Achilles tendon ruptures

Abstract

Achilles tendon ruptures are increasing in incidence, with the greatest incidence in the over 60s age group. The rehabilitation time following this injury is prolonged and patients have calf weakness of up to 30%. There is debate over the optimal method of management between nonoperative and operative repair, followed by rehabilitation. Aims of treatment are to restore activities of daily living and sports activity with minimal complications. Operative treatment reduces tendon elongation, minimizes calf weakness, and may depending upon the age of the patient reduce the re-rupture rate. Open repair is the traditional operative technique although there is increasing evidence of the effectiveness of percutaneous and minimally invasive surgery. The avoidance of early weight-bearing does not prevent tendon lengthening. Nonoperative treatment consisting of 2 weeks in cast followed by the use of an adjustable external equinus corrected brace and rehabilitation shows low re-rupture rates and allows patients to return to daily activities without a problem. Management of Achilles tendon rupture must be tailored to individual patient requirements for the resumption of day-to-day activities, return the return to sport with optimal ankle plantar flexion strength and the risk of re-rupture.