From the Guidelines
The most appropriate treatment for an interstitial Achilles tendon tear with tendon thickening in a low-demand 76-year-old female patient with limited physical activity is conservative management.
Treatment Options
- Eccentric strength training is a popular and effective option for treating Achilles tendinopathy, as it helps to improve tendon strength and reduce pain 1.
- Stretching and deep friction massage of the gastrocnemius-soleus complex can also be beneficial in reducing pain and improving mobility 1.
- Heel lift orthotics can be used to unload the tendon and provide pain relief, especially in patients with anatomic misalignment or overpronation 1.
Rationale
Given the patient's age and limited physical activity, conservative management is the preferred treatment approach, as it is less invasive and has a lower risk of complications compared to surgery.
Surgery
Surgery may be considered only if pain persists despite a well-managed conservative treatment trial, and after referral to an orthopedic surgeon for surgical evaluation 1.
Important Considerations
It is essential to pay special attention to anatomic deformities, such as forefoot and heel varus, and excessive pes planus or foot pronation, which are often associated with Achilles tendinopathy, and address them with shoe orthotics if necessary 1.
From the Research
Treatment Options for Interstitial Achilles Tendon Tear with Tendon Thickening
- For a low-demand 76-year-old female patient with limited physical activity, conservative treatments may be considered, such as:
- In cases of interstitial Achilles tendon tears with tendon thickening, injection therapies such as platelet-rich plasma injections or microfragmented adipose tissue injections may be considered, as they have shown promise in promoting healing and improving function 3
- It is essential to note that the size of the tendon gap may affect patient-reported outcomes, and gaps greater than 5mm or 10mm may be associated with lower outcomes 4
- Surgical options may not be the preferred treatment for low-demand patients, as nonoperative treatment is often recommended for normal demand patients 5
Diagnostic Considerations
- Ultrasound and magnetic resonance imaging (MRI) can be useful in diagnosing Achilles tendon tears and thickening, with MRI providing slightly better sensitivity and specificity 2
- Patient self-reports of morning stiffness and/or pain in the tendon area, pain on palpation of the tendon, and detection of Achilles tendon thickening are also useful diagnostic tools 2
Rehabilitation and Recovery
- Functional rehabilitation has become an increasingly popular treatment for Achilles tendon ruptures, providing comparably low re-rupture rates to surgery, while avoiding risks of surgical complications 4
- Prolonged immobility following tendon rupture can cause increased scar tissue proliferation, hindering functional rehabilitation progress and negatively impacting the reparative process 6