What is the best treatment for acute rupture of the Achilles tendon?
Acute Achilles tendon rupture usually results from a forced contraction of the gastrocnemius muscle against resistance, which occurs either during sports participation or from a fall. It is not rare, and these are not subtle injuries. The patient usually has symptoms of pain, most notable in walking, and weakness in the push-off phase of gait. A positive Thompson test is common oftentimes with a palpable defect in the tendon.
The best treatment remains controversial. Options include closed treatment with placement in a long or short leg cast with the foot in equinus (plantar-flexed by gravity). A percutaneous suture repair has been reported with good results but may risk some injury to the sural nerve. The third option is open direct primary surgical repair. Many long-term studies have compared surgical with nonsurgical treatment. The healing rate is excellent with all techniques. The most recent literature reports that the closed technique is equivalent to surgical intervention with the advent of early functional rehab and modern reports of re-rupture rates are similar between the two groups. Some studies do show earlier and better restoration of calf strength with surgical intervention. Therefore, selection of the best treatment option is individualized, with age, activity level, patient and surgeon interests, and experience as guiding parameters.