Achilles Rupture: Operative vs. Nonoperative Treatment

What is an achilles rupture?

The achilles tendon is formed by the gastrocnemius and soleus tendon and inserts into the back of the heel (calcaneus bone). The achilles tendon is the major tendon involved in bending the ankle down (plantar flexion) and allowing the foot to push off the ground. 

Why is it important to treat an achilles rupture?

If the achilles tendon rupture is not treated properly, then it will be healed in an elongated position. When the achilles is healed in elongated position then you will lose the ability to properly walk and lose the strength to push off your foot. 

What is the best way to treat an achilles rupture?

Surgery was previously thought to be the best way to treat achilles ruptures due to lower rates of re-rupture and higher strength recovery, but achilles surgery has a high risk of soft tissue complications. Nonoperative treatment used to consist of keeping people casted for months, but we have learned that nonoperative accelerated functional rehabilitation produces comparable rerupture rates and strength recovery to surgery. 

What are the new surgical treatments for achilles ruptures?

Studies have shown that surgery allows the recovery of higher peak strength and lower re-rupture rates, so surgery is highly recommended for people that are young and/or athletic. There are many new techniques for repairing achilles ruptures that are minimally invasive and help prevent that soft tissue complications that were common in traditional open achilles ruptures. A popular minimally invasive technique is using Arthrex Pars system.

What is the accelerated functional rehabilitation protocol?

0-2 weeks: Non-weigbearing with crutches in splint or boot with the ankle plantar flexed 20 degrees. 2-6 weeks: Protected weight bearing progression 25%, 50%, 75%, 100% of weight over the 4 weeks in a Walking boot with a 2cm heel lift. 6-8 weeks: weightbearing as tolerated in a walking boot and slowly decrease heel lift height every week.8-12 weeks: Slowly wean out of the boot and use crutches/cane as necessary.  Continuing working on motion, strength, and proprioception. 12 weeks-5 months: continue working on strength, range of motion and proprioception. Can begin sports specific training and dynamic weightbearing exercise, but avoid high impact activity. >5 months: can begin running and high impact activity. 

If you have foot or ankle pain and would like a consultation. Make an appointment at Orange County Podiatry with Dr. Andrew Yang or call (949) 651-1202