A 35-year-old recreational runner presents with acute onset heel pain during a sprint, feeling a 'pop,' with a palpable gap in the Achilles tendon 4 cm above the calcaneal insertion. The Thompson test is positive. What is the most appropriate management?

• A Immediate immobilisation in plaster in equinus position for 12 weeks
• B Surgical repair (open or percutaneous) with early functional rehabilitation using a functional brace ✓
• C Corticosteroid injection into the tendon gap to reduce inflammation
• D Platelet-rich plasma (PRP) injection as primary treatment

Explanation

For acute complete Achilles tendon rupture in an active young patient, surgical repair (open or percutaneous end-to-end repair) followed by early functional rehabilitation in a walking boot with heel rise is the preferred management. It provides superior strength of repair, lower re-rupture rate compared to non-operative treatment in active individuals, and earlier return to sport. Non-operative treatment in equinus cast is acceptable in elderly, sedentary, or high-risk patients but has higher re-rupture rates (10-15% vs 3-5%). Corticosteroid injection into the tendon is absolutely contraindicated as it further weakens the tendon. PRP lacks evidence as primary treatment.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.