Treatment

Treatment for a ruptured Achilles tendon often depends on your age, activity level and the severity of your injury. In general, younger and more active people, particularly athletes, tend to choose surgery to repair a completely ruptured Achilles tendon, while older people are more likely to opt for nonsurgical treatment.

Recent studies, however, have shown fairly equal effectiveness of both surgical and nonsurgical management.

Nonsurgical treatment

This approach typically involves:

  • Resting the tendon by using crutches
  • Applying ice to the area
  • Taking over-the-counter pain relievers
  • Keeping the ankle from moving for the first few weeks, usually with a walking boot with heel wedges or a cast, with the foot flexed down

Nonoperative treatment avoids the risks associated with surgery, such as infection.

However, a nonsurgical approach might increase your chances of re-rupture and recovery can take longer, although recent studies indicate favorable outcomes in people treated nonsurgically if they start rehabilitation with weight bearing early.

Surgery

The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair might be reinforced with other tendons.

Complications can include infection and nerve damage. Minimally invasive procedures reduce infection rates over those of open procedures.

Rehabilitation

After either treatment, you'll have physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to their former level of activity within four to six months. It's important to continue strength and stability training after that because some problems can persist for up to a year.

A type of rehabilitation known as functional rehabilitation also focuses on coordination of body parts and how you move. The purpose is to return you to your highest level of performance, as an athlete or in your everyday life.

One review study concluded that if you have access to functional rehabilitation, you might do just as well with nonsurgical treatment as with surgery. More study is needed.

Rehabilitation after either surgical or nonsurgical management is also trending toward moving earlier and progressing faster. Studies are ongoing in this area also.

Aug. 02, 2017
References
  1. Maughan KL. Achilles tendinopathy and tendon rupture. https://www.uptodate.com/contents/search. Accessed June 26, 2017.
  2. Achilles tendon rupture. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=av0003. Accessed June 26, 2017.
  3. Li Q, et al. Minimally invasive versus open surgery for acute Achilles tendon rupture: A systematic review of overlapping meta-analyses. Journal of Orthopaedic Surgery and Research. 2016;11:65.
  4. Zhang H, et al. Surgical versus conservative intervention for acute Achilles tendon rupture: A PRISMA-compliant systematic review of overlapping meta-analyses. Medicine. 2015;94:1.
  5. Functional rehabilitation. American Academy of Physical Medicine and Rehabilitation. http://www.aapmr.org/about-physiatry/conditions-treatments/musculoskeletal-medicine/functional-rehabilitation. Accessed June 27, 2017.
  6. Barfod KW, et al. Nonoperative dynamic treatment of acute Achilles tendon rupture: The influence of early weight-bearing on clinical outcome. Journal of Bone and Joint Surgery. 2014;96:1497.