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Blood Flow Restriction Training (BFRT) and Achilles Tendinopathy

 

BFRT is a lower-load path to recovery when heavy resistance training is too painful or when progress has plateaued.

 

The study that tested BFRT

 

A 2021 study investigated the effects of BFRT on Achilles tendon thickness by comparing exercise protocols.

 

• 52 participants were split into three groups: low-intensity resistance exercise (LI), high-intensity resistance exercise (HI), and low-intensity resistance with BFR (LI-BFR).

• Only the LI-BFR group showed significant reductions in Achilles tendon thickness, measured immediately after exercise, at 60 minutes, and at 24 hours.

• The HI and LI groups alone produced no measurable change.

• Cuff pressure was set at 30% of individual occlusion pressure. 

 

Overall, the research supports BFRT as a promising adjunct for Achilles tendinopathy rehabilitation. 

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Fibular Malreduction: The Real Reason for Deltoid Repair

by Vince Vacketta, DPM

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Yes, I’m back on this topic again. 

 

Study questions need for deltoid repair

 

A study published early this month provides compelling evidence that omitting deltoid repair does not worsen short-term outcomes. Researchers analyzed 132 SER-IV (AO/OTA 44-B2) ankle fractures:

 

• 89 bimalleolar fractures.

• 43 deltoid-variant.

• No deltoid ligament repairs were performed.

• Patients requiring posterior malleolar fixation or syndesmotic fixation were excluded. 

 

After a mean follow-up of 11.8 months, both groups maintained equivalent mortise reduction and radiographic alignment, with no differences in complications, secondary surgery, or short-term clinical outcomes.

 

Why this study stands out

 

Previous studies have often compared deltoid repair to syndesmotic fixation, making it difficult to determine whether stability came from the deltoid repair or the syndesmotic implant. 

 

This study is unique because patients achieved equivalent outcomes without routine syndesmotic fixation or deltoid repair, suggesting that anatomic fibular reduction and restoration of a stable mortise alone may be sufficient in many SER-IV injuries. It adds to growing evidence that routine deltoid repair may not be necessary after anatomic fibular fixation. If the deltoid ligament is unstable after fibular reduction, look critically at fibular length and rotation. The deltoid isn’t out; the fibula is malreduced.

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Antigravity Treadmill Therapy After Lower Extremity Fractures

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Antigravity treadmills, popularized by the leading AlterG brand, use pressurized air to reduce effective body weight by up to 80%. Long employed by high-profile athletes, the technology now raises the question of whether it can help everyday fracture patients.

 

Testing antigravity therapy 

 

A recent trial examined whether antigravity treadmill therapy improves recovery after lower extremity fractures compared to standard care.

 

• 78 patients with knee and distal tibia fractures were randomized to 10 weeks of antigravity treadmill therapy versus standard care.

• Distal tibia fracture patients trended toward better ankle outcomes with antigravity therapy (p = 0.05), which was the largest difference in the study.

• No significant difference in six-month function scores was found for knee fracture patients.

• No differences in fracture healing or complication rates were found between groups.

• Patients on the antigravity treadmill reported significantly higher satisfaction at six weeks and three months.

 

What this means for patients

 

Antigravity treadmill therapy did not outperform standard care overall. However, its safety profile, higher patient satisfaction, and potential benefit for distal tibia fractures make it worth considering if it's accessible for patients.