Using a Tarsal Brace with Graduated Articulation


Most would agree that as practitioners we need to protect the Achilles tendon injury/repair early on and then slowly load the Achilles Tendon over time. That said, it is difficult to find a consensus on how to implement these needs. Below is a jumping-off point, a work in progress, based on my experiences and the knowledge gained from research of my peers. Please leave comments on how you think we should make it better.

Partial Achilles Tendon Rupture or Post -Operative Arthrodesis

  1. Day 0 -Impression/casting at the time of diagnosis of partial tear or end of surgery. Custom Orthotic will be taking place of Bivalve Cast/Splint in 2-3 weeks.
  2. Weeks 0-2 -After Casting/Impression is performed place in Bivalve cast/Splint with flexion of toes if possible at 45 degrees. Tarsus will typically be at 135 degrees extension. Recheck bivalve cast weekly.
  3. Weeks 3-7  Sutures removed at 10-14 days post-op if used. Fit orthotic to pet. Orthotic is non-articulating. Wear in place of cast 24/7. Owner/practitioner to check 3-4 times a day for pressure sores. Begin rehab therapy. Continue rechecks every two weeks with Surgeon/RDVM.
  4. Weeks 8-11  -Cut brace to allow 15 degrees of articulation if partial tendon rupture. Continue rehab in clinic and at home.
  5. Weeks 12-16:  Pet out of brace or using as a “Sport Brace”, times of high activity. Pet needs to have sufficient strength to maintain a normal standing angle in Hock. Pet should be challenged with Rear leg in “Three-legged Stand”. Typically 135 Degrees of extension.

NOTE: Time intervals are stated as a guide. Some pets will need more or less time as they heal. This is where the “Art” of being a Practitioner is applied.

Items to consider:

Normal Range of Motion of the Tarsus. Flexion is 40 Degrees and Extension is 170 Degrees in a relaxed pet.

Normal Standing angle of Tarsus for Tarsal Arthrodesis is 135 Degrees

According to Millis and Levine: Early partial weight-bearing and joint movement create stress to promote parallel collagen alignment and increases tendon strength.

The Hero Brace Tarsal Orthotic may help bypass or relieve weight-bearing forces to the healing tendon much like incorporating a walking ring into a cast or external fixator.

References:

Small Animal Surgery 3rd Edition.  Fossum  pgs 1322-1324

Veterinary Surgery Small Animal 2nd Edition. Johnston and Tobios Vol 1 pgs 1204-1209

Small Animal Orthopedics and Fracture Repair 4th Edition. Brinker, Piermattei and Flo pgs 674-678

Canine Rehabilitation and Physical Therapy. Millis and Levine 2nd Edition pg 573

“Calcaneal Tendon Tears in Dogs” Four Leg Rehab Inc Newsletter March-April 2012 Vol1 : Issue 1. Laurie Edge Hughes

“Post-Operative Management of Tendon Repairs” Four Leg Rehab Inc Newsletter May-June 2012 Vol 1 : Issue 2. Laurie Edge Hughes

Copyright Paul Brumett DVM, CCRP, cAVCA