From the Guidelines
Achilles injuries, whether tendinitis or rupture, require immediate attention to prevent further damage and promote healing, with treatment options including rest, ice, compression, elevation, and potentially surgical repair for ruptures, as evidenced by studies such as 1 and 1. For mild Achilles tendinitis, the RICE protocol is recommended: Rest the affected area, apply Ice for 20 minutes every 2-3 hours, use Compression with an elastic bandage, and Elevate the foot above heart level. Some key points to consider in the management of Achilles injuries include:
- Taking over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours with food) or naproxen (220-440mg twice daily) to reduce pain and inflammation, as suggested by general management principles.
- Gentle stretching exercises, such as calf stretches held for 30 seconds and repeated 3 times daily, can help once acute pain subsides, promoting recovery and preventing further injury.
- For a suspected Achilles tendon rupture, characterized by a popping sensation and inability to stand on tiptoes, seeking immediate medical attention is crucial, as this may require surgical repair or immobilization, with options including open, limited open, and percutaneous techniques, as discussed in 1.
- The return to sports after surgical treatment of acute Achilles tendon rupture can be considered within 3 to 6 months, as indicated by 1, emphasizing the importance of patience and proper rehabilitation in the recovery process.
- It's also important to note that while studies like 1 discuss treatment options for heel pain, the specific management of Achilles injuries may differ, highlighting the need for tailored approaches based on the nature and severity of the injury.
From the Research
Overview of Achilles Injury
- Achilles tendon rupture is a common injury, typically occurring in middle-aged men who participate in recreational sports 2.
- The injury often presents with a loud popping noise and immediate pain and weakness of the lower extremity during actions such as jumping or running 2.
Diagnosis and Treatment
- The diagnosis of Achilles tendon rupture is made clinically, but an MRI is often obtained for confirmation of rupture and to aid in surgical planning 2.
- Treatment options include operative (open or minimally invasive approaches) or non-operative (functional bracing or plaster casting) methods 2.
- Neither treatment option is currently considered superior to the other in all cases, and the decision should be guided by the individual patient's goals and priorities 2.
- Minimally invasive surgery (MIS) was found to have a lower risk of complications resulting in surgery compared to other treatment options 3.
Risk Factors and Prevention
- Risk factors for Achilles tendon rupture include age, sex, and participation in sports that involve running, jumping, and agility activities 4.
- Regular physical activity can help promote tendon hypertrophy, increase nutrient delivery, and reduce collagen fiber fatigue, which can help prevent rupture 4.
- Eccentric exercise and shock wave therapies have been found to be effective in treating Achilles tendinopathy, a condition that can increase the risk of rupture 5.
Treatment Outcomes
- Studies have found that the risk of rerupture is similar across different treatment options, including open surgery, MIS, functional rehabilitation, and primary immobilization 3.
- The choice of treatment should be based on individual patient factors, such as age, activity level, and comorbidities 2, 3.
- Early functional treatment has been found to be effective in promoting tendon healing and reducing rehabilitation time 6.