Achilles tendon rupture: how do you choose between nonoperative treatment and surgery?

Being able to take a few steps does not mean the tear is mild

The Achilles tendon transfers force from the calf muscles to the heel. You use it to push off the ground and raise your heel. To assess an acute rupture, doctors look at how the injury happened, examine you and use imaging as needed. If you were injured recently and suspect an Achilles tendon rupture, seek care locally as soon as possible. This article compares treatments for adults who have been assessed and have an acute closed rupture. An open wound or a rupture that has become chronic requires a different approach. [1]

What nonoperative treatment and surgery each involve

China’s evidence-based clinical guideline for Achilles tendon rupture discusses the role of dynamic ultrasound in assessing how the torn ends line up. Doctors may use the findings to judge whether a brace or boot can protect the tendon in a suitable position. If you choose nonoperative treatment, follow your care team’s plan for when you can put weight on the foot and how far you can move the ankle. Surgery repairs the torn tendon. The healing tissue also needs protection before you gradually regain strength and movement. [1]

A Norwegian randomized trial compared nonoperative treatment, open repair and minimally invasive repair. Among the 526 adults in the final analysis, there was no clear difference between the three groups in patient-reported outcomes or physical function at 12 months. In the trial, the tendon ruptured again in 6.2% of the nonoperative group and 0.6% of each surgical group. Nerve injuries were more common in both surgical groups. Functional outcomes and complications reflect different trade-offs. These figures reflect the patients and treatment conditions in this trial, and your individual risk may differ. [2]

Tell your doctor in China what rehabilitation you can access

When you see a foot and ankle surgeon, sports medicine specialist or orthopaedic trauma specialist, bring the date of the injury, any original ultrasound or magnetic resonance imaging (MRI) scans, and records of any brace, boot or cast you have already used. Ask which options the tear location and the alignment of the torn ends support, and what limits you would face in returning to standing for long periods, climbing stairs, running or jumping. If you live outside the city where you are being treated, say whether you can return for follow-up and whether a rehabilitation team where you live can take over. This needs to be arranged for both rehab in a brace or boot and rehab after surgery. [1]

Before leaving the treating hospital, ask the team to write down how to use the brace or boot, your current limits on weight-bearing and ankle movement, what the next follow-up will assess, and who will adjust the plan. Your doctor and rehabilitation team decide which exercises you should do and how quickly you should progress. You can use the guide to arranging follow-up after treatment away from home to prepare the records for the handover.