Archive for June 10th, 2011

Jun 10 2011

Bruce Twaddle’s recovery plan (copied off Bronny’s blog)

Published by mtbrider under Uncategorized

Hi i copied this from Bronny’s blog - hope you do not mind Bronny. It outlines the manner in which Bruce Twaddle approaches an ATR. This is pretty much whay I think I would like to go through:

Hi all

Awhile back I said I’d emailed Bruce Twaddle who was one of the authors of the NZ study that Norm has referenced which looked at operative and non-operative recovery and showed similar results for the two.  Anyway, he responded with his protocol which he was happy for me to post here (”Knowledge is Power”). The same protocol was applied to both operative and non-operative. I don’t have the full results but you can see the summary on Norm’s blog I think.

In addition to the protocol I asked him about heel raises in particular (as I went to heel raises for the 8-12 week stage) and he commented that while he isn’t a big user of heel raises, he recognises that some people feel more comfortable with them for awhile (i.e didn’t seem to think there was a problem with that).  I don’t want to get into a conversation about surgical /non surgical here, but he also commented that he doesn’t  see any place for surgery in the primary treatment of ATR even in elite athletes - he will operate if people want it, but would apply the same rehab.

So here it is:

1. For the first 2 weeks after injury the patient should be immobilised in a hanging equinus pop (not forced equinus) and be mobilising non-weight bearing.

2. After 2 weeks up until 4 weeks from injury the patient can be placed in a removal orthosis set at 20deg of equinus. The patient is allowed to remove their foot from the boot for 5 minutes of every hour and move their ankle with dorsiflexion and plantar flexion, being careful not to come beyond a right angle, as the greatest risk is having a tendon that heals long. This should be repeated 5 minutes of every hour where possible.

3. At 4 weeks from Injury the moon boot is brought to 10deg of equinus and the range of motion exercises continue, being careful again not to bring the ankle beyound a right angle position. The patient can be touch weight bearing through the toe of the boot , up to 20kgs of pressure, from 4-6 weeks.

4. At 6 weeks from injury the patient can bring the orthosis to O deg and begin weight bearing as tolerated, weaning himself/herself off the crutches by 8 weeks from injury. They need to continue on with the range of motion exercises of their ankle and can remove the orthosis at night.

5. At 8 weeks from injury they can come out of the boot and start toe raising exercises, increasing the weight bearing on the affected leg. When they can single leg toe raise and support their own weight they can start a stretching and strenthening programme and increase their activity level according to their symptoms. This should allow them a quick and full a functional recovery as possible.

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