Diagnosis and Treatment of Tendon Rupture and Ankle Swelling

Diagnostic Considerations

The American Academy of Orthopaedic Surgeons recommends performing at least two clinical tests, including the Thompson test, palpable gap, decreased ankle plantar flexion strength, and increased passive ankle dorsiflexion, to diagnose acute Achilles tendon rupture 2, 3
Severe night pain is a red flag for septic arthritis, inflammatory arthropathies, or neurologic causes, and requires urgent evaluation 1
Inability to bear weight requires immediate medical evaluation 1
Systemic symptoms, fever, or rapid progression of swelling suggest infection and need urgent joint aspiration and culture 1
Erythema may indicate septic arthritis, which can present without fever 1

The American Academy of Orthopaedic Surgeons states that both surgical repair and nonsurgical treatment are acceptable options for acute Achilles tendon rupture, with the choice depending on patient factors including activity level, age, and rupture characteristics 2, 6
Functional rehabilitation is strongly preferred over immobilization for better outcomes 2, 6
Supervised exercise therapy should be started as soon as possible, focusing on proprioception, strength, coordination, and function 1, 5
Semirigid ankle support is superior to elastic bandages and is the most cost-effective option 4, 5
Functional treatment allows return to work 7.1 days sooner than immobilization 5
Functional treatment allows return to sports 4.6 days sooner than immobilization 5
Nonsurgical treatment shows no significant difference from surgery in functional outcomes, pain levels, or time to return to work, though surgical repair has lower rerupture rates 2

Percutaneous repair results in significantly less wound breakdown, fewer scar adhesions, and higher patient satisfaction scores compared to open repair 6
Limited open repair allows faster return to normal walking, stair climbing, and sports compared to standard open repair 6
Open repair provides direct visualization but has higher rates of wound complications 6

The American Academy of Family Physicians recommends applying the PRICE protocol initially, though evidence for RICE alone is limited 4, 5
Protection with semirigid brace, rest for 3-5 days only, then early mobilization, ice/cryotherapy combined with exercise therapy, compression with functional support, and elevation to reduce swelling are all recommended 4, 5
NSAIDs reduce pain and swelling in the acute phase and may decrease time to return to usual activities, but should be used cautiously as they may suppress natural healing 4, 5
Supervised exercise therapy should be started immediately after the initial RICE period, focusing on proprioception, strength, coordination, and functional exercises 1, 5

Continuing to wear a semirigid ankle brace for prevention of recurrent injuries is recommended, as bracing is superior to taping and has level 1 evidence 5
Implementing neuromuscular training programs, including proprioceptive exercises, can help prevent recurrent sprains 5