From the Guidelines
Treatment for a partial Achilles rupture should begin with conservative management, including rest, ice, compression, and elevation (RICE protocol), as it avoids surgical complications while achieving good functional outcomes. Patients should immobilize the affected ankle using a walking boot or cast with the foot positioned in slight plantar flexion for 6-8 weeks 1. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) can help manage pain and inflammation. After the initial immobilization period, physical therapy is crucial, focusing on progressive strengthening exercises, stretching, and proprioception training for 8-12 weeks. The rehabilitation process should be gradual, avoiding activities that cause pain.
Some key points to consider in the treatment of partial Achilles ruptures include:
- The use of protective devices that allow for postoperative mobilization, as suggested by moderate-strength recommendations 1
- The consideration of nonsurgical treatment as an option for patients with acute Achilles tendon rupture, with studies showing no significant difference in functional outcomes between surgical and nonsurgical treatments in some cases 1
- The importance of avoiding surgical complications, such as extreme residual tendon lengthening, deep vein thrombosis (DVT), and "major" complications, which were not significantly different between patients treated surgically and those treated nonsurgically 1
Surgery is generally reserved for high-performance athletes or cases that don't respond to conservative treatment after 3-6 months. Full recovery typically takes 4-6 months, and patients should not return to full athletic activities until they have regained at least 90% strength compared to the uninjured side. It is essential to prioritize conservative management and carefully consider the individual patient's needs and circumstances before deciding on surgical intervention 1.
From the Research
Treatment for Partial Achilles Rupture
The treatment for a partial Achilles rupture can be divided into two main categories: conservative and surgical.
- Conservative Treatment: This approach is often recommended as the first line of treatment for partial Achilles ruptures 2. It typically involves:
- Using a 2 cm heel lift for the first 6 weeks to reduce stress on the tendon
- Avoiding tendon stretching for 12 weeks
- Gradually introducing progressive tendon loading at weeks 7-12
- Removing the heel lift after 12 weeks if pain-free, and starting eccentric exercises to strengthen the tendon
- Surgical Treatment: If conservative management is not effective, surgical exploration and excision of the partial rupture, followed by suturing, may be necessary 2. Augmentation procedures or anchor applications may also be useful for partial ruptures in the Achilles insertion, depending on the size and location of the rupture.
Rehabilitation Protocols
Rehabilitation protocols for partial Achilles ruptures can vary, but a typical 12-14 week program may include:
- Weight-bearing: Gradually increasing weight-bearing over time
- Range of motion: Gradually increasing range of motion exercises
- Physiotherapy: Starting physiotherapy at around 2-3 weeks post-injury
- Orthosis: Using a convertible vacuum brace system to support the tendon during rehabilitation 3
Additional Considerations
Other treatments, such as platelet-rich plasma (PRP) applications, may also be considered for Achilles tendon ruptures, including partial ruptures 4. However, the effectiveness of PRP therapy can vary depending on the preparation method and modality of application.