Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 2 - Medical Guidelines › Chapter 23 - Upper and Lower Extremities Medical Treatment Guidelines › Subchapter A - Lower Extremities › Section I-2309 - Specific Lower Extremity Injury Diagnosis, Testing, and Treatment

Current through Register Vol. 50, No. 6, June 20, 2024
1. Foot and Ankle
a. Achilles Tendonopathy/or Injury and
					 Rupture (ALTERNATE SPELLING: "TENDINOPATHY"):
i. Description/Definition: Rupture or tear of
					 Achilles tendon or insertional or non-insertional tendonopathy.
ii. Occupational Relationship: Tears or
					 ruptures are related to a fall, twisting, jumping, or sudden load on ankle with
					 dorsiflexion. Tendonopathy may be exacerbated by continually walking on hard
					 surfaces.
iii. Specific Physical
					 Exam Findings: Swelling and pain at tendon, sometimes accompanied by crepitus
					 and pain with passive motion. Rupture or partial tear may present with palpable
					 deficit in tendon. If there is a full tear, Thompson test will usually be
					 positive. A positive Thompson's test is lack of plantar flexion with
					 compression of the calf when the patient is prone with the knee
					 flexed.
iv. Diagnostic Testing
					 Procedures: Radiography may be performed to identify Haglund's deformity;
					 however, many Haglund's deformities are asymptomatic. MRI or ultrasound may be
					 performed if surgery is being considered for tendonopathy or rupture.
v. Non-operative Treatment Procedures:
(a). Initial Treatment: Cast in non
					 weight-bearing for tears. Protected weight-bearing for other
					 injuries.
(b). Medications such as
					 analgesics and anti-inflammatories may be helpful. Refer to medication
					 discussions in Medications and Medical Management.
(c). Patient education should include
					 instruction in self-management techniques, ergonomics, body mechanics, home
					 exercise, joint protection, and weight management.
(d). Benefits may be achieved through
					 therapeutic rehabilitation and rehabilitation interventions. Eccentric training
					 alone or with specific bracing may be used for tendonopathy. Manual therapy may
					 also be used. Therapy will usually include range-of-motion (ROM), active
					 therapies, and a home exercise program. Active therapies include,
					 proprioception training, restoring normal joint mechanics, and clearing
					 dysfunctions from adjacent structures. Passive as well as active therapies may
					 be used for control of pain and swelling. Therapy should progress to
					 strengthening and an independent home exercise program targeted to further
					 improve ROM, strength, and normal joint mechanics influenced by distal and
					 proximal structures. Refer to Therapeutic Procedures, Non-operative.
(i). Passive modalities are most effective as
					 adjunctive treatments to improve the results of active treatment. They may be
					 used as found in Therapeutic Procedures, Non-operative.
(e). Steroid injections should generally be
					 avoided in these patients since this is a risk for later rupture.
(f). Return to work with appropriate
					 restrictions should be considered early in the course of treatment. Refer to
					 Return to Work.
(g). Other
					 therapies in Therapeutic Procedures, Non-operative may be employed in
					 individual cases.
vi.
					 Surgical Indications/Considerations: Total or partial rupture.
(a). Smoking may affect soft tissue healing
					 through tissue hypoxia. Patients should be strongly encouraged to stop smoking
					 and be provided with appropriate counseling by the physician.
vii. Operative Procedures: Repair
					 of tendons open or percutaneously with or without anchors may be required.
					 Tendon grafts are used for chronic cases or primary surgery failures when
					 tendon tissue is poor.
viii.
					 Post-operative Treatment:
(a). An
					 individualized rehabilitation program based upon communication between the
					 surgeon and the therapist using therapies as outlined in Section F, Therapeutic
					 Procedures, Non-operative.
(b).
					 Treatment may include the following: restricted weight-bearing, bracing, active
					 therapy with or without passive therapy.
(c). Range of motion may begin at three weeks
					 depending on wound healing. Therapy and some restrictions will usually continue
					 for six to eight weeks.
(d). Return
					 to work and restrictions after surgery may be made by an attending physician
					 experienced in occupational medicine in consultation with the surgeon or by the
					 surgeon.