Non-Surgical Management of Achilles Ruptures

1. Acute Achilles tendon tears are becoming more common as individuals stay more active in their later years. 2. An acute tear is typically diagnosed from the patient's history and by examination of the affected foot. Patients typically have a palpable defect, a positive result in the Thompson squeeze test, and are unable to perform a single-limb rise. 3. Ultrasound imaging and MRI can provide accurate diagnosis of an acute Achilles tendon tear and can help evaluate the amount of gap between the tendon edges and the quality of the remnant tendon. 4. Patients showing less than 5 mm of gap between the tendon edges with maximum plantarflexion, 10 mm, with the foot in neutral, or patients showing apposition of the tendon edges with 20 degrees of plantarflexion are candidates for non-operative management. 5. Functional rehabilitation of these patients with a removable cast or boot with minimal restriction of weight bearing and motion leads to increased patient satisfaction and greater likelihood of return to preinjury activities 6. Patients must cooperate with the strict requirements of the non-operative rehabilitation because early discontinuation of immobilization will result in rerupture and a poor outcome.