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Management of Achilles Tendon Ruptures

Ruby Elder • May 30, 2023

What is an Achilles Tendon rupture?

Achilles tendon rupture is an injury that occurs when the tendon that attaches the calf

muscle to the heel bone is torn.


It typically occurs during a fast acceleration from standing and the patient feels they have been hit in the back of the leg and hear a loud pop.


Who is at risk?


Males between the ages of 30-50 who participate in sports with explosive movements such as

basketball, soccer or tennis are most at risk of Achilles rupture.


Medical conditions such as

  • diabetes,
  • obesity
  • high blood pressure


Can also predispose to achilles rupture.


Management


The management of achilles tendon rupture has evolved over the years, and this blog post

aims to review the most recent approaches to initial management of the injury, with a

particular focus on surgical vs conservative management.


Conservative management

This involves non-surgical treatment options such as: 


  • immobilisation in a boot with heel
  • wedges or a plaster cast, non-steroidal anti-inflammatory (NSAIDs)
  • guidance through a physiotherapy program


This approach is often chosen by patients who have less active

lifestyles and may have underlying medical conditions that make surgery a higher risk.


A recent systematic review published in the British Journal of Sports Medicine (2021)

evaluated the effectiveness of conservative management for achilles tendon ruptures. The

review found that immobilisation in a cast or boot within 2 weeks of initial injury, followed

by functional rehabilitation had similar outcomes to surgery in terms of overall recovery and

return to sports. Furthermore, patients who participated in an accelerated functional

rehabilitation program with early range of motion were at no more risk of re-rupture than

surgical patients.


Surgical management

Surgical management involves repairing the torn tendon through a surgical incision under

anaesthetic. This approach has historically been the favoured option, however recent

evidence is indicating similar results in conservative management regarding return to sport

and re-rupture rate, with a lower risk of complications.


A systematic review from the Journal of Foot and Ankle Surgery compared outcomes of

surgically managed patients with conservative management.

They reported surgical management had a higher risk of complications such as: 

  • wound infection
  • nerve damage
  • blood clots


Contrary to the review discussed previously, there was a higher re-rupture rate

in conservatively managed patients. However these patients were not require to undergo a

functional rehabilitation program following the acute management.


Comparing Conservative and Surgical Management


Overall, the evidence currently supports conservative management with a functional

rehabilitation program. This plan has demonstrated similar outcomes as surgical

management regarding:

  • re-rupture risk
  • return to sport time
  • and eliminates risks associated with surgery


It is worth noting a higher re-rupture risk has been reported in these articles

with patients who did not undergo a functional rehabilitation program during conservative

management. This emphasises the importance of rehabilitation regardless of operative or

conservative management.


In conclusion, the management of achilles tendon has evolved over the years. Decision

making is a collaborative process and should be made on a case by case basis with the

patients activity level, overall health and personal preferences in mind.


The current literature supports conservative management as a viable option that eliminates

complications associated with surgery and produces similar outcomes regarding return to

sport and ankle function.




References:

Maffulli, N., Loppini, M., & Spiezia, F. (2019). Management of acute Achilles tendon ruptures

in athletes. Foot and Ankle Clinics, 24(4), 761-775. https://doi.org/10.1016/j.fcl.2019.06.002


Ochen Y, Beks R B, van Heijl M, Hietbrink F, Leenen L P H, van der Velde D et al. Operative

treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review

and meta-analysis BJM, 2019 doi:10.1136/bmj.k5120


Zhang, S., Shi, W., Ren, L., Chen, X., & Wang, H. (2021). Surgical versus conservative

treatment for acute Achilles tendon rupture: A systematic review and meta-analysis of

randomized controlled trials. Journal of Orthopaedic Surgery and Research, 16(1), 1-9.

https://doi.org/10.1186/s13018-021-02779-0

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