Objective Achilles tendon ruptures lead to long-term structural and functional deficits. Prior research that sought to identify optimal rehabilitation techniques was fundamentally limited by the inability to continuously monitor Achilles tendon loading during rehabilitation. Our objective was to develop a data-driven model that predicts per-step peak Achilles tendon loading from only a single, boot-mounted accelerometer.

Methods Nineteen patients recovering from an acute Achilles tendon rupture completed in-lab walking trials while wearing an instrumented immobilizing boot. A boot-mounted inertial measurement unit provided acceleration signals used for prediction, while a force-sensing insole provided ground truth tendon-loading data through a validated ankle moment balance. We developed a stance-detection algorithm, as well as a personalized one-dimensional convolutional neural network (1D-CNN) to estimate per-step peak Achilles tendon load. Our training framework incorporated a small patient-specific personalization sample and was evaluated on held-out steps.

Results The stance detection algorithm identified stance phases with 99.8% precision and mean timing errors of 27.3 ms for heel strike and 61.9 ms for toe-off. The CNN estimated per-step peak Achilles tendon load with a mean absolute error of 0.14 bodyweights (R2=0.68) across rupture patients.

Conclusion Continuous, objective estimation of Achilles tendon loading during early rehabilitation is feasible using a single, boot-mounted accelerometer. Model errors were small (9%) relative to the wide range of tendon loading exhibited during immobilizing boot walking. Our proposed approach enables clinicians to continuously monitor mechanical loading during a previously unobservable rehabilitation period and provides a foundation for personalized rehabilitation guidance after Achilles rupture.

The authors have declared no competing interest.

This work was supported by National Institutes of Health P50AR080581 and by a grant from the American Orthopaedic Foot & Ankle Society with funding from the Orthopaedic Foot & Ankle Foundation.

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IRB of the University of Pennsylvania gave ethical approval for this work

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