I've seen three surgeons now for a torn Achilles tendon. After listening to everything they had to say, I still can't tell if I should or shouldn't have surgery. I'm turning to the internet as my final source of guidance. What should I do?
Your uncertainty and indecision is no surprise. Despite the fact that every year, many people (athletes and nonathletes alike) injure their Achilles tendons, the best way to treat these injuries is still up in the air.
Tendon ruptures are handled according to the age of the patient, activity level, and patient/surgeon preference. There is no agreement yet as to the optimal treatment of acute tendon ruptures. Published studies so far show there are fewer reruptures after surgery, improved strength, and faster return to sports for affected athletes.
For patients with acute tendon ruptures who don't want surgery, conservative care continues to be used successfully by many people. Treatment begins with a cast that places the foot and ankle in slight plantar flexion (toes pointed down). After four weeks, the patient is recast or put in an ankle immobilizer in the neutral position. Rehab and a gradual return to activities follows cast or splint removal.
In the case of chronic Achilles tendon rupture, MRIs may be needed to show the extent of damage. Although the patient may have weakness and a limp, pain and swelling aren't always present and other tests used for acute tendon rupture are negative. MRIs give the additional information needed to make a treatment decision. Surgery is usually the only way to restore function in the young, athletic or older, active adult. The operation is a bit more tricky than with acute (fresh) ruptures.
By the time the patient has surgery, many weeks have passed by from the acute injury. That means the torn tendon has retracted (snapped back) away from the bone where it originally inserted. And the body has laid down scar tissue to try and heal itself. The surgeon will have to remove the scar tissue, pull the tendon back down and reconstruct the tendon-muscle unit. How this is done depends on how much distance must be made up between the tendon and insertion point on the bone.
There's no doubt that Achilles tendon injuries are fairly common. But high-quality studies with conclusions about the best way to treat them are just lacking right now. Information on surgical techniques isn't the only area where questions exist. There really isn't much evidence to support
one form of conservative care over another. Successful sports rehab treatment protocols is another area where future research is needed to help guide the management of Achilles tendon injuries, especially for competitive athletes.
Daniel S. Heckman, MD, et al. Tendon Disorders of the Foot and Ankle, Part 2. Achilles Tendon Disorders. In The American Journal of Sports Medicine. June 2009. Vol. 37. No. 6. Pp. 1223-1234.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.