Management of Achilles Tendon Rupture

Initial Assessment

The diagnosis of Achilles tendon rupture should be confirmed using at least two of the following: Thompson/Simonds squeeze test, decreased ankle plantar flexion strength, presence of a palpable gap, and increased passive ankle dorsiflexion 3
Advanced imaging (ultrasound or MRI) is not routinely necessary when clinical diagnosis is clear but can be used for confirmation in uncertain cases 3

Non-surgical treatment is preferred for nursing home patients due to similar functional outcomes to surgery when combined with proper rehabilitation, and lower risk of complications, particularly wound-related issues 1, 2
The American Academy of Orthopaedic Surgeons recommends non-surgical management with functional rehabilitation for nursing home patients with Achilles tendon rupture due to lower complication rates and similar outcomes to surgery in this population 1, 2

Progress to protected weight bearing within 2 weeks if possible 3
Transition to a protective device that limits dorsiflexion after initial immobilization period 3
Begin mobilization by 2-4 weeks using a protective device 3

Patient compliance with treatment protocols is crucial to prevent rerupture 3
Nursing home setting may present challenges for rehabilitation adherence, requiring close supervision and modified protocols 1
Monitor for complications such as deep vein thrombosis (DVT), which can occur with both surgical and non-surgical management 1, 2

Deep vein thrombosis is a potential complication that requires monitoring 1
Residual tendon lengthening affecting function is a potential complication that requires monitoring 1

Regular assessment of healing progress and functional recovery is necessary 3
Adjustment of rehabilitation protocols based on patient progress and tolerance is necessary 3