Treatment of Achilles Tendon Rupture
By Kelsey Diemer, DO
NCH Healthcare System
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)
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.
Barfod, Kristoffer Weisskirchner, et al. “Efficacy of Early Controlled Motion of the Ankle Compared with Immobilisation in Non-Operative Treatment of Patients with an Acute Achilles Tendon Rupture: An Assessor-Blinded, Randomised Controlled Trial.” British Journal of Sports Medicine, vol. 54, no. 12, June 2020, pp. 719–24. PubMed, doi:10.1136/bjsports-2019-100709.
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