Current Concepts in the Nonoperative Management of Achilles Tendon Pathologies: A Scoping Review

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.