Treatment for Partial Achilles Tendon Midsubstance Tear
For partial midsubstance Achilles tendon tears, conservative treatment with early protected mobilization is recommended as the first-line approach, including regular calf muscle stretching, activity modification, and orthotic devices to reduce tension on the Achilles tendon. 1, 2
Initial Conservative Management
- Begin with activity limitation that avoids movements aggravating the pain, but complete immobilization should be avoided to prevent muscular atrophy and deconditioning 3
- Apply ice through a wet towel for 10-minute periods to reduce inflammation and provide short-term pain relief 3, 1
- Implement regular calf muscle and Achilles tendon stretching exercises daily to improve flexibility and reduce pain 1
- Use nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, with topical NSAIDs being an option to avoid gastrointestinal side effects 3
- Recommend open-backed shoes to reduce pressure on the inflamed area 3, 1
- Prescribe heel lifts or orthotic devices to reduce tension on the Achilles tendon 3, 1
- Encourage weight loss if indicated to reduce stress on the tendon 3, 1
Progressive Treatment (if no improvement after 6 weeks)
- Transition to a protective device that allows mobilization by 2-4 weeks, with a splint or modified cast device that limits dorsiflexion to protect the healing tendon 3
- Consider early (≤2 weeks) protected weight bearing with limitation of dorsiflexion 3
- Implement eccentric exercise protocols which have proven beneficial in Achilles tendinopathy 3
- Refer to a podiatric foot and ankle surgeon if no improvement occurs after 6 weeks of initial treatment 3
Advanced Treatment Options (if conservative treatment fails)
- Consider immobilization with a walking boot or cast for more stubborn cases 1
- Advanced imaging such as MRI may be needed to assess the condition more thoroughly 1
- For persistent cases unresponsive to conservative management (typically after 2-3 months), consider:
Important Considerations and Pitfalls
- Patient compliance with treatment protocols is crucial to prevent complications and ensure optimal healing 3
- Avoid local corticosteroid injections directly into the tendon substance as they may inhibit healing and reduce tensile strength, potentially predisposing to spontaneous rupture 3
- The Achillon® mini-open suture system is a surgical option with a relatively low complication rate (8.3%) for cases requiring surgical intervention 7
- Early mobilization allows quicker return to activities during the first 6 months compared to traditional immobilization, though ultimate functional outcomes are similar regardless of the postoperative weight-bearing protocol 3
- Microcurrent therapy may be considered as an adjunct to complex conservative treatment, with studies showing good results in pain reduction 4
Remember that while most partial Achilles tendon tears respond well to conservative management, persistent symptoms beyond 2-3 months may require consideration of more advanced interventions or surgical approaches 2, 6.