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magazine 2012/1
Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A, Operative
versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized
trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 2010 Dec
1;92(17):2767-75. Epub 2010 Oct 29.
treatment regime has generally been associ-
ated with higher rates of re-rupture, whereas
operative repair has been associated with
higher rates of complications, including
some serious infections.
In comparison to traditional cast immo-
bilization, functional bracing with early
range of motion and/or weight-bearing has
resulted in improved complication rates and
functional outcomes in both non-operative
and post-operative settings. Specifically,
current high quality trials employing ac-
celerated functional rehabilitation without
prolonged casting and utilization of other
orthotic devices show no significant dif-
ference in re-rupture rates and dramatic
decreases in complication rates favoring
non-operative treatments (reference: Willits
et al. 2010).
“The results are extremely clear. They are at
least equivalent and likely to favor non-
surgical treatment,” says the physician,
summing up the evidence. However, some
confusion over terminology still needs to be
dispelled in certain places. “Non-surgical
does not mean doing nothing at all!”
Dr. ­Glazebrook points out. “It is a term that
is often deliberately misunderstood.”
The results of non-surgical treatment using
suitable medical aids speak for themselves.
To treat a ruptured Achilles tendon, Dr.
Glazebrook prescribes the use of a plaster
cast for two weeks, followed by six weeks
of wearing a special boot with a decreasing
heel height. He uses Bauerfeind compression
stockings as well in this stage. The treat-
ment is finished off with the active sup-
port, AchilloTrain Pro. “The most important
properties offered by Bauerfeind supports
are their ability to reduce swelling and their
proprioceptive effect,” explains Dr. Glaze-
brook. “They quickly give patients confi-
dence. Especially when their pain is rapidly
Using MalleoTrain following ankle
The orthopedic and sports medicine special-
ist considers the ankle support MalleoTrain
to be just as useful as the AchilloTrain Pro.
In the case of sprains or twists, he says, this
support can help “accelerate rehabilita-
tion”. Dr. Glazebrook also believes that
the MalleoTrain can be of use in treating
patients with osteoarthritis in the ankle.
Depending on the stage of the disease, fu-
sion surgery or a total reconstruction of the
ankle joint may be required. According to
Dr. Glazebrook, the MalleoTrain can produce
good results if it is used post-operatively,
particularly in the case of a total reconstruc-
tion. The patients benefit from a feeling of
security and a relatively rapid recovery of
their mobility.
The MalleoLoc stabilizing orthosis provides
“good stability” in the post-traumatic phase
following more severe sprains or ligament
ruptures. “In general, there is an increas-
ing awareness among my colleagues of
the stabilizing elements as well,” says Dr.
Glazebrook, “When Bauerfeind products first
became known in Canada, the main focus of
our attention was still on their compressive
effect,” he recalls. “That has changed. Now
we consider them more broadly. These par-
ticular active supports with their propriocep-
tive and thus actively stabilizing properties
are of great interest to us.” Something else
is also evident: this recognition of the true
strengths of supports and orthoses fits seam-
lessly into the period of transition taking
place in Canadian medical treatment.
Part of the Bauerfeind foot & ankle-range: AchilloTrain Pro, MalleoLoc and MalleoTrain.
“The most important properties
offered by Bauerfeind supports
are their ability to reduce swell-
ing and their proprioceptive
(Dr. Mark Glazebrook)