Achilles Tendon Ruptures Missed in One of Four Cases, But Surgery Not Needed for Most

The Journal of the American Osteopathic Association Study Finds
Proper Diagnosis and Conservative Treatment Yield Consistently Good
Results for Majority of Patients

CHICAGO–(BUSINESS WIRE)–Achilles tendon disorders are common and often misdiagnosed, with about
25 percent of ruptures missed during initial examination, but the
prognosis is favorable for the vast majority of patients, according to
researchers from Rowan University School of Osteopathic Medicine and the
Rothman Institute of Jefferson Medical College.

clinical review
, published in the November edition of The Journal
of the American Osteopathic Association
, noted that most patients
healed better with conservative treatment. Surgery should be reserved
for acute tears occurring in young or very active patients.

“As an osteopathic physician, we approach treating injuries with the
least amount of surgical intervention possible,” said Joseph N. Daniel,
DO, clinical associate professor of orthopaedic surgery at Jefferson
Medical College in Philadelphia. “Injuries of the Achilles are no
different, and this study validates that most patients are better off
with conservative treatment.”

Dr. Daniel noted that surgical intervention in younger, athletic
patients is associated with lower rates of re-rupture and a quicker
return to activity. Diagnostic imaging, such an ultrasound or MRI, is
not recommended unless rupture is suspected.

The Achilles tendon is the largest tendon in the body and functions as
the structural gateway between the leg, ankle, and foot. Its function is
critical for walking, running, and jumping, so the injury is often
associated with athletes, of whom eight percent will likely experience
an acute rupture during their lifetime. About 24 percent of athletes
will battle chronic tendinopathy at some point, researchers noted.

Achilles injuries are somewhat less common among non-athletes but
frequently afflict the elderly and sedentary, as well as patients who’ve
gained significant weight or started an exercise regimen in middle age.
Ruptures are associated with autoimmune disease, plantar fasciitis,
obesity, certain antibiotics, smoking, and localized steroid injections.

In acute cases, patients often report hearing a popping sound at the
time of injury. Chronic ruptures and other Achilles injuries typically
involve heel pain or discomfort that coincides with physical activity.
Primary care physicians are urged to evaluate those with similar
complaints for Achilles injuries and take a conservative approach to

“Mismanaged or neglected injuries will markedly decrease a patient’s
quality of life,” said Dr. Daniel. “In all but a select few cases, we
can resolve the issue with rest, over-the-counter medication, physical
therapy, or a few weeks in a walking boot.”

About The Journal of the American Osteopathic Association

The Journal of the American Osteopathic Association (JAOA) is the
official scientific publication of the American Osteopathic Association.
Edited by Robert Orenstein, DO, it is the premier scholarly
peer-reviewed publication of the osteopathic medical profession. The JAOA’s
mission is to advance medicine through the publication of peer-reviewed
osteopathic research.


The Journal of the American Osteopathic Association
Lauren Brush,