presented with closed rupture were treated surgically using achillon technique were treated with same preoperative cast, post operative orthosis and rehabilitation protocol. All the patients had suture removed at 10 days after the surgery and followed up at 3 weeks, 8 weeks, 12 weeks and 6 months and yearly.

Results: The average operating time is 38 mins [range 27-58mins]. Mean length of incision is 3.4cm. No patient had clinical DVT, sural nerve disturbance and failure of repair and no bed stay.

Summary: Achillion Method helps to repair tendon under direct visualization, preserving its vascularity. We found no complication in wound healing. This surgical technique reduces financial burden in terms of bed use and wound care to the care provider. Randomised control studies may be necessary to highlight potential cost effectiveness

Achilles tendinopathy is a common cause of disability. Despite the economic and social relevance of the problem, the causes and mechanisms of Achilles tendinopathy remain unclear. Tendon vascularity, gastrocnemius-soleus dysfunction, age, gender, body weight and height, pes cavus, and lateral ankle instability are considered common intrinsic factors. The essence of Achilles tendinopathy is a failed healing response, with haphazard proliferation of tenocytes, some evidence of degeneration in tendon cells and disruption of collagen fibres, and subsequent increase in non-collagenous matrix. Tendinopathic tendons have an increased rate of matrix remodelling, leading to a mechanically less stable tendon which is more susceptible to damage. The diagnosis of Achilles tendinopathy is mainly based on a careful history and detailed clinical examination. The latter remains the best diagnostic tool. Over the past few years, various new therapeutic options have been proposed for the management of Achilles tendinopathy. Despite the morbidity associated with Achilles tendinopathy, many of the therapeutic options described and in common use are far from scientifically based. New minimally invasive techniques of stripping of neovessels from the Kager's triangle of the tendo Achillis have been described, and seem to allow faster recovery and accelerated return to sports, rather than open surgery. A genetic component has been implicated in tendinopathies of the Achilles tendon, but these studies are still at their infancy

Percutaneous repair of the ruptured tendo Achillis has a low rate of failure and negligible complications with the wound, but the sural nerve may be damaged. We reviewed 96 patients who had an acute percutaneous repair done by a single surgeon at district general hospital between January 1998 to April 2004. The mean follow up was 27 months. The repair is carried out using six stab incisions over the posterolateral aspect of the tendon. The procedure can be carried out under local anaesthesia. All patients were put in a below knee cast after the operation. Cast was changed at 4 weeks keeping the foot in plantigrade position. The mean period of immobilization was 8 weeks. They returned to work at 12 weeks and to sport at 16. One developed a minor wound infection and another complex regional pain syndrome type II. There were 2 injuries to the sural nerve. There were no late reruptures. This technique is simple to undertake and has a low rate of complications. We present one of the largest series reported in literature

Jimmy Craig had many talents and virtues. A keen sportsman, he played rugby for his school and university and in his younger days was an amateur boxer of note. Directly from medical school he joined the Medical Corps of the South African Forces fighting in the Western desert, and then went up the boot of Italy. On his return to Johannesburg, his home town, he developed expertise in cerebral palsy treatment and surgery. From about 1970 until the year before his death in 1992, he regularly visited Ikhwezi Lokusa School for the Orthopaedically Handicapped, just outside Umtata, once or twice a year. His visits lasted a week at a time. In those years he assessed approximately 1 500 children and operated on about 600. For the first 15 years, the operations were almost exclusively soft tissue surgery: tendon lengthening, tendon transfers and clubfoot releases. As the facilities in Umtata were upgraded, he performed an increasing amount of bone surgery. The operations he did were mainly on the lower limbs. They included lengthening of the triceps surae at the level of the gastrocnemius, lengthening of the tendo Achillis, release of hamstrings and hip adductors, recession of iliopsoas recession at the hips and Souter slides. On the upper limbs he fairly regularly performed surgical release of the first web space and release of flexor carpi ulnaris. He closely supervised the postoperative care provided by the school, which always had at least one expert Bobarth trained physiotherapist in residence

Congenital vertical talus is a rare deformity. Many different surgical procedures have been described, and there is debate about whether the correction should be done in one or two stages. We review the results of single stage surgical correction of congenital vertical talus. Between 1992 and 2000, five boys and seven girls were treated, ranging in age from eight months to two years. In six children both feet were involved, so there was a total of 18 feet. One child had spina bifida, four had arthrogryposis multiplex congenita and three had syndromes and chromosomal abnormalities. Four cases were idiopathic. Dorsolateral and medial incisions were used. Through the dorsolateral the sinus tarsus, calcaneocuboid and talonavicular joints were released and the extensors lengthened. Through the medial incision the navicula was reduced onto the talus, the tibialis posterior and talonavicular capsule were reefed and the tendo Achillis lengthened. The talonavicular and calcaneocuboid joints were pinned. The tibialis anterior was re-routed through the talar neck. Plasters were changed after two weeks and serial plasters were applied for four to six months. Follow-up ranged from one to seven years. Results were assessed clinically and radiologically, using the Adelaar 10 point scoring system. There were no wound complications or cases of avascular necrosis of the talus. Further surgery was required to correct cavus in two feet, to correct forefoot abduction in two, and to correct hindfoot valgus in one. Results were rated good in 12 feet and fair in six. Radiologically there was notable improvement in the anteroposterior and lateral talocalcaneal and tarso-first metatarsal angles. All patients were ambulant at last follow-up. In treating congenital vertical talus, good clinical and radiological results can be obtained with single stage correction of the hindfoot and midfoot deformities

The August 2012 Children’s orthopaedics Roundup³⁶⁰ looks at: whether 3D-CT gives a better idea of coverage than plain radiographs; forearm fractures after trampolining accidents; forearm fractures and the Rush pin; the fractured distal radius; elastic stable intramedullary nailing for long-bone fractures; aponeurotic recession for the equinus foot; the torn medial patellofemoral ligament and the adductor tubercle; slipped capital femoral epiphysis; paediatric wrist arthroscopy; and Pirani scores and clubfoot.