Ruptures of the Achilles tendon can be managed surgically or nonsurgically.

Traditionally in this country we have managed them surgically however in Canada and in the United States they have often been managed nonsurgically.

A recent review of the literature and randomised controlled trial found no significant difference between surgical and nonsurgical treatment.

The objectives of treatment are to restore function,comfort and strength. The avoidance of surgical complications and low risk of re-rupture are also considerations.

When comparing surgical and nonsurgical treatment we must compare the best surgical treatment with the best nonsurgical treatment not the best surgical treatment with the worst nonsurgical treatment or vice versa.

The complications of surgery include anaesthetic problems, infection, DVT, risk of re-rupture and nerve damage. The complications of nonsurgical treatment include DVT, lengthening of the tendon resulting in poor strength and risk of rerupture.

If nonsurgical treatment is to be instituted the patient must be more compliant as nonsurgical treatment takes longer.

The protocol I commonly used for nonsurgical treatment is that of Prof Bruce Twaddle from Auckland. Basically the patient is non-weightbearing for two weeks in plaster. After two weeks they are placed in an orthosis in full plantar flexion and for the next six weeks gradually are brought to neutral and gradually increase weight bearing. They are managed in a Vacoped Boot which is designed for Achilles Rupture management.

The surgical treatment protocol employed consists of a repair of the tendon with two weeks non-weightbearing to allow wound healing and then four weeks graduated weight bearing and restoration of function and flexion.

Although Achilles tendon ruptures are less common in the elite athlete the Orthosports Doctors would never contemplate managing an elite athlete nonsurgically.

Surgical complications in the acute rupture with an experienced and careful surgeon are rare. Whether treated surgically or nonsurgically patients with Achilles tendon ruptures do have a high incidence of DVT and therefore anticoagulation should be instituted.

Physiotherapy starts at week 7 aiming to gradually restore strength, movement and balance.