Welcome to Orthosports Question for Physiotherapists, August 2023. This month Dr John Negrine discusses Achilles Tendon Ruptures.
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QUESTION | WHICH ACHILLES TENDON RUPTURES CANNOT BE MANAGED NON SURGICALLY?
ANSWER | As you may know, 20 years ago in Sydney everybody had surgery for ruptured Achilles tendons. There has recently been interest based on quite good evidence that a properly treated non surgical rupture of the Achilles tendon in a compliant patient will in the long-term do just as well as a surgically treated one.
Unfortunately, there are a group of patients in whom non surgical treatment will never work.
Image 1: This is an intra-operative photograph of a patient with an Achilles tendon avulsion managed non surgically.
As can be seen the Achilles tendon is a long way from the insertion and never healed.
If a distal rupture is suspected a lateral x-ray will often show a flake of bone that has migrated proximally with the Achilles tendon as above.
I feel that a lateral xray is advisable in all cases of Achilles tendon rupture (more often than not however the patient arrives with an ultrasound reported incorrectly as showing a “partial rupture”).
The surgery is accompanied by a much longer convalescence (six weeks non-weight bearing and four weeks in a walking boot.