From the Guidelines
Treatment of a partial tear of the distal Achilles tendon typically begins with conservative management for most patients, focusing on rest, ice, compression, and elevation (RICE protocol) for the first 48-72 hours to reduce pain and swelling, as recommended by 1. The initial treatment approach is crucial in managing the condition and preventing further injury.
- Rest is essential to decrease repetitive loading of the damaged tendon, as noted in 1.
- Non-weight bearing or protected weight bearing with a walking boot or cast with the foot in slight plantar flexion is recommended for 2-6 weeks, depending on tear severity.
- Pain management can include NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks, as mentioned in 1.
- Physical therapy should be initiated after the acute phase, focusing on progressive strengthening exercises, eccentric heel drops, and range of motion exercises for 8-12 weeks, with the goal of improving functional outcomes and reducing the risk of further injury.
- Gradual return to activities is advised, typically starting at 6-12 weeks post-injury, to allow for adequate healing and rehabilitation. For more severe partial tears or those not responding to conservative treatment after 3-6 months, surgical repair may be considered, involving direct repair of the tendon, followed by similar rehabilitation protocols but with a longer initial immobilization period, as discussed in 1.
- The decision to proceed with surgery should be made on a case-by-case basis, taking into account the individual patient's condition, response to conservative management, and overall health status.
- It is essential to weigh the potential benefits of surgery against the risks of complications and the impact on the patient's quality of life, as highlighted in 1 and 1.
From the Research
Treatment Options for Partial Tear of the Distal Achilles Tendon
- Conservative treatment, including exercise, tendon loading, electrical stimulation, and photobiomodulation, has been shown to be effective in some cases 2
- Extracorporeal shockwave therapy (ESWT) has also been used as an alternative treatment for Achilles tendon partial tear, with positive outcomes 3
- Orthotic devices and physiotherapy may be used to reduce tendon load and correct training errors, but significant partial ruptures may respond poorly to conservative measures 4
- Surgical treatment, including excision of degenerated tissue, may be recommended for persistent Achilles tendon pain due to partial rupture, with high success rates in most cases 4, 5