Rosh Emergency Medicine Practice Test

In a case of a suspected acute Achilles tendon tear, what is the most appropriate management option for the injury?

1. Controlled ankle movement boot, weight-bearing as tolerated, outpatient orthopedic referral

2. Elastic bandage, ice, NSAIDs, activity modification

3. Short leg splint in slight dorsiflexion, non-weight-bearing, outpatient orthopedic referral

4. Short leg splint in slight plantar flexion, non-weight-bearing, outpatient orthopedic referral

The correct answer is: Short leg splint in slight plantar flexion, non-weight-bearing, outpatient orthopedic referral

In the case of a suspected acute Achilles tendon tear, placing the leg in a short leg splint in slight plantar flexion is considered the most appropriate management. This positioning is crucial because it mimics the natural resting position of the foot and helps to relieve tension on the ruptured tendon, thereby promoting optimal healing conditions. The non-weight-bearing restrictions further prevent additional stress on the already compromised tendon, which could lead to complications or delayed recovery. Furthermore, this management option aligns with current practices in orthopedic treatment of Achilles tendon injuries, as it allows for stabilization while minimizing the risk of re-rupture while waiting for further evaluation or surgical intervention. An outpatient orthopedic referral is an essential component of this management strategy, allowing for more definitive treatment options such as surgery or rehabilitation based on the specific nature and degree of the injury. In contrast, other options either do not provide adequate immobilization or proper positioning that would support recovery. For instance, methods that involve ice, NSAIDs, or merely modifying activity without sufficient immobilization may lead to inadequate healing or unanticipated complications due to excess strain on the tendon.