Enhanced Achilles Tendon Gliding Through Ultrasound-Guided Manual Therapy Post-surgical Repair: A Case Report

Achilles tendon rupture is a common injury with established surgical treatments, but optimizing postoperative recovery remains challenging. Dynamic tendon gliding is necessary for normal ankle function, yet its role in recovery is not fully understood. This report highlights a novel approach using dynamic ultrasound imaging and ultrasound-guided manual therapy to improve Achilles tendon gliding post-surgery. A 65-year-old man presented eight weeks after surgical repair of a left Achilles tendon rupture. Despite full weight-bearing ability and normal range of motion, the patient exhibited persistent dysfunction, such as an inability to perform single-leg stands and single-leg heel raises. Suspecting a dynamic issue with the Achilles tendon, dynamic ultrasound revealed significant adhesion between the Achilles tendon and Kager's fat pad. To address this, ultrasound-guided manual therapy, involving specific mobilization of the tendon under ultrasound visualization, was initiated. The patient underwent 16 sessions over eight weeks, during which real-time ultrasound confirmed gradual improvement in tendon gliding. Post-treatment, the patient achieved marked functional recovery, demonstrated by the ability to perform single-leg heel raises and toe walking. His Achilles tendon Total Rupture Score improved from 47 to 75 points, with sustained benefits observed at the 26-week follow-up. Ultrasound-guided manual therapy targeting tendon gliding dysfunction improved functional recovery in this patient. This approach underscores the importance of addressing tendon gliding in rehabilitation protocols to optimize outcomes. Further research is needed to validate these findings with a broader patient population.