Hullfish Todd J, Woods Madison M, Kwon Michelle P, Boakye Lorraine A T, Humbyrd Casey Jo, Baxter Josh R
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Orthop J Sports Med. 2024 Oct 16;12(10):23259671241283806. doi: 10.1177/23259671241283806. eCollection 2024 Oct.
Achilles tendon rupture is an increasingly common injury treated with progressive rehabilitation in an immobilizing boot. However, it is poorly understood how ankle angle, boot type, and walking speed affect Achilles tendon loading.
These different parameters would affect Achilles tendon loading in terms of (from greatest to least) ankle angle constraint, immobilization style, boot construction, and walking speed.
Descriptive laboratory study.
Ten healthy young adults (8 women and 2 men; age, 21 ± 2 years; body mass index, 21.5 ± 3.0 kg/m) walked in 3 different immobilizing boots at self-selected slow, medium, and fast walking speeds. The authors estimated Achilles tendon loading using a 3-part instrumented insole within the immobilizing boot. The authors averaged tendon load across every stride for each condition and calculated 2-sided bootstrap confidence intervals. Peak tendon loading was compared across all boots, ankle angles, and walking speeds.
All boots and immobilization styles decreased tendon loading with respect to shod walking. Immobilization angle had the largest effect on tendon loading, followed by boot construction, and finally walking speed.
Ankle angle, boot type, and walking speed can be modified to change loading progression during rehabilitation.
Understanding how immobilization affects tendon loading will enable clinicians to modify rehabilitation to improve functional outcomes.
跟腱断裂是一种日益常见的损伤，通常采用在固定靴中进行渐进性康复治疗。然而，对于踝关节角度、靴子类型和步行速度如何影响跟腱负荷，目前了解甚少。
这些不同参数会按照（从最大到最小）踝关节角度限制、固定方式、靴子构造和步行速度的顺序影响跟腱负荷。
描述性实验室研究。
10名健康的年轻成年人（8名女性和2名男性；年龄21±2岁；体重指数21.5±3.0kg/m²）穿着3种不同的固定靴，以自我选择的慢、中、快步行速度行走。作者使用固定靴内的三部分式仪器化鞋垫来估计跟腱负荷。作者计算了每种情况下每一步的肌腱负荷平均值，并计算双侧自助置信区间。比较了所有靴子、踝关节角度和步行速度下的肌腱负荷峰值。
与穿鞋行走相比，所有靴子和固定方式都降低了肌腱负荷。固定角度对肌腱负荷的影响最大，其次是靴子构造，最后是步行速度。
在康复过程中，可以通过改变踝关节角度、靴子类型和步行速度来改变负荷进展。
了解固定如何影响肌腱负荷将使临床医生能够调整康复方案以改善功能结果。
