Blog Layout

Management of Achilles Tendon Ruptures

Ruby Elder • May 30, 2023

What is an Achilles Tendon rupture?

Achilles tendon rupture is an injury that occurs when the tendon that attaches the calf

muscle to the heel bone is torn.

It typically occurs during a fast acceleration from standing and the patient feels they have been hit in the back of the leg and hear a loud pop.

Who is at risk?

Males between the ages of 30-50 who participate in sports with explosive movements such as

basketball, soccer or tennis are most at risk of Achilles rupture.

Medical conditions such as

diabetes,
obesity
high blood pressure

Can also predispose to achilles rupture.

Management

The management of achilles tendon rupture has evolved over the years, and this blog post

aims to review the most recent approaches to initial management of the injury, with a

particular focus on surgical vs conservative management.

Conservative management

This involves non-surgical treatment options such as:

immobilisation in a boot with heel
wedges or a plaster cast, non-steroidal anti-inflammatory (NSAIDs)
guidance through a physiotherapy program

This approach is often chosen by patients who have less active

lifestyles and may have underlying medical conditions that make surgery a higher risk.

A recent systematic review published in the British Journal of Sports Medicine (2021)

evaluated the effectiveness of conservative management for achilles tendon ruptures. The

review found that immobilisation in a cast or boot within 2 weeks of initial injury, followed

by functional rehabilitation had similar outcomes to surgery in terms of overall recovery and

return to sports. Furthermore, patients who participated in an accelerated functional

rehabilitation program with early range of motion were at no more risk of re-rupture than

surgical patients.

Surgical management

Surgical management involves repairing the torn tendon through a surgical incision under

anaesthetic. This approach has historically been the favoured option, however recent

evidence is indicating similar results in conservative management regarding return to sport

and re-rupture rate, with a lower risk of complications.

A systematic review from the Journal of Foot and Ankle Surgery compared outcomes of

surgically managed patients with conservative management.

They reported surgical management had a higher risk of complications such as:

wound infection
nerve damage
blood clots

Contrary to the review discussed previously, there was a higher re-rupture rate

in conservatively managed patients. However these patients were not require to undergo a

functional rehabilitation program following the acute management.

Comparing Conservative and Surgical Management

Overall, the evidence currently supports conservative management with a functional

rehabilitation program. This plan has demonstrated similar outcomes as surgical

management regarding:

re-rupture risk
return to sport time
and eliminates risks associated with surgery

It is worth noting a higher re-rupture risk has been reported in these articles

with patients who did not undergo a functional rehabilitation program during conservative

management. This emphasises the importance of rehabilitation regardless of operative or

conservative management.

In conclusion, the management of achilles tendon has evolved over the years. Decision

making is a collaborative process and should be made on a case by case basis with the

patients activity level, overall health and personal preferences in mind.

The current literature supports conservative management as a viable option that eliminates

complications associated with surgery and produces similar outcomes regarding return to

sport and ankle function.

References:

Maffulli, N., Loppini, M., & Spiezia, F. (2019). Management of acute Achilles tendon ruptures

in athletes. Foot and Ankle Clinics, 24(4), 761-775. https://doi.org/10.1016/j.fcl.2019.06.002

Ochen Y, Beks R B, van Heijl M, Hietbrink F, Leenen L P H, van der Velde D et al. Operative

treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review

and meta-analysis BJM, 2019 doi:10.1136/bmj.k5120

Zhang, S., Shi, W., Ren, L., Chen, X., & Wang, H. (2021). Surgical versus conservative

treatment for acute Achilles tendon rupture: A systematic review and meta-analysis of

randomized controlled trials. Journal of Orthopaedic Surgery and Research, 16(1), 1-9.

https://doi.org/10.1186/s13018-021-02779-0

< Older Post Newer Post >

The ("Not So") Simple Ankle Injury

By Shane O'Sullivan • 18 Mar, 2024

Picture this : you're walking in the sunshine, whistling dixie and having the best day. All of a sudden you step wrong, and your ankle twists. Ouch! You've got yourself a ‘ simple ’ ankle sprain, right? Well, not so fast. What might seem like a minor injury can sometimes turn into a bigger problem than you'd expect. Here's the lowdown: An ankle sprain happens when the bands of tissue (ligaments) that hold your ankle bones together get stretched or torn. You might think r est , ice , and a bit of elevation will sort it out – and sometimes they do. But other times, there's more going on under the surface. Amazingly, Once you have injured your ankle for the first time, you have a whopping 47% chance of re-injuring that same ankle in the future! Not to mention 40% of first time ankle sprainers, go on to develop Chronic Ankle Instability (CAI)!

Anterior Knee Pain

By Shane O'Sullivan • 26 Feb, 2024

Do you get pain at the front of your knee? Walking downstairs? Sometimes you feel like you have to go down sideways ! When you’re hiking…… Especially when you have to go downhill? Playing sport…. Especially when you have to do a lot of short stop and start type movements?

ACL Injury - Do I need surgery?

By Shane O'Sullivan • 30 Jan, 2024

So, you have done your ACL. You felt the pop, your knee collapsed and the pain was excruciating for the first 30 seconds. You hobble off the field, and thoughts start rushing through your mind… Oh no I'm going to need surgery! How much will it cost me? How long will I be ou t for?

Adhesive Capsulitis

By Jacob Jewson • 24 Oct, 2023

Adhesive capsulitis , or frozen shoulder , is a condition that affects the capsule/lining of the shoulder joint. It occurs most commonly in people aged 40-60 and while it can result from an injury or surgery to the shoulder, in the majority of cases there is no obvious cause. The condition involves inflammation and scarring of the shoulder joint capsule. The inflammation causes pain, particularly at night, while the scarring results in reduced range of motion in the shoulder joint as the capsule tightens. Then if the shoulder is pushed into extreme positions, the scar tissue becomes irritated, causing more discomfort. While there is often no cause, adhesive capsulitis occurs more commonly in people with diabetes and other systemic inflammatory diseases, so it may be worth performing some blood tests if these haven’t been done previously. Imaging with an X-ray and ultrasound (or sometimes an MRI) is not always essential as adhesive capsulitis can be diagnosed based on symptoms and clinical tests, but may be performed to ensure there is not another diagnosis to explain the symptoms. Adhesive capsulitis has a natural history of resolution after typically 12-24 months. It is characterised by 3 phases: freezing, frozen and thawing phase. The freezing phase is often the most painful, as the inflammation causes progressive pain and loss of range of motion. The duration of symptoms is often unchanged by treatments, however the goal of management strategies is to reduce pain and improve function during the course of the condition.

The Winning Advantage: 5 Reasons to Consult a Sports Physician

By Shane O'Sullivan • 19 Sep, 2023

Whether you're training for the Melbourne marathon, a dedicated athlete or just someone who enjoys staying active, the guidance of a sports physician can be a game-changer! Our very own Dr Jacob Jewson offers a unique set of skills and insights that can enhance your performance, prevent injuries, and keep you in peak condition.

Jaw Pain Temporomandibular Disorders (TMD)

By Sue Gertzel • 11 Apr, 2023

Does the thought of biting into a hard apple give you goose bumps? The constant clicking and pain that occurs when you bite is enough to turn you off hard fruit - For life! & Don't even talk about yawning......

The truth behind why we don't need to stretch in our warm ups!

By Shane O'Sullivan • 14 Mar, 2023

Stretching has long been considered a vital component of a proper warm-up before physical activity..... However, recent studies suggest that stretching may not be as effective as once thought for injury prevention , especially when done before exercise!