From the Guidelines
The treatment of a punctate intrasubstance partial thickness tear of the Achilles tendon typically involves conservative management rather than surgery. Initial treatment includes rest, ice, compression, and elevation (RICE protocol) for the first 48-72 hours to reduce pain and swelling, as recommended by 1. Patients should use non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily) for pain relief and to reduce inflammation for 1-2 weeks.
Key Components of Treatment
- Rest to prevent ongoing damage and reduce pain
- Ice to reduce swelling and pain
- Compression to reduce swelling
- Elevation to reduce swelling
- Eccentric strengthening exercises of the calf muscles, starting with 3 sets of 15 repetitions daily and gradually increasing, as supported by 1
- A walking boot or heel lift (typically 1-2 cm) may be recommended for 4-6 weeks to reduce tension on the tendon during healing
- Progressive weight-bearing should be introduced as pain allows
- Night splints can help maintain ankle dorsiflexion and prevent morning stiffness
Complete recovery typically takes 6-12 weeks, though this varies based on tear severity and patient factors. This conservative approach is effective because these small partial tears have good blood supply and healing potential when properly managed, and surgery is reserved only for cases that fail to respond to conservative treatment after 3-6 months, as noted in 1.
From the Research
Treatment Options for Punctate Intrasubstance Partial Thickness Tear of Achilles Tendon
- Conservative treatment is a viable option for managing Achilles tendinopathy, with eccentric exercise training being the gold standard 2
- However, significant partial ruptures may respond poorly to conservative measures and may not improve with time, suggesting that surgical treatment may be necessary 3
- Activity modification and rehabilitation with a focus on progressive tendon-loading can be effective in managing Achilles tendinopathy, with most patients improving with this approach 4
- In some cases, adjuvant treatment with procedures such as injections or shockwave therapy may be necessary, and rarely, surgical intervention may be required 4
Rehabilitation and Return to Play
- Rehabilitation for Achilles tendon ruptures, including partial thickness tears, is crucial for optimizing recovery and return to play 5
- However, there is limited scientific evidence available for optimized rehabilitation regimens and outcomes regarding return to play 5
Diagnosis and Conservative Management
- Accurate diagnosis and early conservative management of Achilles tendon disorders, including punctate intrasubstance partial thickness tears, can improve patient quality of life and reduce unnecessary surgical consultations 6
- Conservative management may include orthotic devices to reduce tendon load, physiotherapy to correct training errors and strengthen the muscle-tendon unit, and other non-surgical interventions 3, 6