What is the treatment for an Achilles tendon tear?

Treatment of Achilles Tendon Tear

Both surgical and nonsurgical treatments are viable options for Achilles tendon tears, with the choice depending on patient factors and tear characteristics. 1

Diagnosis

Before treatment, proper diagnosis is essential:

• Perform at least two of these tests to confirm diagnosis:
  • Thompson/Simonds squeeze test
  • Assessment of ankle plantar flexion strength
  • Palpation for gap or defect in tendon
  • Evaluation of passive ankle dorsiflexion 1, 2

Treatment Options

Nonsurgical Treatment

• Indicated for:
  • Older, less active patients
  • Patients with significant comorbidities
  • Partial tears 3
  • Patients who prefer to avoid surgical risks

Nonsurgical protocol:

1. Immobilization with cast or fixed-ankle walker device
2. Progressive rehabilitation program
3. Relative rest while avoiding complete immobilization to prevent muscle atrophy 2
4. Ice therapy (10-minute applications through wet towel) for acute pain
5. NSAIDs for pain control 2

Surgical Treatment

• Indicated for:
  • Young, active patients
  • Athletes seeking to return to sports
  • Complete ruptures
  • Persistent partial ruptures not responding to conservative treatment 3

Surgical options include:

1. Open repair: Extended incision allowing direct visualization and suturing
2. Limited open repair: Small incision with direct visualization of ruptured ends
3. Percutaneous repair: No direct exposure of rupture site 1

Advantages of surgical treatment:

• Lower rerupture rates compared to nonsurgical treatment 1
• Better functional outcomes for athletes
• Faster return to sports activities 4

Post-Treatment Rehabilitation

Early Rehabilitation Protocol

• Begin active ankle mobilization before the second postoperative week 5
• Short leg cast for approximately 12-20 days post-surgery 4
• Bracing for 6-8 weeks 4
• Progressive tensile loading exercises to stimulate collagen production
• Eccentric strengthening exercises
• Stretching exercises for posterior leg muscles 2

Outcomes and Complications

Surgical Outcomes

• 75-90% of athletes successfully return to previous activity levels 4, 6
• AOFAS scores ≥90 indicate high patient satisfaction 4
• Potential complications include:
  • Wound infections
  • Nerve injury
  • Rerupture
  • Scar adhesions 1

Nonsurgical Outcomes

• Higher rerupture rates compared to surgical treatment
• Longer recovery time
• May be adequate for less active individuals

Important Considerations

• Avoid corticosteroid injections directly into the tendon as they can inhibit healing and reduce tensile strength 2
• Limited open and percutaneous techniques may reduce wound complications compared to open repair 1
• Patients treated with percutaneous repair show higher physical and mental component scores on quality of life measures 1
• Regular assessment of pain and function is crucial for optimal recovery 2

For persistent partial tears that don't respond to conservative treatment, surgical intervention is often necessary for complete pain relief and functional restoration 3.