The Achilles tendon connects the calf to the heel and is prone to rupture when there is a sudden excessive overload on the tendon (tennis/squash). This is a serious injury, can be very painful and is debilitating. There is some swelling along the tendon and one is unable to go on tiptoes. It normally affects middle-aged patients who exercise casually.
Depending on the position of the tendon stumps conservative of operative treatment will be the preferred treatment of choice. Besides the thorough clinical examination, an ultrasound scan will determine the gap of the tendon ends and will allow making the correct decision which treatment will be best for the patient. In case of conservative treatment, a boot will be provided and the position of the foot in the boot will be reviewed and adjusted regularly.
Open surgery (which can also be performed minimal invasive) will bring the two tendon ends together and they will be held by strong stitches. Thereafter patients will have their tendon temporarily immobilised in a boot. This will allow to restore the anatomy and function of the tendon appropriately.
The duration of either treatment does not vary a lot as good protection in boot for roughly six weeks is needed for either treatment.
The benefit for those patients who can have conservative treatment is that there are no surgical risks but the risk of a re-rupture seems to be a bit higher.
The benefit of surgery is that the two tendon ends are held firmly in the correct position allowing a more focused and intense post op physiotherapy. Surgery means that there are potential risks like an infection but it seems that recovery is a bit quicker.
For patients with delayed presentation of the rupture, other treatment options are available. Sometimes a lengthening of one of the stumps will be necessary to close the gap. If the gap is too big another tendon (FHL) can be used to augment the Achilles tendon and allow good function of calf muscle again.