A 40-year-old runner presents with acute onset severe pain and a 'pop' sensation in the calf. Examination reveals a palpable gap 4 cm above the calcaneal insertion and Thompson's test is positive. The most appropriate initial management for a complete Achilles tendon rupture in this active patient is:
- A Plaster cast in equinus for 8 weeks (non-operative management)
- B Open surgical repair followed by early functional rehabilitation ✓
- C Platelet-rich plasma injection under ultrasound guidance
- D Immediate weight-bearing in a walking boot
Explanation
Thompson's test (calf squeeze test) is positive in complete Achilles rupture when plantar flexion is absent on squeezing the calf. For young, active patients (athletes, physically demanding occupations), surgical repair is preferred because it offers lower rerupture rates (~2–5% vs 10–12% with non-operative treatment) and earlier return to sport. Modern protocols combine open or minimally invasive repair with functional rehabilitation in a boot. Non-operative management (A) is appropriate for elderly, sedentary, or high anaesthetic risk patients. PRP (C) is not a primary treatment modality for complete ruptures.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.