What is the treatment for a ruptured gastrocnemius tendon?

Treatment of Ruptured Gastrocnemius Tendon

For a ruptured gastrocnemius tendon (not Achilles), conservative treatment with protected weight bearing and functional rehabilitation is the primary approach, as surgical intervention is reserved for younger, athletic patients who demonstrate superior outcomes with operative repair.

Important Distinction: Gastrocnemius vs Achilles Tendon

The gastrocnemius muscle rupture is a distinct injury from Achilles tendon rupture. The gastrocnemius typically ruptures at the musculotendinous junction of the medial head during sudden overstretching with combined ankle dorsiflexion and knee extension 1.

Treatment Algorithm

Conservative Management (First-Line for Most Patients)

• Initial immobilization with the ankle in slight plantarflexion to reduce tension on the injured muscle 1
• Protected weight bearing should begin within 2 weeks to prevent complications and promote healing 2
• Cryotherapy applied through a wet towel for 10-minute periods provides acute pain relief 3
• Relative rest of the affected area is essential to prevent further damage while promoting healing 3

Surgical Management (Selective Indications)

Surgical exploration with direct suture repair is indicated for younger, athletic patients who require return to high-level sports activity 1.

• A 2-year follow-up study demonstrated that surgical suture of the muscle gave better results than conservative treatment, particularly in younger and athletic patients 1
• Surgical exploration verifies rupture at the musculotendinous junction and allows direct repair 1

Rehabilitation Protocol

Early Phase (0-4 Weeks)

• Protective device limiting dorsiflexion should be used to protect the healing tissue 2
• Begin mobilization by 2-4 weeks using a protective device that prevents excessive stretch 2, 4
• NSAIDs (topical or systemic) are effective for short-term pain relief, with topical formulations having fewer systemic side effects 3

Progressive Phase (4-12 Weeks)

• Eccentric strengthening exercises should be implemented as they are effective for treatment and may reverse degenerative changes 3
• Most patients with tendon injuries fully recover within three to six months 3

Critical Caveats

Avoid Corticosteroid Injections

• Locally injected corticosteroids may provide acute pain relief but should be used with extreme caution as they inhibit healing, reduce tensile strength, and potentially predispose to spontaneous rupture 3

Patient Compliance is Essential

• Patient adherence to the prescribed protocol is crucial to prevent complications and ensure optimal healing 2, 4
• Non-compliance with protective devices significantly increases rerupture risk 5

Monitor for Complications

• Deep vein thrombosis requires monitoring in all patients, regardless of treatment approach 2, 4
• Residual muscle lengthening can affect function and may require specialized intervention in athletes 6

Outcomes

• By 12 months, outcomes such as pain and function are similar between different treatment protocols when properly executed 2
• Athletic patients treated surgically demonstrate better return to sport compared to conservative management 1
• The AOFAS hindfoot score shows significant improvement with appropriate treatment, with the greatest gains in activity limitation domains 6