Treatment of Achilles Tendon Rupture
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)
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
- O’Brien M. The anatomy of the Achilles tendon. Foot Ankle Clin. 2005 Jun;10(2):225-38. doi: 10.1016/j.fcl.2005.01.011. PMID: 15922915.
- Hall MM, Finnoff JT, Smith J. Musculoskeletal complications of fluoroquinolones: guidelines and precautions for usage in the athletic population. PM R. 2011 Feb;3(2):132-42. doi: 10.1016/j.pmrj.2010.10.003. PMID: 21333952.
- Lemme NJ, Li NY, DeFroda SF, Kleiner J, Owens BD. Epidemiology of Achilles Tendon Ruptures in the United States: Athletic and Nonathletic Injuries From 2012 to 2016. Orthopaedic Journal of Sports Medicine. November 2018.
- Gravlee JR, Hatch RL, Galea AM. Achilles tendon rupture: a challenging diagnosis. J Am Board Fam Pract. 2000 Sep-Oct;13(5):371-3. PMID: 11001009.
- Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. J Bone Joint Surg Am. 2010 Dec 1;92(17):2767-75. doi: 10.2106/JBJS.I.01401. Epub 2010 Oct 29. PMID: 21037028.
- Heckman DS, Gluck GS, Parekh SG. Tendon Disorders of the Foot and Ankle, Part 2: Achilles Tendon Disorders. The American Journal of Sports Medicine. 2009;37(6):1223-1234.
- Khan RJ, Fick D, Keogh A, Crawford J, Brammar T, Parker M. Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2005 Oct;87(10):2202-10. doi: 10.2106/JBJS.D.03049. PMID: 16203884.
- Brotzman S, Manske R, Daugherty K. Clinical Orthopaedic Rehabilitation An Evidence-Based Approach / S. Brent Brotzman, Robert C. Manske ; Managing Editor, Kay Daugherty [e-book]. Philadelphia, PA : Elsevier Mosby, c2011.; 2011. Available from: Library Catalog-Arizona, Ipswich, MA. Accessed July 3, 2014.
- Costa ML, Achten J, Marian IR, Dutton SJ, Lamb SE, Ollivere B, Maredza M, Petrou S, Kearney RS; UKSTAR trial collaborators. Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet. 2020 Feb 8;395(10222):441-448. doi: 10.1016/S0140-6736(19)32942-3. PMID: 32035553; PMCID: PMC7016510
- Young SW, Patel A, Zhu M, van Dijck S, McNair P, Bevan WP, Tomlinson M. Weight-Bearing in the Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Randomized Controlled Trial. J Bone Joint Surg Am. 2014 Jul 2;96(13):1073-1079. doi: 10.2106/JBJS.M.00248. Epub 2014 Jul 2. PMID: 24990972.
- Zellers JA, Carmont MR, Grävare Silbernagel K. Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play. Br J Sports Med. 2016 Nov;50(21):1325-1332. doi: 10.1136/bjsports-2016-096106. Epub 2016 Jun 3. PMID: 27259751; PMCID: PMC5136353.
- 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.
- Barfod, Kristoffer Weisskirchner, et al. “Nonoperative Dynamic Treatment of Acute Achilles Tendon Rupture: The Influence of Early Weight-Bearing on Clinical Outcome: A Blinded, Randomized Controlled Trial.” The Journal of Bone and Joint Surgery. American Volume, vol. 96, no. 18, Sept. 2014, pp. 1497–503. PubMed, doi:10.2106/JBJS.M.01273.