Table 1 Treatment overview. CARTA Copenhagen Achilles Rupture Treatment Algorithm, CALM Copenhagen Achilles Length Measure, ATRA Achilles Tendon Resting Angle

1

Day 0

Emergency Department

Surgeon

Diagnosis of Achilles tendon rupture. The injured leg will be placed in a split plaster cast with the ankle in maximal plantar flexion achieved by placing the patient in prone position on the examination bed.

2

0-4 days

Outpatient clinic

Surgeon or physiotherapist

Inclusion, informed consent, randomization and decision of treatment based on CARTA.

1) For the patients allocated individualized treatment the finding of ultrasonographic evaluation decides further treatment of non-operative and operative regime.

2) Patients allocated non-operative treatment will be treated with a circular below-the-knee cast

3) Patients allocated operative treatment will be scheduled and prepared for surgery.

3

0-14 days

Operating theatre

Surgeon

Operation of the patients appointed for operative treatment performed or supervised by trained orthopedic surgeon specialized in Foot- and Ankle, Traumatology or Sports Traumatology.

4

3 weeks

Outpatient clinic

Nurse Physiotherapist

Removal of cast and any sutures. Injured leg placed in functional brace with 20 degrees plantar flexion of the ankle. Instructions of limited, protected movements over the ankle and successive removal of two wedges at 2 weeks interval.

5

9 weeks

Outpatient clinic

Physiotherapist

Functional brace is removed, and the tendon is examined. Instructions by physiotherapist of rehabilitation from 9 weeks and onwards.

6

6 months

Outpatient clinic

Physiotherapist

Follow-up evaluation with Heel-Rise Work Test, CALM and ATRA.

7

12 months

Outpatient clinic

Physiotherapist

Follow-up evaluation with Heel-Rise Work Test, CALM and ATRA.