Achilles tendon rupture. Is casting enough?
Rupture of the Achilles tendon is relatively uncommon, but most primary care physicians are occasionally faced with evaluation and treatment of such an injury. Diagnosis is not difficult and is based almost solely on the history and physical findings. To avoid misdiagnosis, the Thompson test should be performed in any evaluation of ankle pain. The three management options are casting, open surgical repair, and percutaneous surgical repair. Incidence of rerupture is slightly higher with casting, but the greater costs and higher risk of complications with surgical treatment seem to outweigh the benefits. Because there is no conclusive evidence that functional activity is any better with surgical repair, we recommend casting for a minimum of 8 weeks. After this, the patient should wear a heel lift and begin a supervised physical rehabilitation program.