A Wearable Biofeedback Device for Monitoring Tibial Load During Partial Weight-Bearing Walking.

Patients with tibial fractures are usually advised to follow a partial weight-bearing gait rehabilitation program after surgery to promote bone healing and lower limb functional recovery. Currently, the biofeedback devices used for gait rehabilitation training in fracture patients use ground reaction force (GRF) as the indicator of tibial load. However, an increasing body of research has shown that monitoring GRF alone cannot objectively reflect the load on the lower limb bones during human movement. In this study, a novel biofeedback system was developed utilizing inertial measurement units and custom instrumented insoles. Based on the data collected from experiments, a hybrid approach combining a physics-based model and neural network architectures was used to predict tibial force. Compared to the traditional physics-based algorithm, the physical guided neural networks method showed better predictive performance. The study also found that regardless of the type of weight-bearing walking, the peak tibial force was significantly higher than the peak tibial GRF, and the time at which the peak tibial compression force occurs may not be consistent with the time at which the peak vertical GRF occurs. This further supports the idea that during gait rehabilitation training for patients with tibial fractures, monitoring and providing feedback on the actual tibial force rather than just the GRF is necessary. The developed device is a non-invasive and reliable portable device that can provide audio feedback, providing a viable solution for gait rehabilitation training outside laboratory and helping to optimize patients' rehabilitation treatment strategies.

Continuous real-time biofeedback in orthosis improves partial weight bearing on stairs.

INTRODUCTION: Climbing up and down stairs with crutches is a particular challenge. The current study evaluates a commercially available insole orthosis device for weighing an affected limb and for biofeedback training of gait. This study was done on healthy, asymptomatic individuals before applying to the intended postoperative patient. The outcomes should demonstrate whether a continuous real-time biofeedback (BF) system is more effective on stairs than the current protocol involving a bathroom scale. MATERIALS AND METHODS: 59 healthy test subjects received both crutches and an orthosis and learned to apply a 3-point gait with a partial load of 20 kg using a bathroom scale. Thereafter, the participants were asked to complete an up-and-down course, first without (control group) and then with (test group) an audio-visual real-time biofeedback (BF). Compliance was evaluated using an insole pressure measurement system. RESULTS: Using the conventional therapy technique, 36.6% of the steps up and 39.1% of the steps down in the control group were loaded with < 20 kg. By activating continuous biofeedback, steps with < 20 kg could be increased significantly to 61.1% upstairs (p < 0.001) and 66.1% downstairs (p < 0.001). All subgroups profited from the BF system, independent of age, gender, side relieved, dominant or non-dominant side. CONCLUSIONS: Traditional training without biofeedback led to poor performance for partial weight bearing on stairs, even among young and healthy individuals. However, continuous real-time biofeedback clearly improved compliance, indicating its potential to enhance training and support future research in patient populations.

Can elderly individuals perform partial weight bearing on their lower limbs? A prospective cohort study using ambulatory real-time biofeedback.

BACKGROUND: Partial weight bearing in an orthosis and with forearm crutches is a widespread and well-accepted therapeutic principle after an injury of the lower extremity during early rehabilitation. Complying may be challenging to do under these circumstances, especially for elderly people. This study compares the spatiotemporal parameters and peak loads performed by a group of older participants before and after activating real-time biofeedback (BF) to determine whether they benefit from a biofeedback. METHODS: Twenty-four healthy subjects between 61 and 80 years learned how to walk using forearm crutches in a lower leg orthosis while performing a weight of 20 kg using a bathroom scale with the aim of loading in a zone between 15 and 30 kg. After that, they completed a course that was on level ground (50 m) and another course on stairs (11 steps). They did a walk without BF first, and then with BF. Each step was given a maximum load, which was determined and statistically checked. In addition, spatiotemporal parameters were collected. RESULTS: The classical teaching method with a bathroom scale was ineffective. Only 32.3% of the loads could be adequately carried by a person on level ground in the 15-30 kg target zone. On the stairs, it was 48.2% and 34.3%, respectively. Thus, on level ground, 52.7% of loads exceeded 30 kg. Downstairs it was 46.4%, and upstairs it was 41.6%. Subjects clearly benefit from activated biofeedback. Biofeedback significantly reduced missteps > 30 kg in every course. The loads decreased significantly to 25.0% on level ground, to 23.0% upstairs, and to 24.4% downstairs. At the same time, speed and stride length decreased per course while total time increased. CONCLUSION: Partial weight bearing is more complex and difficult for the elderly. These study results may help better understand 3-point gait in older adults in an outpatient setting. When partial weight bearing is recommended, special follow-up attention must be given for this group. Age-based therapy strategies can be developed and monitored with the assistance of ambulatory biofeedback devices. Trial registration Retrospectively registered, https://www.drks.de/DRKS00031136 .

Mattress Coil Spring Fatigue and Weight-Bearing Support: Comparison of Weight-Bearing and Non-Weight-Bearing Springs.

OBJECTIVE: The purpose of this study was to compare the firmness of used mattress coil springs from the areas bearing greatest body weight versus areas subjected to little compression. METHODS: Weight-bearing springs (WBS) extracted from the center of the mattresses (N = 32), and non-weight-bearing springs (NWBS) extracted from the head/foot were of the same mattresses. To determine spring weakness, a 1296-g ingot was placed on the coil, and the compression distance was measured (cm). In addition, a gauge was used to measure the amount of pressure required to compress the coil springs a distance of 2 cm. Comparison between WBS and NWBS data were statistically treated using independent t tests and a 1-way analysis of variance. RESULTS: There were no significant group differences in weight or height in unloaded coils. However, there were significant (P < .05) differences in coil spring compression distance under load (WBS = 2.78 ± 0.34 cm; NWBS = 1.52 ± 0.39 cm) and force gauge compression (WBS = 1090.51 ± 88.42 g; NWBS = 1213.12 ± 71.38 g) between groups. CONCLUSION: This study found that WBSs were weaker when compressed than the NWBS from used mattresses, and such characteristics may not be visually apparent in a mattress when not in use. Thus, coil springs in bedding systems may eventually fail to provide the initial structural support after use. Such sagging may compromise sleep posture with accompanying poor sleep quality and quantity.

Trunk muscle activity during holding two types of dynamic loads in subjects with nonspecific low back pain.

BACKGROUND: Chronic low back pain due to manual lifting continues to be one of the significant common public health challenges in modern societies despite increased automation. While there are extensive studies on the biomechanics of lifting as associated with LBP, the role of unstable and time-varying dynamic loads, quite common in industrial lifting and daily life, remains elusive. OBJECTIVES: The present study aimed to investigate the response of trunk muscles in subjects with chronic non-specific low back pain (CNLBP) while holding unstable dynamic loads. METHODS: Twelve male patients with CNLBP and twelve healthy controls participated in this cross-sectional study. The subjects held static and dynamic loads in neutral positions. Normalized EMG data of the trunk muscles were captured and analyzed by repeated-measures ANOVA test. RESULTS: The low back pain group demonstrated significantly higher activation levels of the internal and external abdominal oblique muscles while holding dynamic loads (p < 0.05). CONCLUSION: Our results suggest that the neuromusculoskeletal system in low back patients holding dynamic loads may invoke a motor control strategy that significantly increases muscle co-activation leading to higher joint stiffness at the expense of higher compressive loads on the lumbar spine. Importantly, the type of load plays a critical role in terms of external perturbations that may lead to spinal injury in CNLBP patients and must, therefore, be considered in the risk prevention and assessment of lifting and other manual material handling tasks.

Antinociceptive and chondroprotective effects of prolonged ß-caryophyllene treatment in the animal model of osteoarthritis: Focus on tolerance development.

Osteoarthritis (OA) is a chronic joint disease in which cartilage degeneration leads to chronic pain. The endocannabinoid system has attracted attention as an emerging drug target for OA. However, the therapeutic potential of cannabinoids is limited by psychoactive side-effects related to CB1 activation and tolerance development for analgesic effects. ß-Caryophyllene (BCP) is a low-efficacy natural agonist of CB2 and a common constituent of human diet with well-established anti-inflammatory properties. The results presented herein show the anti-nociceptive and chondroprotective potential of BCP in an animal model of OA induced by intra-articular injection of monoiodoacetate (MIA). Behavioural assessment included pressure application measurement and kinetic weight bearing tests. Histological assessment of cartilage degeneration was quantified using OARSI scoring. Experiments established the dose-response effects of BCP and pharmacological mechanisms of the antinociceptive action dependent on CB2 and opioid receptors. Chronic BCP treatment was able to hamper cartilage degeneration without producing tolerance for the analgesic effects. The data presented herein show that BCP is able to produce both acute and prolonged antinociceptive and chondroprotective effects. Together with the safety profile and legal status of BCP, these results indicate a novel and promising disease-modifying strategy for treating OA.

Joint Angles and Joint Moments of the Lower Limbs in Four Typical Tai Chi Movements: Consideration for Management of Knee Osteoarthritis.

This study examined the biomechanics of the lower limbs during four typical Tai Chi (TC) movements: wave hand in cloud, leaning fly side, repulse monkey, and brush knee and twist step, in order to provide biomechanical evidence-based recommendations for patients with knee osteoarthritis (OA) practicing TC. Joint angles and joint moments of the hip, knee, and ankle in frontal and sagittal plane as well as ground reaction forces were examined while performing TC and regular walking in an experienced 38 years old TC master. The results showed that relative to walking, the four TC movements are characterized by a wide motion range of lower limbs, slow increase in joint loading, and strong muscle activity during performance. Therefore, these TC movements could be suitable for patients with knee OA to practice for improving the muscle strength of their lower limbs and functional ability.

Examining the Use of Kinesiology Tape During Weight Bearing Exercises on Proprioception in Participants With Functional Ankle Instability.

The aim of this study was to examine the effect of tape worn during weight bearing exercises on proprioception (i.e., ankle angle repositioning error) in participants with functional ankle instability. We employed a randomized, controlled clinical study in a laboratory setting, with 56 participants with functional ankle instability. Participants were randomly assigned to three groups: (a) weight bearing exercises without tape (n = 18), (b) weight bearing exercises with tape (n = 19) and controls not engaged in weight bearing exercises (n = 19). Weight bearing exercises included six weeks of bilateral squats in partial form with up to 45 degrees of knee flexion, and unilateral partial squats with full heel raise, and with full toe raise. In the taped condition, participants wore tape for six weeks with up to three tape replacements per week. Proprioception was measured as ankle repositioning error. Results showed that the mean angle repositioning error among participants in the active weight bearing groups was decreased by the taping intervention, relative to the control group's performance (p = 0.042). There were no significant differences between weight bearing exercise groups and control groups. The addition of kinesiology tape in weight bearing exercises can improve proprioception in active conditions.

A comparison of mobilization and mobilization with movement on pain and range of motion in people with lateral ankle sprain: A randomized clinical trial.

BACKGROUND: Maitland and Mulligan mobilization techniques are two manual therapy methods to increase the range of motion following immobility treatment. The present study was conducted to compare two therapeutic methods, namely mobilization and mobilization with movement (MWM), on the pain and range of motion in people with lateral ankle sprain. METHODS: A total of 40 individuals with grade two lateral ankle sprain were randomly divided into two groups, including the Maitland's mobilization intervention group, and the Mulligan's mobilization intervention group. Both groups underwent treatment every other day for two consecutive weeks. The pain intensity was measured using the Visual Analogue Scale (VAS), and the ankle dorsiflexion movement range using the Weight Bearing Lunge Test (WBLT) before and one day after the intervention. RESULTS: There were no significant differences between the two groups in terms of pain (P = 0.297) and range of motion (P = 0.294) before the intervention. Meanwhile, after the intervention, a significant change was observed in both groups in terms of these variables, which indicates the effectiveness of both interventions (P < 0.001) and the greater effect of the mobilization with movement in reducing pain (P = 0.037) and increasing the range of motion (P = 0.021). CONCLUSIONS: Both techniques significantly improved the range of motion and reduced pain in people with lateral ankle sprain, but Mulligan's technique was significantly more effective among the two, perhaps due to joining active and passive mobilizing tensile forces as well as interaction of afferents and efferents in the reflex arc.

Rehabilitation and Return to Play Following Meniscus Repair.

Injuries to the meniscus, particularly tears, can have significant negative impacts on pain, function, and quality of life. Preservation of the meniscus is favorable, especially in the athletic and active populations. While first line treatment is often nonoperative in nature, recalcitrant, and more complex tears, typically require surgery. Meniscus repair rates have increased significantly during the last 2 decades as surgical techniques and postoperative outcomes have improved. Longer postoperative timeframes are to be expected when compared with menisectomy, however, accelerated programs have demonstrated favorable outcomes. Rehabilitation and return to play guidelines should reflect the intricacies of the tear type and repair procedure. Close communication with the surgeon is a vital component to optimize patient outcomes. Further, the patient's goals and expected level of return to function, or sport, must be taken into account for a rehabilitation program to be fully successful.

Local and systemic inflammation after implantation of a novel iron based porous degradable bone replacement material in sheep model.

Despite the high potential of healthy bone to regenerate, the reconstruction of large bone defects remains a challenge. Due to the lack of mechanical stability of existing bone substitutes, recently developed degradable metallic alloys are an interesting alternative providing higher load-bearing capabilities. Degradable iron-based alloys therefore might be an attractive innovation. To test the suitability of a newly-designed iron-based alloy for such applications, an animal experiment was performed. Porous iron-based degradable implants with two different densities and a control group were tested. The implants were positioned in the proximal tibia of Merino sheep. Over a period of 6 and 12 months, blood and histological parameters were monitored for signs of inflammation and degradation. In the histological evaluation of the implants` environment we found degraded alloy particles, but no inflammatory reaction. Iron particles were also found within the popliteal lymph nodes on both sides. The serum blood levels of phosphorus, iron and ferritin in the long term groups were elevated. Other parameters did not show any changes. Iron-based degradable porous bone replacement implants showed a good biocompatibility in this experiment. For a clinical application, however, the rate of degradation would have to be significantly increased. Biocompatibility would then have to be re-evaluated.

Losartan protects endothelium-dependent relaxation in vivo in a murine model of rheumatoid arthritis.

Angiotensin II-type 1 receptor stimulation is recognised to promote inflammation, a state central to the development and maintenance of rheumatoid arthritis. Herein we examined the use of losartan, an angiotensin II-type 1 receptor antagonist, on vascular reactivity, knee joint diameter and behavioural assessment of pain in a Freund's complete adjuvant (FCA) mouse model of joint inflammation. Monoarthritis was induced via FCA in the presence or absence of losartan with naive mice serving as controls. Knee joint swelling, joint pain (assessed by dynamic weight bearing of limb use), knee joint artery reactivity (assessed ex vivo) and blood perfusion of the knee joint (assessed in vivo) were determined. FCA mediated a significant increase in knee joint diameter and reduced weight-bearing (a surrogate for pain sensation) of the affected limb. Notably, these phenomena were substantially reduced when mice were prophylactically treated with losartan. Assessment of arterial relaxation and blood perfusion with acetylcholine stimulation revealed that FCA resulted in significant vascular dysfunction, which was resolved to naïve levels with losartan treatment. Through the actions of losartan, these findings indicate that the angiotensin II-type 1 receptor is a likely therapeutic target of importance in the development of the physical changes, pain sensation and vascular dysfunction found in inflammatory arthritis.

Ultrasound-guided surgery for lateral snapping hip: a novel ultraminimally invasive surgical technique.

BACKGROUND: Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain including greater trochanteric bursitis, tendinopathy and tears of the gluteus minimus and medius, and lateral snapping hip (LSH). Surgical options for LSH range from open surgery to endoscopic surgery, including a diamond-shaped cut or a simple transversal release to gluteus maximus tendon release. Resection of an area of proximal iliotibial band (ITB) and step-cut or z-plasty lengthening have not proven superior to transverse release of the ITB. Therefore, making a complete and effective transverse cut guided by ultrasound may represent a potential advance over endoscopic surgery. PURPOSE: In this case series study, we describe how to perform proximal release of the ITB guided by ultrasound. METHODS: The surgical technique-either z-plasty or transverse section of the ITB-was first validated on 10 cadaver specimens and then used in clinical practice. Fourteen patients (5 males and 9 females) were operated from 2014 to 2018. Mean age was 43 years (29-62). RESULTS: The snap resolved in all patients, as verified actively during the surgical procedure as the patient has only local anesthesia. The VAS score for sports activity improved from 7 (5-9) before surgery to 0 (0-2) after 1 year. The HSS score improved from 58 points (47-72) to 96 at 1-2 years. There were no complications other than minor hematomas nor recurrences. CONCLUSION: Ultrasound-guided release of the LSH is a novel surgical option with encouraging results in patients for whom conservative protocols have failed. It can be performed under local anesthesia in an outpatient setting with minimal aggressiveness. It is relatively easy, quick, and painless; no stitches are required. Weight bearing is immediate, and patients usually need crutches for only 2-3 days. Although complete recovery may take 3 months, the rehabilitation protocol is fast and painless.

Lower extremity joint loading during Bounce rope skip in comparison to run and walk.

BACKGROUND: Bounce rope-skip holds immense scope as an aerobic exercise in space and time constrained urban setting with additional constraints placed by pandemic situations such as Covid 19, wherein adherence to commonly performed weight-bearing, aerobic activities like walking and running is a challenge. Limited knowledge informing biomechanical demands and misconceptions about knee joint loading, confines safe application of bounce rope-skip in health promotion. Thus, present study aimed to explore kinematics and lower-extremity joint loading during rope-skipping compared to walking and running. METHODS: Following ethical approval, 3D motion analysis of bounce rope-skip, walk and run was captured from 22 healthy female participants aged 18-25yr using 12-camera Vicon system and 2AMTI force plates. Three trials for bounce rope-skip were recorded with five skip-jumps on force-plates at a cadence of 105 skips/min. Mid-skip, mid-gait and mid-run data were averaged to compute kinetic and kinematic variables for hip, knee and ankle during loading/initial contact, take-off/push-off and flight/mid-swing phases of rope-skip, walk and run. RESULT: Average time of one rope-skip cycle was 1.2sec; mean foot contact time was 0.55sec and flight time was 0.65sec. In one bounce rope-skip cycle, hip motion ranged between 13.4o-35.3oflexion; knee between 13.6 o-67.9° flexion and ankle between 34.5odorsiflexion to-13.40plantarflexion. Vertical ground reaction force (vGRF) during rope-skip (landing-phase) was lower compared to run; however, it was higher than walk (p < 0.001). In coronal plane, peak hip and knee adductor moment during rope-skip were lower compared to run and higher than walk (p < 0.001). CONCLUSION: Bounce rope-skip generated low lower extremity joint loading compared to run; supporting its prescription as a hip and knee joint-protective aerobic weight-bearing exercise for health promotion in young adults.

Short-Term Creatine Loading Improves Total Work and Repetitions to Failure but Not Load-Velocity Characteristics in Strength-Trained Men.

This study assessed the effects of a 7-day creatine (CRE) supplementation on the load-velocity profile and repeated sub-maximal bouts in the deep squat using mean propulsive velocity (MPV) and mean propulsive power (MPP). Eleven strength-trained men (31.4 ± 5.4 years) supplemented 0.3 g·kg-1·d-1 CRE or a placebo (PLA, maltodextrin) for seven days in a randomized order, separated by a 30-day washout period. Prior to and after the supplementation, the subjects performed an incremental maximal strength (1RM) test, as well as 3 × 10 repetitions and a repetitions-to-failure test (RFT), all at 70% 1RM. Maximal strength remained statistically unaltered in CRE (p = 0.107) and PLA (p = 0.568). No statistical main effect for time (p = 0.780) or interaction (p = 0.737) was observed for the load-velocity profile. The number of repetitions during RFT remained statistically unaltered in both conditions (CRE: +16.8 ± 32.8%, p = 0.112; PLA: +8.2 ± 47.2%, p = 0.370), but the effect size was larger in creatine compared to placebo (g = 0.51 vs. g = 0.01). The total work during RFT increased following creatine supplementation (+23.1 ± 35.9%, p = 0.043, g = 0.70) but remained statistically unaltered in the placebo condition (+15.0 ± 60.8%, p = 0.801, g = 0.08; between conditions: p = 0.410, g = 0.25). We showed that CRE loading over seven days did not affect load-velocity characteristics but may have increased total work and power output during submaximal deep squat protocols, as was indicated by moderate effect sizes.

The Effects of Insole-Based Visual Feedback on Weight-Bearing in Patients Undergoing Total Hip Replacement.

This study aimed to investigate the visual biofeedback effect of a sensorized system for plantar pressure dynamic evaluation of in patients with a total hip replacement. Experimental group followed the rehabilitation training wearing sensorized insoles that provided images on three monitors. The control group followed the verbal instructions of physiotherapists during training. Weight bearing percentage healthy limb (WBPH), weight bearing percentage surgical limb (WBPS), swing healthy limb (SWH) and swing surgical limb (SWS) improved significantly more in the experimental group. The results underline the effectiveness of visual biofeedback based on sensorized system with dynamic evaluation of the plantar pressure.

Optimization of backpack loads using gait parameters in school boys.

BACKGROUND: Backpacks are an efficient way of manual carriage used by people of all ages, and is commonly used by schoolchildren. Carrying heavy backpacks may result in cumulative trauma later in life due to biomechanical adaptations during gait. Gait parameters are known to be sensitive to force vectors, which can be altered by load carrying. This study attempts to find the most favorable backpack weight using gait changes as an indicator. METHODS: This was an observational study conducted on twenty typically developing boys aged between 9 and 14 years. Gait analysis was done using standard recommendations, with increasing backpack loads with respect to their body weights. Gait cycles were captured using video cameras and analyzed using Kinovea0.8.25 motion analyzing software. RESULTS: As the backpack load increased, significant kinematic changes were noted in the child's ankle, knee, and hip joints. These changes were evident when the backpack load increased beyond 15% of their body weight. CONCLUSIONS: This study concludes that the optimum weight that can be carried without having an impact on dynamic posture will be less than 15% of the body weight.

Effects of high-intensity interval training in more or less active mice on biomechanical, biophysical and biochemical bone parameters.

High-intensity interval training (HIIT) is of scientific interest due its role in improving physical fitness, but the effects of HIIT on bone health need be carefully explored. Further, it is necessary to know whether HIIT effects on bone health are dependent on the physical activity levels. This may be experimentally tested since we have built a large cage (LC) that allows animals to move freely, promoting an increase of spontaneous physical activity (SPA) in comparison to a small cage (SC). Thus, we examined the effects of HIIT on biophysical, biomechanical and biochemical parameters of bone tissue of C57BL/6J mice living in cages of two different sizes: small (SC) or large (LC) cages with 1320 cm2 and 4800 cm2 floor space, respectively. Male mice were subdivided into two groups within each housing type: Control (C) and Trained (T). At the end of the interventions, all mice were euthanized to extract the femur bone for biophysical, biomechanical and biochemical analyses. Based a significant interaction from two-way ANOVA, trained mice kept in large cage (but not for trained mice housed in SC) exhibited a reduction of tenacity and displacement at failure in bone. This suggests that long-term HIIT program, in addition with a more active lifestyle correlates with exerts negative effects on the bone of healthy mice. A caution must also be raised about the excessive adoption of physical training, at least regarding bone tissue. On the other hand, increased calcium was found in femur of mice housed in LC. In line with this, LC-C mice were more active (i.e. SPA) than other groups. This implies that an active lifestyle without long-term high intensity physical training seems to play a role in promoting benefits to bone tissue. Our data provides new insights for treatment of osteo-health related disorders.

Rehabilitation regimen for non-surgical treatment of Achilles tendon rupture: A systematic review and meta-analysis of randomised controlled trials.

OBJECTIVES: To compare re-rupture rate, functional and quality-of-life outcomes, return to sports and work, complications, and resource use in patients treated non-surgically with different rehabilitation regimens for Achilles tendon rupture. DESIGN: Systematic review and meta-analysis. METHODS: We performed a systematic literature search in PubMed, Embase, Scopus and the Cochrane Library through May 2020 to identify randomized controlled trials (RCTs) that included patients treated non-surgically for Achilles tendon rupture. All analyses were stratified according to rehabilitation protocols. RESULTS: Eight RCTs with a total of 978 patients were included. There was no significant difference about re-rupture rate (P=0.38), return to sports (P=0.85) and work (P=0.33), functional outcome (P=0.34), quality of life (P=0.50), and complication rate (P=0.29) between early weight bearing with functional ankle motion and traditional ankle immobilisation with non-weight bearing. Similarly, no significant difference in re-rupture rate (P=0.88), return to sports (P=0.45) and work (P=0.20), functional outcome (P=0.26), and complication rate (P=0.49) was seen between ankle immobilisation with non-weight bearing and early weight bearing without functional ankle motion. CONCLUSIONS: Traditional ankle immobilisation with non-weight bearing was not found to be superior to early weight bearing with or without functional ankle motion for patients treated non-surgically for Achilles tendon rupture. Clinicians may consider early weight bearing in functional brace as a safe and cost-effective alternative to non-weight bearing with plaster casting.