Case study: Achilles rupture in a 46-year-old club hockey player

Presentation

A 46-year-old recreational hockey player felt a sudden blow to the back of the calf while pushing off, with an audible snap and immediate inability to push off the toes. He presented to clinic four days later, having been managed initially in a walking boot.

Assessment

Examination showed a palpable gap approximately 5cm above the insertion, absent plantarflexion on calf squeeze and an increased resting ankle angle compared with the other side. Ultrasound confirmed a complete mid-substance rupture with good tendon end apposition in equinus.

Management

Given good end apposition and no adverse healing factors, a functional non-operative pathway was chosen: a boot with graduated heel wedges, immediate protected weight bearing and a structured rehabilitation programme with fortnightly review through the first two months.

Outcome

• Out of the boot at 10 weeks with a symmetrical resting ankle angle
• Single heel raise achieved at 16 weeks
• Return to non-contact training at 6 months, competitive club hockey at 9 months
• Heel raise endurance within 12% of the uninjured side at one year

The decision between operative and non-operative treatment for Achilles rupture is rarely clear cut. What consistently matters more than the choice itself is early protected loading, a rehabilitation plan the patient understands, and realistic timelines set at the outset.