From the Guidelines
Achilles tendon injuries should be treated with a combination of rest, ice, compression, and elevation (RICE) in the acute phase, and for severe tears or ruptures, surgical repair might be required, especially in younger, active individuals, with options including open, limited open, and percutaneous techniques 1.
Treatment Options
For mild tendonitis or tendinopathy, initial treatment includes:
- Reducing activities that cause pain
- Taking non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600mg three times daily with food) for 1-2 weeks to reduce inflammation
- Gentle stretching exercises Physical therapy focusing on eccentric strengthening exercises, such as heel drops performed 3 sets of 15 repetitions twice daily for 12 weeks, is highly effective for chronic cases 1.
Surgical Repair
Surgical repair is an option for patients with acute Achilles tendon rupture, with studies showing that patients treated surgically had better functional ability than those treated nonsurgically, and significantly fewer reruptures 1.
Recovery
Recovery typically takes 4-6 months, with gradual return to activities, and treatments work by reducing inflammation, promoting proper healing alignment of collagen fibers, and strengthening the tendon to prevent recurrence.
Considerations
When considering treatment options, it's essential to weigh the benefits and risks of each approach, including the potential for complications such as deep vein thrombosis (DVT) and "major" complications, which were not significantly different between patients treated surgically and those treated nonsurgically 1.
From the Research
Treatment Options for Achilles Tendon Injuries
- Conservative treatment is often recommended for acute injuries such as insertional tendonitis, retrocalcaneal bursitis, and paratenonitis, and typically includes rest, ice, anti-inflammatory measures, and physical rehabilitation 2.
- For chronic conditions like Achilles tendinosis, conservative treatment may also be effective, but treatment may be prolonged 2.
- Surgical treatment may be recommended in some cases, such as for Achilles tendon ruptures, although the optimal intervention remains controversial 2, 3.
Surgical vs. Conservative Management for Acute Achilles Tendon Rupture
- A systematic review and meta-analysis found that surgical treatment can effectively reduce the re-rupture rate compared to conservative management 3.
- The study found that the total re-rupture rate was significantly lower in the surgical group (3.7%) compared to the nonsurgical group (9.8%) 3.
- However, no significant differences were found between the two treatment groups in terms of deep venous thrombosis, return to sport, ankle range of motion, or physical activity scale 3.
Conservative Treatment of Chronic Achilles Tendinopathy
- A systematic review found that eccentric exercise training is the gold standard and a commonly used protocol for conservative treatment of Achilles tendinopathy 4.
- The review noted that several conservative treatments have been proposed, but no therapy is universally accepted except for eccentric exercise training 4.
Rehabilitation Protocols for Surgically Repaired Acute Mid-Substance Achilles Rupture
- A consensus statement from the "GAIT" study group recommended an evidence-based protocol for rehabilitation, including average postoperative non-weightbearing for 2.3 weeks and avoiding ROM exercises beyond neutral 5.
- The group also recommended starting stretching and eccentric exercise not before 12 weeks, and using a 1/8th-1/4th inch heel cushions in daily shoes after 8 weeks 5.
Outcomes and Treatment Options for Achilles Tendon Injuries
- A review of the current literature found that the incidence of Achilles tendon injuries is increasing, but the necessity for surgical intervention is decreasing due to improved conservative therapies 6.
- The review noted that most patients are able to return to pre-injury level of activity, but further research is needed into the etiology, potential preventative measures, and longer-term outcomes of the different treatment options for Achilles pathology 6.