Treating Achilles Tendon Rupture: Strategies and Recovery
Case Question
A) Start early motion at day 1 from injury
B) Start early motion after 3 weeks of immobilization
C) Wait until 8 weeks to begin range of motion exercises
D) Range of motion exercises should not be started until 12 weeks and ultrasound confirms tendon healing.
Integrity of the Achilles tendon can be assessed by squeezing the calf, known as Thompson’s test. Absence of plantarflexion indicates a positive test (Figure 1).

Figure 1: Illustration of Thompson Test

Figure 2: Clinical example of increased resting dorsiflexion (courtesy of orthobullets)

Figure 3: MRI demonstrating achilles tendon rupture (courtesy of orthobullets)
Case Conclusion
Correct Answer: B. Range of motion exercises should begin after 3 weeks of immobilization. In June 2020 Barford et al. looked at the roll of early controlled motion after achilles tendon rupture at three weeks from the time of injury. They found that the group that performed early range of motion and those with complete immobilization did not have any difference in re-rupture rates of the tendon. However, early range of motion did not lead to any statistically significant improvement in any of their primary endpoints.
Kelsey Diemer, DO
NCH Healthcare System
Naples, Florida
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