{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T12:27:56Z","timestamp":1785760076559,"version":"3.56.0"},"reference-count":43,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Achilles tendon pathologies, such as Achilles tendinitis, tendinosis, ruptures, and equinus contracture, cause pain and functional impairment. While surgical intervention is indicated in some cases, many patients are successfully managed with nonoperative treatment. The goal of this review was to evaluate the current evidence-based treatments for the nonoperative management of Achilles tendon disorders, focusing on indications and clinical outcomes. Methods: A scoping review of the literature was conducted from 2015 to 2025 from the PubMed database. Research published in the last ten years was included if it addressed nonoperative treatments for Achilles tendinopathy, acute ruptures, and\/or equinus contracture. The outcome measures of interest included functional outcomes, re-rupture rates, and overall patient satisfaction. Results: Nonoperative management results in favorable outcomes for a wide range of Achilles tendon pathologies. Eccentric loading is supported for chronic tendinopathy, and functional rehabilitation programs with early mobilization have shown comparable outcomes to surgical repair for acute tendon ruptures. Combination therapy for the nonoperative management of equinus is favored. These therapies include stretching protocols, casting, and the botulinum toxin. Conclusions: The literature supports the notion that nonoperative management strategies for Achilles tendon pathologies provide symptom relief and functional improvement in patients. However, these treatment plans should be individualized and tailored to patient-specific goals.<\/jats:p>","DOI":"10.3390\/jcm14134736","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T05:54:52Z","timestamp":1751608492000},"page":"4736","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Current Concepts in the Nonoperative Management of Achilles Tendon Pathologies: A Scoping Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5790-9977","authenticated-orcid":false,"given":"Jennifer A.","family":"Kipp","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0724-4361","authenticated-orcid":false,"given":"Cody D.","family":"Blazek","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA"},{"name":"Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1177\/1938640009355191","article-title":"Achilles tendon rupture: A review of etiology, population, anatomy, risk factors, and injury prevention","volume":"3","author":"Hess","year":"2010","journal-title":"Foot Ankle Spec."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Olewnik, \u0141., Wysiadecki, G., Podg\u00f3rski, M., Polguj, M., and Topol, M. (2018). The Plantaris Muscle Tendon and Its Relationship with the Achilles Tendinopathy. Biomed. Res. Int., 2018.","DOI":"10.1155\/2018\/9623579"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1186\/s13643-018-0912-5","article-title":"Protocol for treatment of Achilles tendon ruptures; a systematic review with network meta-analysis","volume":"7","author":"Meulenkamp","year":"2018","journal-title":"Syst. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.fcl.2017.07.002","article-title":"Tendonitis and tendinopathy: What are they and how do they evolve?","volume":"22","author":"Federer","year":"2017","journal-title":"Foot Ankle Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e12166","DOI":"10.7717\/peerj.12166","article-title":"The clinical diagnosis of Achilles tendinopathy: A scoping review","volume":"9","author":"Matthews","year":"2021","journal-title":"PeerJ"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Merry, K., Napier, C., Waugh, C.M., and Scott, A. (2022). Foundational Principles and Adaptation of the Healthy and Pathological Achilles Tendon in Response to Resistance Exercise: A Narrative Review and Clinical Implications. J. Clin. Med., 11.","DOI":"10.3390\/jcm11164722"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.cpm.2016.10.008","article-title":"Equinus and Lengthening Techniques","volume":"34","author":"DeHeer","year":"2017","journal-title":"Clin. Podiatr. Med. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1056\/NEJMoa2108447","article-title":"Nonoperative or surgical treatment of acute Achilles tendon rupture","volume":"386","author":"Myhrvold","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1053\/j.jfas.2017.05.036","article-title":"Surgical Treatment Versus Conservative Management for Acute Achilles Tendon Rupture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"56","author":"Deng","year":"2017","journal-title":"J. Foot Ankle Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2406","DOI":"10.1177\/0363546516651060","article-title":"A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles Tendon Ruptures","volume":"44","author":"Lantto","year":"2016","journal-title":"Am. J. Sports Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3528","DOI":"10.1007\/s00167-023-07411-1","article-title":"Lower re-rupture rates but higher complication rates following surgical versus conservative treatment of acute achilles tendon ruptures: A systematic review of overlapping meta-analyses","volume":"31","author":"Seow","year":"2023","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1177\/1071100720919029","article-title":"Return to sport and patient satisfaction at 5-year follow-up after nonoperative treatment for acute Achilles tendon rupture","volume":"41","author":"Lerch","year":"2020","journal-title":"Foot Ankle Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"k5120","DOI":"10.1136\/bmj.k5120","article-title":"Operative treatment versus nonoperative treatment of Achilles tendon ruptures: Systematic review and meta-analysis","volume":"364","author":"Ochen","year":"2019","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/S0140-6736(19)32942-3","article-title":"UKSTAR trial collaborators. Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): A multicentre randomised controlled trial and economic evaluation","volume":"395","author":"Costa","year":"2020","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1177\/0363546515623501","article-title":"Prospective use of a standardized nonoperative early weightbearing protocol for Achilles tendon rupture: 17 years of experience","volume":"44","author":"Ecker","year":"2016","journal-title":"Am. J. Sports Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Prud\u00eancio, D.A., Maffulli, N., Migliorini, F., Serafim, T.T., Nunes, L.F., Sanada, L.S., and Okubo, R. (2023). Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: Systematic review and meta-analysis. BMC Sports Sci. Med. Rehabil., 15.","DOI":"10.1186\/s13102-023-00618-2"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2325967120930567","DOI":"10.1177\/2325967120930567","article-title":"Comparative Efficacy and Tolerability of Nonsurgical Therapies for the Treatment of Midportion Achilles Tendinopathy: A Systematic Review with Network Meta-analysis","volume":"8","author":"Rhim","year":"2020","journal-title":"Orthop. J. Sports Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1001\/jama.2021.6986","article-title":"Effect of Platelet-Rich Plasma Injection vs Sham Injection on Tendon Dysfunction in Patients with Chronic Midportion Achilles Tendinopathy: A Randomized Clinical Trial","volume":"326","author":"Kearney","year":"2021","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.2106\/JBJS.20.01826","article-title":"Shockwave Therapy Plus Eccentric Exercises Versus Isolated Eccentric Exercises for Achilles Insertional Tendinopathy: A Double-Blinded Randomized Clinical Trial","volume":"103","author":"Mansur","year":"2021","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ko, V.M., Cao, M., Qiu, J., Fong, I.C.-K., Fu, S.-C., Yung, P.S.-H., and Ling, S.K.-K. (2023). Comparative short-term effectiveness of non-surgical treatments for insertional Achilles tendinopathy: A systematic review and network meta-analysis. BMC Musculoskelet. Disord., 24.","DOI":"10.1186\/s12891-023-06170-x"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1186\/s13018-021-02370-0","article-title":"Nonoperative treatment of insertional Achilles tendinopathy: A systematic review","volume":"16","author":"Zhi","year":"2021","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_22","first-page":"e36851","article-title":"The Effects of Botulinum Toxin and Casting in Spastic Children with Cerebral Palsy: A Systematic Review and Meta-Analysis","volume":"15","author":"Kumar","year":"2023","journal-title":"Cureus"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e8186","DOI":"10.1097\/MD.0000000000008186","article-title":"Conservative treatment for equinus deformity in children with cerebral palsy using an adjustable splint-assisted ankle-foot orthosis","volume":"96","author":"Chen","year":"2017","journal-title":"Medicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1186\/s13018-022-03301-3","article-title":"Efficacy of conservative treatment for spastic cerebral palsy children with equinus gait: A systematic review and meta-analysis","volume":"17","author":"Klaewkasikum","year":"2022","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e1646","DOI":"10.1002\/pri.1646","article-title":"A Critical Evaluation of the Updated Evidence for Casting for Equinus Deformity in Children with Cerebral Palsy","volume":"22","author":"Tustin","year":"2017","journal-title":"Physiother. Res. Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1186\/s12984-024-01473-z","article-title":"The dose effectiveness of extracorporeal shockwave on plantar flexor spasticity of ankle in stroke patients: A randomized controlled trial","volume":"21","author":"Yang","year":"2024","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Campanini, I., B\u00f2, M.C., Bassi, M.C., Damiano, B., Scaltriti, S., Lusuardi, M., Merlo, A., and Hoover, D.L. (2023). Outcome measures for assessing the effectiveness of physiotherapy interventions on equinus foot deformity in post-stroke patients with triceps surae spasticity: A scoping review. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0287220"},{"key":"ref_28","first-page":"YC01","article-title":"To Evaluate the Effectiveness of TBTS\u2014A Novel Device to do Self-Stretching of Gastroc-Soleus Muscle in Patients with Equinus Deformity","volume":"11","author":"Muzaffar","year":"2017","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.fcl.2019.05.001","article-title":"Functional rehabilitation for nonsurgical treatment of acute Achilles tendon rupture","volume":"24","author":"Glazebrook","year":"2019","journal-title":"Foot Ankle Clin."},{"key":"ref_30","first-page":"e10298","article-title":"Achilles Tendon Rupture: Can the Tendon Gap on Ultrasound Scan Predict the Outcome of Functional Rehabilitation Program?","volume":"12","author":"Mubark","year":"2020","journal-title":"Cureus"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1302\/0301-620X.102B11.BJJ-2020-0908.R1","article-title":"Does size of tendon gap affect patient-reported outcome following Achilles tendon rupture treated with functional rehabilitation?","volume":"102-B","author":"Yassin","year":"2020","journal-title":"Bone Jt. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1053\/j.jfas.2021.06.014","article-title":"Functional Gains Using Radial and Combined Shockwave Therapy in the Management of Achilles Tendinopathy","volume":"61","author":"Robinson","year":"2022","journal-title":"J. Foot Ankle Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.fas.2020.07.009","article-title":"Evidence for the use of PRP in chronic midsubstance Achilles tendinopathy: A systematic review with meta-analysis","volume":"27","author":"Nauwelaers","year":"2021","journal-title":"Foot Ankle Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.amsu.2020.04.042","article-title":"The use of PRP in treatment of Achilles Tendinopathy: A systematic review of literature. Study design: Systematic review of literature","volume":"55","author":"Madhi","year":"2020","journal-title":"Ann. Med. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1007\/s11999.0000000000000258","article-title":"Is Platelet-rich Plasma Injection Effective for Chronic Achilles Tendinopathy? A Meta-analysis","volume":"476","author":"Zhang","year":"2018","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Arthur Vithran, D.T., Xie, W., Opoku, M., Essien, A.E., He, M., and Li, Y. (2023). The Efficacy of Platelet-Rich Plasma Injection Therapy in the Treatment of Patients with Achilles Tendinopathy: A Systematic Review and Meta-Analysis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12030995"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"CPG1","DOI":"10.2519\/jospt.2024.0302","article-title":"Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision-2024","volume":"54","author":"Chimenti","year":"2024","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_38","first-page":"465","article-title":"Effects of stretching the gastrocnemius muscle","volume":"30","author":"Grady","year":"1991","journal-title":"J. Foot Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.foot.2011.09.001","article-title":"The effect of calf muscle stretching exercises on ankle joint dorsiflexion and dynamic foot pressures, force and related temporal parameters","volume":"22","author":"Macklin","year":"2012","journal-title":"Foot"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1136\/bjsm.2006.029348","article-title":"Does stretching increase ankle dorsiflexion range of motion? A systematic review","volume":"40","author":"Radford","year":"2006","journal-title":"Br. J. Sports Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2473011421S00735","DOI":"10.1177\/2473011421S00735","article-title":"Success Rate of Non-Operative Treatment of Insertional Achilles Tendinopathy","volume":"7","author":"Kunkle","year":"2022","journal-title":"Foot Ankle Orthop."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2840","DOI":"10.1007\/s00167-018-5295-6","article-title":"Medical comorbidities increase the rate of surgical site infection in primary Achilles tendon repair","volume":"27","author":"Dombrowski","year":"2019","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1093\/rheumatology\/kes395","article-title":"Occurrence of tendon pathologies in metabolic disorders","volume":"52","author":"Abate","year":"2013","journal-title":"Rheumatology"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4736\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:04:25Z","timestamp":1760033065000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4736"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,4]]},"references-count":43,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134736"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134736","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,4]]}}}