The Management of Achilles Tendon Ruptures

A rupture of the Achilles tendon is not an uncommon problem in sporting activity and is very dramatic if it happens, as the calf muscles and the connected Achilles tendon play such an necessary function. It is more likely to happen in explosive activities like tennis. The real issue is that the achilles tendon and the two muscles connected to it cross two joints (the knee and the ankle) and if both joints are moving in contrary directions at the same time, particularly if instantly (as might happen in tennis), then the chance of something failing is pretty high.

The management of an achilles tendon rupture is a bit controversial as there are two options that the majority the research shows have much the same outcomes. One choice is conservative and the other is operative. The conservative choice is typically placing the leg in cast which supports the foot pointing downwards slightly. It will take up to six weeks to get better and after the cast is removed, there should be a slow and gentle resumption of physical activity. Physical therapy is usually used to assist with that. The surgical option is to surgically stitch the two edges of the tendon back together, this is followed by a period in a cast which is shorter than the conservative choice, and will be followed by a similar slow and steady return to activity. If longer term results are evaluated the final result is typically about the same, but the surgical technique has the additional potential for surgical or anaesthetic complications that the conservative strategy does not have. The decision as to which approach is better is going to have to be one dependent on the experiences of the surgeon and the choices of the person with the rupture. There is a trend for competitive athletes to go along the operative pathway because it is considered that this may give a improved short term outcome and get them back to the sports field a lot quicker.