A systematic review of orthotic devices for conservative management of achilles tendon rupture in adults.

BACKGROUND

The conservative management of Achilles tendon rupture (ATR) commonly utilises various orthotic devices to facilitate healing alongside functional rehabilitation protocols. However, comparative evidence regarding functional outcomes, complication rates, re-rupture rates and return to pre-injury status between individual orthoses remains limited. The aim of this systematic review was to assess which orthotic device yielded the best results for these categories.

METHODS

We performed a systematic review of 14 studies including 2011 patients treated non-operatively for ATR with five orthotic device categories: VACOped®, Ossur Boot/Fixed Angle Walking Wedge (FAWW), Mixed, Foam Walker/Aircast, and Other. Outcomes included demographic data and patient reported outcome measures. Specifically, Achilles Tendon Total Rupture Score (ATRS) at < 6 and > 12 months, complication and re-rupture rates, and time to return to pre-injury function.

RESULTS

Mean patient age ranged from 40.7 to 49.8 years. ATRS was the only patient-reported functional outcome reported with sufficient consistency for grouped comparison. Complications, re-rupture, and return to pre-injury status were analysed on an outcome-specific descriptive basis. ATRS scores showed no statistically significant differences between boot types at both < 6 and > 12 months follow-up. Complication rates varied significantly (p < 0.0001), with Mixed (31.2%) and Ossur/FAWW (19.5%) groups exhibiting the highest rates, while VACOped® (5.75%) and Foam Walker (4.4%) had the lowest. Re-rupture rates ranged from 3.05% (VACOped®) to 12.5% (Other) without significant intergroup differences. Return to pre-injury function times varied widely (13.8-40 weeks), with no statistically significant differences.

CONCLUSION

Orthotic device selection influences complication risk but not long-term functional outcomes in non-operative ATR treatment. VACOped® and Foam Walker/Aircast were associated with more favourable descriptive outcome profiles; however, findings should be interpreted cautiously given the heterogeneity of included studies and the absence of formal meta-analytic effect estimation. Further prospective, standardised research is required to confirm these findings and inform evidence-based orthotic selection in Achilles tendon rehabilitation.