From the Guidelines
Treatment for partial tears of the Achilles tendon should begin with conservative management, prioritizing rest, ice, compression, and elevation (RICE protocol), as well as physical therapy and pain management with over-the-counter medications like acetaminophen or NSAIDs, with surgery reserved for cases that don't respond to conservative treatment after 3-6 months. The goal of treatment is to reduce pain and inflammation, promote healing, and prevent further injury. Conservative management is effective for most patients, with about 80% fully recovering within three to six months 1.
Key Components of Conservative Management
- Rest the affected leg to avoid further strain on the tendon
- Apply ice for 20 minutes every 2-3 hours during the first 48-72 hours to reduce inflammation
- Use compression with an elastic bandage to help reduce swelling
- Elevate the leg above heart level when possible to reduce swelling
- Over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours) or NSAIDs such as ibuprofen (400-600mg every 6-8 hours) can help manage pain and inflammation
- A walking boot or cast may be recommended for 4-8 weeks to immobilize the tendon and promote healing
- Physical therapy is crucial for recovery, typically starting after the immobilization period with gentle stretching exercises and gradually progressing to strengthening exercises over 3-4 months
Additional Considerations
- For more severe partial tears, platelet-rich plasma injections might be considered 2
- Surgery is generally reserved for cases that don't respond to conservative treatment after 3-6 months, as it can be effective in promoting healing and reducing the risk of further injury 2
- Complete recovery can take 6-12 months, and returning to sports should only occur when full strength and range of motion are restored
- Eccentric strength training is a particularly popular and effective option for treating Achilles tendinopathy, and can be incorporated into physical therapy 3
From the Research
Treatment Options for Partial Tears of the Achilles Tendon
The treatment options for partial tears of the Achilles tendon can be categorized into non-surgical and surgical methods.
- Non-surgical treatment: This approach includes a range of therapies such as: + Conservative treatment with exercise, tendon loading, electrical stimulation, and photobiomodulation 4 + Extracorporeal shockwave therapy (ESWT) 5 + Micro-current therapy 6 + Physical therapy, including orthotic devices to reduce tendon load and physiotherapy to correct training errors and strengthen the muscle-tendon unit 7
- Surgical treatment: This approach involves excision of degenerated tissue, which can lead to complete pain relief and full restoration of function 7 ### Considerations for Treatment When choosing a treatment option, it is essential to consider the individual patient's characteristics and the severity of the partial tear.
- The treatment should be catered to the individual patient 8
- Significant partial ruptures may respond poorly to conservative measures and may not improve with time, making surgical treatment a preferable option 7
- Further research is required to confirm the efficacy of available treatment options and to discover new therapeutic modalities 8