Achilles Tendon Rupture in Older Age or Reduced Functional Demands
This protocol addresses the non-surgical management of Achilles tendon rupture in patients who are older, have reduced functional demands, or present with contraindications to surgery.
Clinical Scenario
Non-surgical management is appropriate when the tendon rupture gap measures less than 5 mm on ultrasonography with the foot in equinus. This threshold reliably confirms adequate apposition of the tendon ends and is the recommended cut-off for conservative treatment. Historically, older patients and those with reduced functional demands or distinct surgical contraindications have been directed toward this pathway.
Treatment Approach (partial overview)
Initial management centres on below-knee cast immobilization with the foot in plantar flexion to permit haematoma consolidation and restoration of tendon continuity, followed by a structured functional rehabilitation programme that combines protected weight-bearing and early controlled motion in an orthosis. The complete sequencing, progression criteria, and rehabilitation milestones are available in the full regimen.
Key Clinical Goal
Adequate Achilles tendon stump apposition confirmed on repeat ultrasound examination performed 2 to 5 days after the initial scan.
References
DOI: 10.1302/2046-3758.710.BJR-2018-0004.R2
- Historically, non-surgical treatment always tended to be offered to older patients and those with reduced functional demands, or who had distinct surgical contraindications.
- Therefore, a distance of less than 5 mm is more reliable to confirm adequate apposition of the tendon ends and hence is recommended as the cut-off point for conservative treatment.
- Immobilizing the ankle in equinus for one to three weeks is important in order to allow the haematoma to consolidate and also to restore the continuity of the tendon.
- The most widely used functional protocols combine protected weight-bearing and early controlled movement in an orthosis.
- This begins with a period of immobilization, gradually progressing from the maximum equinus position to a neutral position, using an elevated heel insert to bring the ends of the tendon closer together.
- The authors proposed that a repeat ultrasound examination should be performed two to five days after the initial ultrasound to confirm the indications for nonoperative treatment.
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