Achilles Tendon Ruptures: Cause, Diagnosis, Treatment

April 20, 2019

Part 4

Achilles Tendon Ruptures: Treatment

Initially, the RICE protocol should be followed as soon as possible to minimize pain, inflammation and swelling: Rest, Ice, Compression, and Elevation. Acetaminophen to address pain, or Ibuprofen to address pain and inflammation may also be taken.

Options are both surgical and non-surgical, but the goal for both is to restore the normal length and tension of the muscle/tendon complex to allow you to do the activities you did before the injury. Unfortunately, the protection needed to protect the repair can lead to stiffness, and the motion needed to restore normal motion can harm the repair and lead to reinjury. This is true for surgical and non-surgical options alike.

Non-surgical options, which are often used for the ill, elderly or non-athlete, can avoid the expense or possible complications of surgery, but involve long periods of casting, braces, foot orthotics and, of course, physical therapy. This option has its own complications, however, in that muscle atrophy and weakness can be significant and shortening of the muscle/tendon complex can occur. This can result in the higher re-rupture rate that studies confirm when the ends of the tendon are >5 mm apart.

However, recent studies suggest that re-rupture rates are comparable for surgical and non-surgical treatment when the ends of the tendon are less than 5 mm apart. So current thought is that non-surgical intervention may be the better option for a large population of individuals who have experienced this type of injury.

Understandably, surgery has historically been the option of choice for athletes and people with high levels of physical activity, as it allows for a quicker return to activity and sport and a higher level of function with less shortening of the muscle tendon complex. Without surgery, the duration is longer before resuming pre-injury level of play, and there will be muscle atrophy, weakness, and range of motion (ROM) deficits that can impact performance. There is also evidence that the incidence of re-rupture is less with surgical treatment IF the distance between the ends of the tendon in the non-surgical casting/bracing process cannot be brought to within 5mm.

However, surgical repair is not without its risk and complications. Because it involves both cutting the skin and suturing the ends of the tendon back together, there are risks from anesthesia, infection from the incision, nerve damage from the procedure, and the danger of blood clots or excessive bleeding. Additional complications can include scarring and less-than-optimal length and tension, with sub-optimal strength and range of motion (ROM). Because of these factors, and the recent comparative outcome studies between non-surgical and surgical intervention, serious consideration is warranted when determining what course of intervention you should  take.



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