Achilles Tendon Rupture: Therapy

General measures

  • Review of permanent medication due topossible effect on existing disease.

Conventional non-surgical therapy methods

  • Conservative therapy: pointed foot position for several weeks for scar healing by approximation of the tendon ends. Full weight-bearing is recommended from day one. Indication:
    • Dehiscence (divergence) of the tendon stumps in neutral position < 10 mm and in 20° plantarflexion (flexion in the direction of the sole of the foot) the complete approximation of the tendon stumps is achieved.
    • Patients with low mobility requirements
  • Treatment regimen for conservative therapy:
    • Day 0 – Day 2: Ventral lower leg splint (plastic long sleeve; “to the front of the body”) in 20° plantarflexion (movement of the foot in the ankle joint in the direction of the sole of the foot = pointed foot position/tiptoe gait), elevation, cooling.
    • Day 3 – 5: special shoe (therapeutic shoe) with 3 cm heel elevation (24 hours daily); training on forearm crutches (UAGST).
    • Day 6 – 4th week: full load in the special shoe with 3 cm heel; isometric exercises, massage, possibly lymphatic drainage.
    • 4th week: ultrasound control [fiber reformation around the rupture, tendon thickness 6-8 mm]Palpation: tendon pervasively palpableFunction: flexion against resistance shows the contraction of the gastrocnemius muscle.
    • 5th -6th week: special shoe with 2 cm heel increase; full load for the first time!
    • 7th -8th week: ultrasound control [fiber texture recognizable; tendon thickness 10-14 mm]Function: plantar flexion force against resistance possibleContinued: Special shoe with 1 cm heel, full load
    • > 9th week: omit the special shoe; running training, cycling, swimming; proprioception training.
  • Notice. With conservative therapy, the risk of re-rupture (recurrence of rupture) is higher; furthermore, there is an increased likelihood of persistent (permanent) reduction in strength of plantar flexion.
  • Analgesics (painkillers) if needed; if necessary, administration of anti-inflammatory drugs (anti-inflammatory drugs).
  • Thrombosis prophylaxis
  • Autologous conditioned plasma (ACP) therapy (administration of platelet-rich plasma (“PRP”)): A randomized placebo-controlled trial of more than 200 patients with Achilles tendon rupture found no significant difference between intervention and placebo groups, so the use of ACP in soft tissue injuries must be questioned.

Medical aids

  • Forearm crutches
  • Orthotics, special shoes (therapeutic shoes)
  • Shoe heel elevation

Sports Medicine

Physical therapy (including physiotherapy)