Acute Achilles Tendon Rupture: A Review of the Current Best Practice Advice

Your opponent friend Bob jumps up to grab a rebound in the twice-a-week pick-up basketball game, then painfully grabs his right lower calf muscle’s tendon. He hobbles off the court with one sore heel cord. Bob has just joined the growing population of middle-agers with an Achilles tendon strain. The likelihood of Achilles tendon tears has grown in recent decades.   A recent review of the research has found strong support that men, like Bob, around thirty to forty years and women between sixty to eighty are struck with this common injury.

This review article aimed to add strength to the current ‘weak’ body of research on the appropriate management of torn Achilles tendons.  They highlighted the growing research on best management this calf injury both with and without surgery. The authors dug into the studies on this topic and followed groups of injured study subjects to learn more about the effects of complications (for example, repeat ruptures or infections) and/or successes. They also assessed how well they returned to their prior daily activities in the weeks and years following the tendon tear.

When a patient is examined in a medical provider’s office for this injury, there are many assessment options. Expensive MRI’s, ultrasound tests, squeezing the calf and feeling for a gap along the tendon are some of the common injury tests. This review found the calf squeeze test, also known as the Thompson test was the most effective way to diagnose a full Achilles tendon tear.  The provider should be on high alert for this injury when the patient older than fifty-five, or obese, or is injured participating in something nonathletic, or all of the above. 

The role of physical therapy and best-practice plans to improve the patient’s function were reviewed as well.  These well-researched action plans that do not involve a surgical repair were found to effectively reduce the tendon injury from happening again. Patients that opted to undergo surgical treatments had some earlier improvements in tasks like walking and getting back to work, but more recent studies suggested that the improvements were short-lived or minor.

One common problem associated with this tendon injury is a higher risk of a blood clot in the veins of the lower leg.  This study found no support that a tear in your Achilles tendon made you more at risk than any other injury to your foot or ankle. The most common risk factors for a dangerous clot problem were in patients that did not get up and move after their injury and/or those older than forty.