What is the recommended treatment for a partial Achilles tendon rupture?

Treatment of Partial Achilles Tendon Rupture

The recommended treatment for a partial Achilles tendon rupture is conservative management with relative rest, ice therapy, NSAIDs, heel lifts, and eccentric strengthening exercises for 6-8 weeks. 1

Diagnostic Approach

Before initiating treatment, proper diagnosis is essential:

• Physical examination should include:

  • Thompson/Simonds squeeze test
  • Assessment of decreased ankle plantar flexion strength
  • Checking for a palpable gap
  • Evaluation of passive ankle dorsiflexion

• Imaging:

  • MRI is highly accurate with 95% sensitivity and 95% specificity 1
  • Ultrasound is also effective with 92% accuracy for differentiating full versus partial tears 1

Treatment Algorithm for Partial Achilles Rupture

First-Line Treatment (Conservative Management)

1. Initial 6-8 week protocol:

   • Relative rest (reducing activities that exacerbate symptoms)
   • Ice therapy for pain management
   • NSAIDs for acute pain relief (not recommended for long-term use)
   • Heel lifts or orthoses to reduce tendon strain
   • Open-backed shoes to reduce pressure on the tendon
   • Eccentric strengthening exercises (most effective conservative treatment)
   • Weight loss if indicated 1

2. Rehabilitation exercises:

   • Tensile loading exercises to stimulate collagen production
   • Eccentric strengthening exercises
   • Stretching exercises for posterior thigh muscles 1

3. Early protected weight-bearing and mobilization to prevent muscle atrophy and deconditioning 1

Treatment Monitoring

• Regular clinical assessment of pain and function
• Progressive return to activities based on functional improvement
• Most patients (80%) fully recover within 3-6 months with proper conservative care 1

When to Consider Surgery

• Persistent partial ruptures not responding to 2-3 months of conservative treatment 1
• Young, active patients and athletes may benefit from surgical intervention if conservative treatment fails 1, 2

Surgical Options (If Conservative Treatment Fails)

1. Open repair:

   • Traditional approach with good to excellent outcomes
   • Higher risk of wound complications 2, 3

2. Minimally invasive repair:

   • Comparable functional results to open repair
   • Minimal soft tissue complications 4
   • May provide the best balance between preventing rerupture and avoiding complications 1

3. Percutaneous repair:

   • Shorter operation duration compared to open repair
   • Lower risk of infection but higher risk of sural nerve injury 1, 3

Post-Surgical Management

• Early mobilization with functional bracing shows better outcomes than cast immobilization
• Functional bracing is associated with shorter hospital stay, less time off work, quicker return to sports, and lower complication rates 5, 3
• Intermittent pneumatic compression (IPC) may enhance tendon healing during immobilization by improving blood flow 6

Common Pitfalls to Avoid

• Misdiagnosis (most cases labeled as "tendonitis" are actually degenerative tendinopathy) 1
• Injecting corticosteroids directly into the tendon (increases rupture risk) 1
• Prolonged immobilization leading to muscle atrophy and deconditioning 1
• Inadequate imaging for proper diagnosis 1
• Overly aggressive early rehabilitation 1
• Neglecting biomechanical factors (foot pronation, pes planus, heel varus) 1

Special Considerations

• Bilateral tendon damage is common even when symptoms appear unilateral
• Address biomechanical factors and rehabilitation of both limbs to prevent future injury 1
• Athletes with complete ruptures typically require surgical repair to minimize re-rupture risk and optimize return to sport 1