Treatment of Partial Thickness Achilles Tendon Tear
Begin with a minimum 3-6 months of conservative management including relative rest, NSAIDs, ice therapy, and eccentric strengthening exercises before considering surgical intervention. 1, 2
Initial Conservative Treatment (First-Line)
Conservative management successfully resolves approximately 80% of tendon injuries within 3-6 months and should be the primary approach for partial Achilles tears. 1, 2
Core Conservative Interventions
Relative rest with activity modification to reduce repetitive stress while maintaining some activity to prevent muscle atrophy and deconditioning 1, 2
NSAIDs (oral or topical) for acute pain relief, with topical formulations preferred to eliminate gastrointestinal hemorrhage risk 1, 2
Ice therapy applied through a wet towel for 10-minute periods to reduce pain and blunt inflammatory response 1, 2
Eccentric strengthening exercises as the cornerstone of rehabilitation—these stimulate collagen production and guide proper fiber alignment of newly formed collagen 1, 2
Progressive rehabilitation program with controlled tendon loading is essential for tissue healing 3
Treatment Duration and Monitoring
Continue conservative treatment for a full 3-6 months before escalating to more invasive options 1, 2, 4
Clinical improvement should be monitored through ankle dorsiflexion range of motion and functional hop tests 3
MRI or ultrasound imaging can confirm tissue repair and guide treatment progression 5, 3
Second-Line Interventions (If Conservative Measures Plateau)
Corticosteroid Injections - Use With Extreme Caution
CRITICAL PITFALL: Never inject corticosteroids directly into the Achilles tendon substance—this weakens the tendon and dramatically increases rupture risk 6, 1
Corticosteroid injections may provide short-term pain relief but do not improve long-term outcomes and may inhibit healing 1, 2
Avoid multiple injections due to cumulative deleterious effects on tendon healing 1
If used, inject only in peritendinous tissues, never into tendon substance 6
Advanced Non-Surgical Options
Extracorporeal shock wave therapy (ESWT) is safe, noninvasive, and effective for chronic tendinopathy when conservative measures fail 1, 2, 4
Platelet-rich plasma (PRP) injections may promote rapid tendon healing with high-quality tissue formation, though this represents emerging evidence 5
Additional modalities include electrical stimulation and photobiomodulation as adjuncts to exercise therapy 3
Surgical Management (Reserved for Treatment Failures)
Surgery is indicated only after 6 months of well-managed conservative treatment has failed 1, 4
Surgical techniques typically involve excision of abnormal tendon tissue and longitudinal tenotomies to release scarring and fibrosis 2
Arthroscopic or open surgical repair yields excellent functional results and high patient satisfaction when appropriately indicated after failed conservative care 1
Approximately 25% of athletes with Achilles tendon overuse injuries ultimately require surgery, with frequency increasing with symptom duration 7
Critical Clinical Pitfalls to Avoid
Never rush to surgery without at least 3-6 months of comprehensive conservative treatment 1, 4
Never inject corticosteroids into the tendon substance itself 6, 1
Do not abandon conservative treatment prematurely—most patients (80%) fully recover with appropriate non-surgical management 1, 2
Avoid multiple corticosteroid injections due to cumulative tendon damage 1
Expected Outcomes and Return to Activity
With appropriate conservative treatment, athletes can return to competitive sports within 2-3 months for partial tears 5, 3
Following surgery, approximately 70-90% of athletes successfully return to pre-injury activity levels 7
Conservative treatment enabled return to pre-injury sports activity at 6 months in documented cases of partial Achilles tears 3
Patients should understand that symptoms may recur with either conservative or surgical approaches 4