INFORMATION: Surgical or Non-Surgical Treatment - What Do I Choose?

Surgical or Non-Surgical

The Achilles tendon connects the calf muscle to the heel bone.

Achilles tendon ruptures occur most commonly in 30-50 year olds. It is common in the recreational athlete.

The reason for rupture is when the tendon is rapidly loaded when it is already under tension. Common mechanisms include jumping from a height, pushing off for a tennis shot, or tripping on a curb.

How is it diagnosed?

The diagnosis is made by clinical examination.
Ultrasound is not required in most situations

What are the treatment options?

• Non operative
• Operative repair

Both options have been shown to provide good outcomes in compliant patients.

In some situations one option is preferred.

Non operative treatment is advised in:

• Diabetics
• Vascular disease
• Other severe medical problems
• Low functional demand patients

Achilles rupture Non-operative treatment Info-sheet

Operative treatment is advised in:

• Delayed presentation
• No initial treatment within 48 hours after injury ( relative indication)
• Athletes

Both options require 8 weeks of immobilisation followed by protected activities and diligent physiotherapy to regain range of motion and strength over a 6 month period.

Non operative treatment

Protected progressive weight bearing in a boot for 8 weeks.

Advantages

• No surgical risk
• No significant difference at 1 year

Disadvantages

• Higher re-rupture rate 8-10%
• Slower initial mobilisation

Operative treatment

This involves a suture repair of the tendon.

Advantages

• Lower risk of rerupture 3-4%
• Possibly better strength
• No difference in the long term
• Quicker recovery in first 3 months

Disadvantage

• Infection and wound healing issues
• Nerve injury
• Anaesthetic problems

What does the rehabilitation involve?

• 1 night in hospital
• 2 weeks elevation of the foot in a cast
• 6 weeks in a boot progressively weightbearing with crutches
• Physiotherapy to start at 2 weeks post operatively to regain ankle motion and strength
• By 8 weeks managing most daily activities in a supportive shoe
• By 4 months back to most recreational walking and beginning to run
• Returning to sport at 6 months
• Swelling resolution at 6-9 months
• 1 year for final result of calf strength

How long will I be off work?

• Seated job 2-3 weeks
• Standing job 8-10 weeks
• Heavy lifting job 3-5 months

When can I run?

• Once you are able to undertake 10 single heel raises you can begin more physical activities such as jogging
• Do not expect to be jogging before 3 months from operation

When can I return to sport?

• It may take 6 months before you can return to sport
• You will need to strengthen your calf and gradually increase your activity under the guidance of a physiotherapist

When can I drive?

• Manual car- 9-10 weeks
• Automatic car – Left foot – 2 weeks
• Automatic car – Right foot – 9-10 weeks

What are the risks of the procedure?

General risks of surgery

• Infection
• Wound healing problems which may require further surgery
• Nerve injury
• Blood clots to the leg
• Anaesthetic problems

Specific risks for achilles repair

• Re- rupture 3-10% – This requires repeat surgery
• Stiffness of the ankle
• Lengthening of the repair
• Weakness
• Swelling over the tendon repair site

Timeline:

• Surgery to be performed ideally 2 weeks after rupture giving leg swelling time to subside.
• Surgery should be done within 6 - 8 weeks after rupture as any delay may involve reconstructive surgery already.

Source: 

Hamish Curry Foot and Ankle Orthopaedic Surgeon

More Information:

Achilles Tendon SURGICAL TREATMENT

NYU Langone Health (Surgical Treatment)

Achilles Tendon NON-SURGICAL TREATMENT

NYU Langone Health (Non-Surgical Treatment)

IMPORTANT: Orthopedic Surgeon / Doctor may have a different surgical or non-surgical protocol. The default patient protocol is to follow what doctors recommend as they know all the information of the patient.