Achilles tendon rupture is one of the most common tendon injuries in active adults, and getting the diagnosis and early management right matters. Delays or inconsistencies in care can lead to prolonged disability, weakness, and even re-rupture. A recent quality improvement study published in Cureus offers a useful look at how structured clinical pathways, and the role of point-of-care imaging within them, can be measured, refined, and improved over time.
The study, conducted at University Hospitals Dorset in the United Kingdom, set out to answer a practical question many institutions face: once you build a care pathway, are clinicians actually following it? And if not, what targeted changes can move the needle?
In 2021, the hospital introduced a standardized pathway for patients arriving with a suspected Achilles tendon rupture. The pathway laid out five clear standards: prescribe blood-clot prevention medication, immobilize the foot in a functional boot with wedges, document weight-bearing advice, refer the patient to a virtual fracture clinic, and perform an ultrasound scan within 14 days to confirm the rupture. That last standard is where ultrasound takes center stage. Confirming the injury early with imaging allows clinicians to identify partial versus complete ruptures and decide whether surgery is warranted, ideally before the patient's first in-person specialist visit. To check whether the pathway was working, the team ran a closed-loop audit, meaning they measured compliance, made changes, and then measured again to see if those changes helped.
The first audit cycle reviewed 138 patients seen between October 2022 and September 2023. The results showed strong compliance in some areas and clear gaps in others. Referral to the virtual fracture clinic was nearly universal at 96 percent, and both clot prevention and boot immobilization sat at 80 percent. The weakest spot was imaging timing. Only 43 percent of patients received their ultrasound within the 14-day target. For an injury where early imaging guides the entire treatment decision, that gap stood out as the clearest opportunity for improvement.
Rather than overhaul the system, the team made a few focused, low-cost adjustments. They shared the audit results with staff via email, displayed the pathway in clinical areas such as the emergency department and fracture clinic, and introduced a dedicated imaging request form labeled "Ultrasound Achilles." Previously, these requests were filed under a more general "Ultrasound Ankle" form, which did not signal the urgency of the 14-day window to radiographers.
The second audit cycle, covering 44 patients between March and June 2024, showed the impact. Ultrasound-within-14-days compliance climbed from 43 percent to 59 percent, the single biggest improvement of any standard and a statistically significant gain. Boot immobilization rose from 80 to 86 percent, and virtual fracture clinic referral reached a perfect 100 percent. Notably, no re-ruptures or blood-clot events were recorded in either cycle. Not everything improved, though. Clot-prevention prescribing stayed essentially flat, and documentation of weight-bearing advice did not budge. The authors point to known barriers, such as clinician uncertainty and inconsistent documentation, and suggest that automated prompts built into electronic prescribing systems may be the next step.
What makes this study worth a closer read is not just the orthopedic outcome. It is the reminder that imaging only delivers value when it happens at the right time, in the right way, by people prepared to perform it. A simple change, renaming a request form, worked because it communicated clinical context to the staff carrying out the scan. That points to a larger truth in point-of-care and diagnostic ultrasound: process and preparation are as important as the technology itself. When clinicians and radiographers understand why a scan matters and when it needs to happen, imaging becomes a faster, more reliable part of the care pathway.
This is where structured ultrasound education makes the difference. Pathways depend on people who can confidently and consistently perform and interpret scans, whether in a busy emergency department or a follow-up clinic. Simulation-based training offers a way to build that competency across an institution, delivering consistent, repeatable learning without relying on the variability of real-world clinical exposure. SonoSim's Musculoskeletal (MSK) Clinical Ultrasound training is built for exactly this kind of preparation, with hands-on scanning practice on real patient cases, including an Achilles rupture case, so clinicians can recognize when an exam is warranted and perform it with confidence. As part of SonoSim's ecosystem of 85+ ultrasound training topics, it helps programs turn a written protocol into reliable, repeatable care.
This audit is a small, single-center study with the usual limitations, including a smaller second sample and reliance on documentation. But its core lesson travels well. Structured pathways improve care, measuring compliance reveals where the real gaps are, and sometimes the most effective fix is also the simplest. For any institution working to embed ultrasound into routine practice, that is a message worth carrying forward.
Read the full study, "Suspected Achilles Tendon Ruptures and the Course of Action: Assessing Compliance With Local Protocols," published open access in Cureus: https://doi.org/10.7759/cureus.95225