There is a lack of consensus as to if surgery or conservative care for an Achilles tendon rupture is the most appropriate treatment
An Achilles tendon rupture is a partial or complete tear of the Achilles tendon, which is the large tendon connecting the calf muscles to the heel bone. The treatment for an Achilles tendon rupture can vary depending on the severity of the injury, the patient’s age, activity level, and overall health. The main treatment options include non-surgical (conservative) and surgical approaches.
Non-surgical treatment options:
- Immobilization and Non-weight-bearing: Initially, the affected leg may be placed in a cast or walking boot with the foot in a downward-pointing position (plantar flexion). This immobilization helps promote healing and reduce stress on the ruptured tendon. Crutches may be used to keep weight off the foot.
- Gradual Weight-bearing and Physical Therapy: After a period of immobilization, weight-bearing may be gradually introduced using a walking boot or special heel wedges. Physical therapy exercises are initiated to improve range of motion, strength, and flexibility. The goal is to restore normal function and prevent complications.
Surgical treatment options:
- Open Repair: In this surgical procedure, a single incision is made to access the ruptured tendon. The surgeon then sutures the torn ends of the tendon together. Sometimes, additional reinforcement with other tissues or sutures may be necessary to strengthen the repair.
- Minimally Invasive or Percutaneous Repair: This technique involves making several small incisions rather than a single large incision. Special instruments are used to suture the tendon ends together through the small incisions. It may be a preferred option for certain patients, as it may have a faster recovery time and potentially fewer complications.
Following surgery, the foot and ankle are typically immobilized in a cast, walking boot, or brace for a period of time. Physical therapy is initiated once healing progresses to help regain strength, flexibility, and function.
The choice of treatment depends on various factors, including the severity of the rupture, patient preferences, and the surgeon’s recommendation. Surgical treatment is often considered for young and active individuals, athletes, and cases with a complete rupture, whereas non-surgical treatment may be appropriate for older or less active individuals or cases with a partial rupture.